Electronic Patient Record (EPR) Requirements

For Multi‑Service Health Harmonie, with Digital Front Door and Intelligent Automation (including ADHD/ASD/Neurodiversity)

HealthHarmonie, as part of the Medinet Group, delivers a broad portfolio of services including:

• Cardiology
• Dermatology
• Endoscopy
• ENT
• Gastroenterology
• Gynaecology
• Ophthalmology
• Oral Surgery
• Orthopaedics
• Respiratory
• Ultrasound
• Urology
• Adult ADHD, Autism and wider neurodiversity services

These services span:

• NHS contracts (including NHS Right to Choose pathways)
• Private, self‑pay and insurer‑funded care

Challenges are common across the portfolio:

• High and growing referral volumes from multiple sources
• Complex, multi‑stage pathways and shared patients across services
• Pressure on waiting times, RTT performance, quality and regulatory compliance
• Need to interoperate with GP systems (e.g. EMIS Web and/or SystmOne), ICBs, acute providers and corporate systems

HealthHarmonie requires a single, modern Electronic Patient Record (EPR) that:

• Acts as the enterprise clinical and administrative platform across services
• Provides a digital front door to support patient access and engagement
• Embeds intelligent, rules‑ and AI‑driven automation for triage and workflows
• Natively supports multiple cohorts and pricing structures (NHS, RtC, private)
• Meets NHS coding, RTT, equality, interoperability and regulatory requirements

• Captures and reports on the required NHSE Secondary Uses Service (SUS) datasets

Adult ADHD/ASD RtC is a key exemplar use case, but the EPR must be conceived and delivered

 as a multi‑service, multi‑cohort enterprise platform.

The EPR and associated modules must:

1. Provide one platform for many services
   • A single technology stack covering all current and planned specialties and sites.
   • Minimise reliance on single‑service point solutions.
2. Support robust episodes, pathways and caseload management
   • End‑to‑end episode and pathway tracking across all services.
   • Operational visibility of caseloads for clinicians, teams and managers.
3. Handle multiple cohorts and pricing models
   • NHS, NHS RtC, self‑pay and insurer pathways within one system.
   • HRG‑based and other pricing structures, including national and local tariffs and private pricing.
4. Enable digital‑first access for patients
   • A unified digital front door for all services, with service‑specific journeys.
   • Online booking, questionnaires, messaging and video consultations.
5. Embed intelligent automation for triage and workflow
   • Configurable rules and AI/LLM components to automate administrative checks and support clinical triage decisions.
   • Human‑in‑the‑loop controls and full audit.
6. Deliver high‑quality data, coding, RTT and equality reporting
   • SNOMED, OPCS‑4, ICD‑10 and HRG support.
   • RTT‑compliant tracking and reporting.
   • Equality and accessibility reporting across services and cohorts.
7. Meet NHS digital, safety and regulatory standards
   • DTAC, DCB 0129/0160, DSP Toolkit, MHRA SaMD/AIaMD where applicable, and AI assurance guidance.

The platform must:

• Be cloud‑native and 100% web‑based, accessible from modern browsers on desktop and mobile devices.
• Provide secure access to NHS/HSCN networks without user‑managed VPNs.
• Offer Role‑Based Access Control (RBAC) with granular permissions and full audit logging of user activity, configuration and data changes.
• Support NHS authentication mechanisms (e.g. CIS2/smartcard/SSO) where feasible.
• Deliver high availability with defined SLAs, resilience and disaster recovery.
• Clearly surface patient alerts and flags (e.g. safeguarding, allergies, risks, reasonable adjustments).

The EPR must maintain a single longitudinal record per patient that includes:

• All encounters and episodes across services and cohorts (NHS and private)
• Multiple identifiers (e.g. NHS number, local MRNs, private IDs)
• Structured data using SNOMED CT and other standards, plus attachments (referrals, reports, images)

The EPR must:

• Represent care as episodes and care pathways, with:
  • Clear start and end points
  • Defined stages/statuses (e.g. referral, triage, diagnostics, treatment, follow‑up, discharge)
• Support multiple concurrent episodes and pathways per patient, including:
  • Parallel pathways within one specialty
  • Pathways across different specialties and providers
  • Safe navigation and visualisation of all open and historic pathways
• Provide caseload and worklist views:
  • Per service, site, team, clinician
  • Cross‑service views (e.g. all urgent cases, all patients awaiting diagnostics)
  • Filters for cohort, contract, priority and stage

The EPR must handle:

• Cohort tagging at patient and episode level:
  • NHS standard, NHS Right to Choose, private self‑pay, insurer‑funded, other
• Cohort‑specific workflows, documentation, SLAs and communication templates
• Configuration of contracts and tariffs per commissioner or private package

The system must support:

• HRG (Healthcare Resource Group) grouping (native or via integration), storing HRG codes against activity
• Multiple pricing structures:
  • National tariff (including best practice tariffs)
  • Local tariffs and block arrangements
  • Private/self‑pay and insurer‑specific prices, linked to HRGs or other units

The EPR must provide or integrate a digital front door that is:

1. Unified for the patient
   • Single identity and portal across all services
   • Ability to see and manage all appointments, documents and messages
2. Service‑aware and configurable
   • Service‑specific landing pages and intake/referral forms
   • Routing logic to direct patients and referrals to the correct service and pathway
3. Self‑service where appropriate
   • Online booking, rebooking and cancellation within configurable rules
   • Appointment management for in‑person and virtual clinics
4. Digital questionnaires and PROMs
   • Configurable, SNOMED‑coded questionnaires (clinical and administrative)
   • Service‑ and cohort‑specific PROMs (e.g. ADHD scales, condition‑specific instruments)
   • Automatic ingestion of responses into the clinical record and workflows
   • Automated reminders and multi‑language options
5. Messaging and communications
   • Secure messaging via SMS/email/portal
   • Templates for standard communications (appointment confirmations, instructions, results notifications, follow‑up prompts)
6. Video consultations and telephony (where required)
   • Integrated video consultations launchable from clinician and patient views
   • Optional telephony integration (click‑to‑call, call routing, call logging)
7. Accessible Information Standard (AIS) and equality
   • Capture and use of communication preferences and reasonable adjustments (format, language, BSL, large print, etc.)
   • AIS‑compliant communications across channels

The EPR must provide:

1. Structured, coded documentation
   • SNOMED CT coding for diagnoses, problems and key clinical concepts
   • OPCS‑4 procedure coding and ICD‑10 (or successor) diagnosis coding for relevant episodes
   • Coding workflows/worklists to support coders and validation
2. Templates
   • In‑built and build‑your‑own clinical and administrative templates
   • Specialty‑specific templates (e.g. cardiology, orthopaedics, ADHD/ASD)
   • Governance for template versioning, approval and rollout
   • Ability to integrate/adapt commercial template sets (e.g. Ardens)
3. AI‑assisted documentation
   • Optional AI ambient transcription / digital scribe, with:
     • Draft notes proposed to clinicians
     • Full clinician control to accept, edit or reject
4. Embedded decision support
   • Guideline‑aligned prompts and safety checks (e.g. medicines safety, red flags)
   • Clearly non‑binding, with final decisions resting with clinicians
5. Clinical coding and reporting
   • Reports and extracts that include SNOMED, OPCS and ICDdata for:
     • Commissioner returns
     • Audit and secondary uses
     • Internal performance and quality reporting

The system must:

• Model end‑to‑end pathways for each service (referral → triage → diagnostics → treatment → follow‑up → discharge)
• Allow service‑specific configuration of:
  • Data fields and forms
  • Milestones and statuses
  • Business rules and SLAs

• Create, assign, reassign, escalate and complete tasks
• Support SLA and due‑date tracking
• Provide worklists filtered by role, team, service, cohort and priority

• Central rules engine capable of triggering:
  • Tasks
  • Messages and reminders
  • Status changes and recalls
• Based on:
  • Events (e.g. referral received, test result available, missed appointment)
  • Data conditions (e.g. high questionnaire score, overdue review)

• MDT lists and meetings for appropriate services
• Shared notes and documented decisions, linked back to episodes/pathways

The EPR must:

• Support upgrade and downgradeof patients between pathways and providers, including:
  • Routine → urgent/suspected cancer
  • Community → acute provider (and vice versa)
• For each change:
  • Record date/time, rationale and responsible clinician/team
  • Maintain or reset RTT clocks in line with national rules
  • Send/receive appropriate structured messages/documents (ERS, MESH/ITK, FHIR) where standards exist

The EPR (and/or its integrated engine/application(s)) must support intelligent triage with human oversight.

• Minimum: integration with EMIS Web; roadmap to TPP SystmOne/others
• Ingest:
  • Demographics and GP registration
  • Problem lists/diagnoses (SNOMED/Read/ICD where present)
  • Medication history (including psychotropics, ADHD meds, etc.)
  • Questionnaire scores (e.g. PHQ‑9, GAD‑7, ADHD/ASD tools)
  • Past letters, diagnostic reports and referral documentation

• Apply configurable rules (and, where appropriate, AI) to:
  • Assess appropriateness of referrals for specific pathways/services
  • Suggest priority (routine/urgent/complex)
  • Recommend next steps (e.g. further information, tests, alternative service)
• Support multiple specialties (e.g. ADHD/ASD, dermatology, orthopaedics, ophthalmology) with shared infrastructure but service‑specific rules.

• Triage dashboards with queues/worklists for referrals awaiting triage
• Patient‑level triage screens summarising key data and suggested recommendations
• Clinicians must be able to Accept, Modify or Reject suggestions
• System records:
  • Final triage decision
  • Clinician identity and role
  • Optional rationale

• Safety:
  • Hard‑wired rules to escalate safeguarding/acute risk; never down‑prioritise such cases
  • Clear indication when data is incomplete/ambiguous
• Degradation:
  • Predictable behaviour if engine/integration is unavailable (manual triage mode; no unsafe defaults)
• Bias & fairness:
  • Tools to review outputs by age, sex, ethnicity, deprivation and comorbidities
  • Mechanisms to log incidents and feed them into post‑market surveillance

The EPR must support or plan to support:

1. NHS Spine Services
   • EPS, PDS, CIS2
2. Messaging and Exchange
   • MESH/ITK
   • GP Connect (read and write where applicable)
   • Patient Flags and CP‑IS (safeguarding)
3. Inter‑Organisational Pathway Placement
   • Structured exchange for upgrade/downgrade and transfer of care using recognised standards (e.g. ERS, FHIR profiles)
   • Preservation of RTT and coding integrity across providers
4. Corporate and Supporting Systems
   • Integration with RADAR (risk/incident), Power BI (analytics), Dynamics 365 or other CRM/ERP systems
5. Standards‑Based APIs
   • Use of SNOMED CT, DM+D, OPCS‑4, ICD‑10, HL7v2/v3, FHIR where appropriate
   • Documented APIs to support future integration needs

Where prescribing and medicines handling are in scope, the EPR must provide:

• NHS and private prescribing workflows, including EPS where applicable
• DM+D‑based formulary management, with role‑ and location‑specific formularies
• Support for PGDs and PSDs
• Pharmaceutical stock management (ordering, receipt, storage, supply)
• Digital controlled drugs register
• Recording of daily max/min temperatures for stock locations (e.g. fridges, stores)

The EPR must support:

1. Clinical Communications
   • Automatic sending of letters and consultation summaries to GP practices and referrers
   • Template management for NHS and private letters
2. Patient Communications
   • SMS/email/portal messaging for appointments, instructions, questionnaires and results notifications
3. Internal Messaging
   • Secure messaging between clinicians and teams, with optional linkage to episodes/pathways
4. Private and Insurer Billing
   • Workflows for quotes, deposits, invoices and refunds
   • Support for self‑pay and insurer‑funded patients
   • Linkage of billing events to episodes, HRGs and contracts for reconciliation

The EPR must provide:

• Snapshot reports showing where each patient is in their pathway
• Waiting list, backlog and DNA analysis by service, site, cohort and clinician
• Real‑time dashboards for key performance indicators

The system must:

• Manage RTT clocksper pathway/episode in line with NHS rules, including:
  • Starts, stops, pauses and restarts
  • Standard RTT outcomes (treatment started, patient DNA, patient declined, decision not to treat, etc.)
• Correctly handle RTT when:
  • Patients are upgraded/downgraded
  • Care is transferred between providers or pathways
• Generate:
  • Standard RTT returns for NHSE/commissioners
  • Operational RTT dashboards (e.g. 18‑week, 52‑week, long‑waiters, by service and cohort)

• Provide extracts and reports containing SNOMED, OPCS, ICD and HRG data
• Support activity and income reporting by:
  • Service, site, clinician
  • Contract/cohort
  • HRG and tariff/price type

• Capture equality characteristics (age, sex, ethnicity, disability, etc.)
• Support equality and accessibility reporting, including:
  • Access, waits and outcomes segmented by equality characteristics and cohort
  • Use of NHS Digital Flags where implemented
• Capture and report on:
  • Clinical outcomes and PROMs across services and cohorts
  • Impact of services on waiting times and clinical effectiveness

Suppliers must demonstrate:

1. DTAC Compliance
   • A current, completed Digital Technology Assessment Criteria (DTAC) pack
2. Clinical Safety (DCB 0129 / DCB 0160)
   • DCB 0129 clinical safety case and hazard log, including triage and automation components
   • Named Clinical Safety Officer (CSO)
   • Support and templates for HealthHarmonie’s DCB 0160 organisation‑level safety case
3. Medical Device (SaMD/AIaMD) Compliance
   • Confirmation of whether triage/decision‑support components are SaMD/AIaMD
   • MHRA registration details and UKCA/CE marking, including device risk classification and scope
4. Information Governance and Security
   • Compliance with UK GDPR and Data Protection Act 2018
   • DSP Toolkit status and relevant security certifications (e.g. Cyber Essentials Plus)
   • DPIA‑ready documentation with data flows, storage locations, transfers and retention
   • Evidence of penetration testing, incident/breach management processes and security posture
5. AI Assurance (where AI is used)
   • Alignment with:
     • BS 30440 (AI validation)
     • NHS AI Assurance and AI & Digital Regulations Service guidance
     • ICO AI guidance, including AI‑specific DPIA
   • Post‑market surveillance and vigilance processes, including incident logging and feedback loops

Suppliers must provide:

1. Implementation and Migration Plan
   • Strategy for integration with EMIS Web and other systems
   • Phased rollout across services (including pilots)
   • Data migration where legacy systems are being replaced
   • Approach to configuring HealthHarmonie’s pathways, cohorts and triage rules
2. Training and Change Management
   • Role‑based training for clinicians, administrators and managers
   • E‑learning, quick reference materials and “train‑the‑trainer” options
   • Structured change‑management and feedback loops during rollout
3. Support and Service Levels
   • Service desk hours and escalation routes
   • SLAs for incident response and resolution
   • Approach to upgrades, roadmap and customer communication
4. Commercial Model
   • Transparent pricing for licences, implementation, integrations and optional modules
   • Clarity on any usage‑based elements (e.g. per referral, per triage, per message)
   • Roadmap for future enhancements and how these will be commercialised