Regional electronic health records

The rise of chronic health conditions as populations age is creating an ever more pressing need for patients’ health information to flow between, as well as within, different healthcare settings. For countries and territories looking to roll out regional health record systems, learning lessons from other jurisdictions can be helpful.

This article provides an overview of the work Italy is doing to roll out electronic health records (EHRs) widely within its regions to connect different layers of health providers.

The exchange of information between different physicians caring for the same patient is nothing new. It has been going on for hundreds of years inside the walls of hospitals either verbally, through the sharing of physical notes or, in recent decades, through the electronic medical record (EMR).

The in-patient journey is rarely the whole story. Aging populations in many parts of the world are causing a rise in chronic health conditions. The typical hospital patient is no longer there for a one-off episode of acute illness. Rather, they are being cared for in a mix of settings, from the home to the primary care clinic to the hospital. Historically, as patients have moved between these settings, the data collected and generated by clinicians in each care setting has not followed the patients.

This is a global problem. Research by the Partnership for Health System Sustainability and Resilience (PHSSR) revealed the interoperability of digital systems — vital for improving coordination between primary care, public health, social care, mental health, and hospital care — is a challenge in many countries¹.

In addition to the need for digitally interconnected care in different settings, the PHSSR research also highlights the need for digital interoperability and single patient digital identities. Instead of siloed medical records held by different care providers, patients should have a unified EHR that contains all of their health information, potentially stretching back to birth. That record could be accessed, and added to, by any healthcare professional who provides care to patients.

In addition to the need for digitally interconnected care in different settings, the PHSSR research also highlights the need for digital interoperability and single patient digital identities. Instead of siloed medical records held by different care providers, patients should have a unified EHR that contains all of their health information, potentially stretching back to birth. That record could be accessed, and added to, by any healthcare professional who provides care to patients.

Across the country, the Italian government is working to realise the vision of digital interoperability and single, lifelong patient digital identities through the expanded use of EHRs. The goal of this undertaking is to empower patients, support healthcare service planning and population health research and management.

Around the world, KPMG professionals have experience supporting healthcare systems and organisations with complex and large-scale technological transformation initiatives. KPMG in Italy has worked with healthcare leaders to roll out EHRs at the regional and national levels. Below are some of the key insights we’ve gained from this work:

• Data integration is possible but expect challenges: One of the biggest challenges in integrating data from different digital health systems is a lack of interoperability between the information and communication technology (ICT) systems of different providers. Any effort to create a regional or national EHR should pull data from myriad technology sources and platforms where it is organised and coded differently and match them with the patients. Advances in artificial intelligence (AI) and natural language processing promise to help overcome these considerable hurdles in the future. For the moment, though, standardising the coding of data remains a major challenge. And this must be done in ways that respect the privacy and regulations that differ by country or region, and enable the safe, secure sharing of information in order to improve communication across care delivery.
• More than just a data repository: Successfully bringing disparate datasets together may feel like achievement enough, but if an EHR simply becomes a single access point for a jumble of records, it will be of little use to anybody. Rather than a disjointed mosaic of information, health systems undertaking an EHR project should seek to layer the information in a meaningful way, creating a unified dashboard or snapshot. The goal is for healthcare professionals and patients to be able to quickly get up to speed with the individual’s health and care journey. Context is critical, as is having some amount of workflow capability and the ability to deliver information in different ways. Only then can it create a clear benefit to healthcare professionals and be embraced by them.     
• An important opportunity: Rolling out a regional or national EHR system presents a critical opportunity to rebuild the continuum of care. Consider whether changes could be made to improve the efficiency, productivity, cost control, and clinician and patient experiences, and design care pathways accordingly.
• Procure software providers early: It is key that ICT players are involved from the outset. Issue guidelines at the beginning of the process in order to implement integrate and semantically consistent applications. That can enable outside software to be integrated into the EHR and support regionally- or nationally-defined care pathways.
• Leading from the top: Building a regional or national EHR system is a project of such a scale that it should be driven from the top by governments, regulators or payers. Regulation is required to demand interoperability, as well as privacy compliance and cybersecurity of digital health systems across care providers.
• Healthcare professional buy-in: Once the data integration work is complete and the project moves onto service design, it is essential to involve the healthcare professionals who will use the EHR system. Designing the services that will draw data from an EHR without their input risks building something that they will not want to use. Health professionals are only likely to adopt an EHR system that helps them do their jobs, rather than burdening them with more processes.
• Appealing for patients: Health data is very sensitive information and needs to be guarded carefully. That doesn’t preclude developing an EHR system. But as with other digital systems that use sensitive information, such as online banking, there should be a clear and robust added value for the patient as well as the healthcare professionals. The COVID-19 pandemic led to the creation of many digital health apps, such as digital vaccine passports, demonstrating that people can quickly adopt digital health technology when it is useful to them. Any digital health offering for patients should make scheduling appointments, getting prescriptions and accessing their own medical data easier. As insights on genetic risk factors grow, EHRs could also become key to identifying patients for preventive medicine.
  

The healthcare sector is entering the era of the unified EHR that brings together data from disparate sources and organises it in a smart way that can help drive clinical decision making.

Developing regional- or national-level EHRs is a complex data integration project that should be fulfilled according to the project’s vision in order to help ensure the system is actually used and embraced by healthcare professionals and citizens. The payoffs in creating regional or national level EHRs can be substantial in terms of improvements to efficiency, productivity, cost control and patient and healthcare professional experiences. 

• Establishing regional or national EHRs are key to supporting service design, coordinating care between settings, and improving patient and healthcare professional experiences. However, lack of interoperability between digital systems is a barrier to transformation for many healthcare systems around the world.
  
• Projects of such immense scale will likely need to be driven by governments, regulators or payers who demand interoperability, strict privacy compliance and cybersecurity capabilities.
• EHRs need to be designed with the end users and their experiences in mind. These systems should be designed to help healthcare professionals do their jobs or lighten their workloads. Patients need systems that make accessing services and their health information easier.

At KPMG, we assist healthcare organisations and systems around the world to navigate the complexities related to EHR systems and work with many EHR system vendors to help deliver successful and sustainable implementations.

Some or all of the services described herein may not be permissible for KPMG audit clients and their affiliates or related entities.

Throughout this webpage, “we”, “KPMG”, “us” and “our” refers to the global organization or to one or more of the member firms of KPMG International Limited (“KPMG International”), each of which is a separate legal entity.

The views and opinions of external contributors expressed herein are those of the interviewees and do not necessarily represent the views and opinions of KPMG International Limited or any KPMG member firm.