Improving data sharing between acute hospitals in England: An overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care
File(s)
Published version
Author(s)
Warren, Leigh
Clarke, Jonathan
Arora, Sonal
Darzi, Ara
Type
Journal Article
Abstract
Objectives
To determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.
Design
Retrospective observational study using Hospital Episode Statistics.
Setting
Acute hospital trusts in the NHS in England.
Participants
All adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.
Primary and secondary outcome measures
Frequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.
Results
21,286,873 patients were involved in 121,351,837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.
Conclusions
Each year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
To determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.
Design
Retrospective observational study using Hospital Episode Statistics.
Setting
Acute hospital trusts in the NHS in England.
Participants
All adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.
Primary and secondary outcome measures
Frequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.
Results
21,286,873 patients were involved in 121,351,837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.
Conclusions
Each year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
Date Issued
2019-12
Date Acceptance
2019-11-19
Citation
BMJ Open, 2019, 9 (12)
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
9
Issue
12
Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Sponsor
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
National Institute of Health Research
National Institute for Health Research
Grant Number
RDPSC 79560
RDPSC 79560
n/a
Subjects
health & safety
health economics
health informatics
health policy
organisation of health services
quality in health care
1103 Clinical Sciences
1117 Public Health and Health Services
1199 Other Medical and Health Sciences
Publication Status
Published
Article Number
e031637
Date Publish Online
2019-12-05