Physician experiences of electronic health records interoperability and its practical impact on care delivery in the English NHS: A cross-sectional survey study

Abstract Background: The lack of interoperability has been a well-recognised limitation associated with the use of electronic health records (EHR). However, less is known about how it manifests for frontline NHS staff when delivering care, how it impacts patient care, and what are its implications on care efficiency. Objectives: (1) To capture the perceptions of physicians regarding the current state of EHRs interoperability, (2) to investigate how poor interoperability affects patient care and safety and (3) to determine the effects on care efficiency in the NHS. Methods: An online survey was conducted to explore how physicians perceived the routine use of EHRs, its effects on patient safety, and impact to care efficiency in NHS healthcare facilities. Descriptive statistics was used to report any notable findings observed. Results: A total of 636 NHS physicians participated. Participants reported that EHR interoperability is rudimentary across much of the NHS, with limited ability to read but not edit data from within their organisation. Negative perceptions were most pronounced amongst specialties in secondary care settings and those with less than one year of EHR experience or lower self-reported EHR skills. Limited interoperability prolonged hospital stays, lengthened consultation times, and frequently necessitated repeat investigations to be performed. Limited EHR interoperability impaired physician access to clinical data, hampered communication between providers, and was perceived to threatened patient safety. Conclusion: As healthcare data continues to increase in complexity and volume, EHR interoperability must evolve to accommodate these growing changes and ensure the continued delivery of safe care. The experiences of physicians provide valuable insight into the practical challenges limited interoperability poses and can contribute to future policy solutions to better integrate EHRs in the clinical environment. Public Interest/Lay Summary Limited interoperability between EHR systems has been a longstanding problem since the technology's introduction in NHS England. However, little research has been done to understand the extent of this problem from the perspective of physicians and the challenges it poses. This study surveyed 636 physicians across England to better understand limited EHR interoperability. Most participants reported that interoperability between NHS facilities was inadequate. Consequences of this included increased duration of hospital stays, lengthened consultation times, and more redundant diagnostic tests performed. Limited interoperability hindered communication between NHS workers and threatened care quality and patient safety. As more healthcare technologies are incorporated into the NHS, gaining greater insight from physicians is critical to finding solutions to address these problems.