Progress in using the electronic health record to improve primary care.

Abstract

Improvement science has been transformed by the electronic health record (EHR) making it possible to share data for patient and population benefit across primary and secondary care organisations, with further linkage to public health, social services, and national registries. Health data analysis is an enabling technology for systems of improvement, promoting behavioural change in professionals and social change and innovation in organisations for patient and citizen benefit. The ability to learn from every patient contact and provide appropriate organisational responses to population needs has been termed a learning health system. The development of IT enabled learning health systems is a journey on which health services have only recently begun. This report describes the impact trajectory over three decades of the Clinical Effectiveness Group (CEG), a quality improvement (QI) organisation serving a population of 2 million in east London. The core aims include delivering improvements to primary care disease management and reducing health inequalities. Commissioning support, public health and research linkage are further derivatives enabled from the curated EHR. CEG has built capacity for real-time monitoring of services from all inner east London GP practices, with support for QI programmes helping to transform service delivery across the primary/secondary interface. The clinical performance of these localities now rank top in national and some international performance metrics. CEG also supports new initiatives to deliver an integrated EHR platform for all primary, secondary and other health and social data sources to provide both direct clinical care and data for secondary uses. This agenda is aligned with national strategy in the NHS England Forward View and the Wachter Report both of which highlight the synergistic gains from aligning improved data uses, quality improvement and health data science.