1. Sean Brennan The Evidence-Based EPR Benefits and Cost Model
A presentation to the The Northern, Yorkshire and Humberside NHS Directors of Informatics Forum
Sean Brennan

2. Evidence-Based EPR Benefits Model
Background
Who are Inform Health & Associates?
What is the EPR Benefits Model ?
How can the model be used by Trusts/Health Boards?
Further Information?
Inform Health & Associates Ltd - EPR Benefits and Cost Model

3. Background
Inform Health & Associates Ltd - EPR Benefits and Cost Model

4. All our yesterdays !
Linking the Benefits to each level of an incremental EPR started in 1998.

5. EPR 6 level model 1998: Target 1
Multimedia / Telematics
Level 5
Specialty modules / Document Imaging
Level 4
Decision support/ Clinical Guidelines
Access to Knowledge
Order entry/Results reporting/Electronic
Prescribing/Integrated Care pathways
Level 3
33%
Level 2
Integrated departmental systems
Labs/X-ray/Pharmacy/Theatre
PAS/MPI/ Departmental systems
Level 1
By Year 2002 ?

6. EPR 6 level model 1998: Target 2
Multimedia / Telematics
Level 5
Specialty modules / Document Imaging
Level 4
Decision support/ Clinical Guidelines
Access to Knowledge
100%
Order entry/Results reporting/Electronic
Prescribing/Integrated Care pathways
Level 3
Level 2
Integrated departmental systems
Labs/X-ray/Pharmacy/Theatre
PAS/MPI/ Departmental systems
Level 1
By Year 2005 ?

7. EPR 6 level model 1998: The Reality
Multimedia / Telematics
Level 5
Specialty modules / Document Imaging
Level 4
Decision support/ Clinical Guidelines
Access to Knowledge
Order entry/Results reporting/Electronic
Prescribing/Integrated Care pathways
Level 3 6%
Level 2
Integrated departmental systems
Labs/X-ray/Pharmacy/Theatre
PAS/MPI/ Departmental systems
Level 1
In 1999 ( ie when Information for Health published)

8. The EPR CD Rom The multi-media EPR
CD Rom attempted to identify the benefits of each incremental Epr development level.
The EPR benefits model has been developed over the last decade and more specifically with Inform Health team in the last three years.
Inform Health & Associates Ltd - EPR Benefits and Cost Model

9. NHS Currently * 0% 1% 47% 4% 9% 16% 15% 8%
HIMSS have adopted the same incremental levels approach to ‘growing’ an EPR 0% 1%
47% 4% 9%
16%
15% 8%
* source: cohort of NHS sites used for the investigation by HIMSS assessment of NHS hospitals’ IT maturity using its EMRAM data (Electronic Medical Record Adoption Model),
Inform Health & Associates Ltd - EPR Benefits and Cost Model

10. How are countries doing?
Inform Health & Associates Ltd - EPR Benefits and Cost Model

11. Another Maturity Index !
Another maturity index (?initially EHI and now adopted by NHS England) has TWO dimensions:
Level of maturity and depth of take-up at each level
Inform Health & Associates Ltd - EPR Benefits and Cost Model

12. Benefits and Digital/System Maturity
We need a process to enable us to anticipate, with a level of confidence, the benefits that this increasing maturity of an EPR will bring.
The benefits model must be based on evidence and locally tailored to suit contexts/business.
It is sometimes difficult to assign a specific benefit to a particular change but the model allows adjustments when a benefit may be the result of multiple changes in practice.
The EPR model can support Options Appraisal or Business Case development or for those who are already in an implementation provide a degree of rigour to Benefits Realisation.
Inform Health & Associates Ltd - EPR Benefits and Cost Model

13. Who are Inform Health & Associates?
Inform Health & Associates Ltd - EPR Benefits and Cost Model

14. Who are Inform Health & Associates?
A small but highly experienced healthcare informatics consulting firm established in We only utilise Associates with exceptional NHS experience, typically with CIO or Director backgrounds. 
We will only assign Associates that meet our stringent criteria
Inform Health & Associates Ltd - EPR Benefits and Cost Model

15. Supporting Trust Informatics Strategies
Inform Health & Associates provide specialist and experienced support in the area of Trust Informatics Strategies, including option appraisals, cost benefits of EPR options and Business Case development.
To date we have provided these type of services to numerous Trusts including the following:
University Hospital of South Manchester & South Sector Group
Royal Liverpool & Broadgreen University Hospitals
University Hospitals of Morecambe Bay
Calderdale & Huddersfield NHS Foundation Trust
University Hospitals of North Midlands
Wirral University Teaching Hospital
At the core of our offering is the UK’s most advanced EPR Benefits and Cost Model and Business Case collateral.
Inform Health & Associates Ltd - EPR Benefits and Cost Model

16. What is the EPR Benefits Model?

17. EPR Options Appraisal Process – Benefit and Cost Model
Inform Health Provide Overview of the Model to Trust
Model provides starter set assumptions and evidence where possible
Set up Benefits Model for Trust
Acute or Community Wide Option
Agree Supplier/Strategic Options to Evaluate
Trust Supply their activity, financial and manpower data, plus current IT system costs that will be displaced by EPR
Review and amend each EPR benefit assumption of impact
Supplement with benefit studies and transformation work
Have any of these benefits been achieved already by existing systems or other planned solutions eg EPMA benefits?
Review and amend phasing of benefits delivery over the 10 years by supplier if required
Inform Health & Associates Ltd - EPR Benefits and Cost Model

18. EPR Benefits – Example Vignettes Provided
Inform Health & Associates provide as part of the EPR Benefits Model example ‘Vignettes’ that help Trusts assess their potential benefits from EPR
Vignettes look at what a current pre EPR workflow would look like, then compare to a workflow after the introduction of an advanced EPR.
Pre and post benefits are then calculated based on a standard acute hospital
Examples of EPR Benefit Vignettes are provided on the web site, go to
Inform Health & Associates Ltd - EPR Benefits and Cost Model

19. EPR Options Appraisal – Benefits Model
Supplier/Solution Evaluation allows each EPR benefit to be profiled with:
Level of confidence (%) the solution will deliver that benefit
This Level of Confidence can be driven by a more detailed structured assessment. For example by assessing solutions by up to 6 categories
Usability
Assessment of UK Functionality
Confidence in the Company to Deliver etc
Trusts can define up to 6 categories and their weightings
Supplier/solutions can have different benefit delivery time profiles
Supplier/solutions can have different cash releasing delivery time profiles
Various EPR Benefit Reports provided based on Trust data and assumptions
Inform Health & Associates Ltd - EPR Benefits and Cost Model

20. EPR Options Appraisal – Benefits Model
Benefits are Grouped under 6 headings:
Staff Efficiency
Non Staff Savings
Clinical Quality & Practice Variation
Length of Stay, Readmissions & Demand Management
IT Displaced Costs
Income
Benefits Delivered to be Categorised into Types:
Cash Releasing
More Time for (or improvements in) Patient Care
Increased Capacity
Improved Income
Cost Avoidance
Inform Health & Associates Ltd - EPR Benefits and Cost Model

21. EPR Options Appraisal – Cost Model
EPR Cost Model:
Estimated Contract Costs for main suppliers
EPR Programme Staffing Model calculates expected increase in EPR staff by supplier option over the 10 years
Training Costs calculated
Procurement/preparation costs and data migration costs
Investment in hardware etc
EPR Benefits and Costs Brought Together
NPV calculations
Various Reports, including relative costs and benefits of different solutions
Benefit and Cost Outputs Feed EPR Outline Business Case if Required
Inform Health & Associates Ltd - EPR Benefits and Cost Model

22. EPR Benefits Model Menu I
BACKGROUND
Set Up
Data & Assumptions
Benefits & Phasing
Supplier Evaluation
QUALITY & EFFICIENCY
Efficiency
Clinical Quality
Displaced IT Costs
Summary
Inform Health & Associates Ltd - EPR Benefits and Cost Model

23. EPR Benefits Model Menu II
Suppliers by year
Cash Released Plan by year
Benefits & High Projection
Cash Benefits by Supplier
Non Cash benefits by Supplier
Benefits Realisation Plan
Costs & Benefits
Costs & Benefits summary
COSTS
Cost Analysis
Supplier Costs Estimation
Staffing
Training
Data Migration
Procurement and prep costs
Supplier Costs
Inform Health & Associates Ltd - EPR Benefits and Cost Model

24. Using the EPR Benefits Model?
Inform Health & Associates Ltd - EPR Benefits and Cost Model

25. Using the EPR Benefits Model
EPR Options Appraisal
EPR Business Case development
EPR Cost Benefits
EPR Strategies
Inform Health & Associates Ltd - EPR Benefits and Cost Model

26. How does it work? Initial walk-through of model. No obligations.
Once signed up then:
IH&A provides an overview of the model and provides starter set assumptions and evidence where possible.
‘Localising’ the model through meetings with IH&A consultants and:
Nursing staff
AHP
Medical Staff
Senior Managers
Transformational change
Anyone else as indicated
Data Assumptions sheet completed
Follow-up meetings
Inform Health & Associates Ltd - EPR Benefits and Cost Model

27. Outputs/Conclusions Reports generated by the IH&A team
Reports/results presented to Trust
Inform Health & Associates Ltd - EPR Benefits and Cost Model

28. Do you want further information?
Inform Health & Associates Ltd - EPR Benefits and Cost Model

29. Additional Information :
Contact: Alan Spours Or Sean Brennan Managing Director Inform Health & Associates Ltd
Inform Health & Associates Ltd - EPR Benefits and Cost Model