When the health secretary, Jeremy Hunt, addressed the NHS Confederation in June he conceded that achieving a paperless NHS was “one of the more bold” promises he’d made after taking up post.
This was no exaggeration. The NHS still struggles under the weight of paper, from medical notes to referral letters. The new Wachter review on the programme of IT adoption in the NHS describes the government’s target of achieving a paperless NHS by 2020 as “unrealistic”, and urges it to put it back to 2023.
Most experts agree that getting rid of paper would be good for patients. According to NHS England, electronic prescribing systems, which support clinicians to ensure the right medicine is provided to the right person in the right quantity, halve medication errors, but are used only in a minority of trusts. Using digital barcodes on medicines, equipment and even on patients can reduce identification errors and improve supply chain efficiency.
There are financial savings too: NHS England estimates that the annual cost of storing paper records at between £500,000 and £1 million for each trust.
Sophie Castle-Clarke, a fellow in health policy at the Nuffield Trust health think-tank, says these are not the only advantages: “One of the biggest benefits of moving to a paperless NHS is being able to share data – not only between professionals in different settings and services, but also between professionals and patients. This means patients will enjoy more joined-up care across the system – so that their hospital consultant, GP and community nurse all have access to their medical history.”
GPs have embraced digital
Maureen Baker, chair of the Royal College of General Practitioners, points out that GPs have led the way in embracing a digital NHS and that measures such as electronic records – which can be stored and backed up – have clear patient safety benefits: “In principle, an electronic record can be shared with healthcare professionals across the NHS, meaning that the same information about a particular patient, and their comprehensive medical history, is being seen whether they are in a GP surgery, hospital or pharmacy. This would be a huge step advancement to ensuring patient safety, but unfortunately we need to see far better integration across primary and secondary care – particularly in terms of compatible IT systems – before we get to this stage.”
One GP practice that saw benefits from moving to a digital system is the Ash Trees Surgery in Lancashire, which replaced its paper-based working processes with the Docman document management system and the Emis Web patient record system. The move has enabled the surgery to pull letters from its local acute trust automatically into its own system, eliminating any document backlog, while an electronic filing system enables GPs to find a document instantly. As a result, the surgery has saved seven hours a day of staff time.
Digital exemplars show what’s possible
Some hospital trusts have also benefited from the move to digital, and the NHS has chosen 12 forward-thinking acute trusts as global digital exemplars that will benefit from accelerated implementation of paperless technologies. In a particularly ambitious project, the West Suffolk NHS foundation trust this year moved to a single integrated electronic patient record and an electronic prescribing system, with a view to improving efficiency and patient safety.
Another exemplar, the Royal Liverpool and Broadgreen University hospitals NHS trust, already has a strong track record in using technology to improve efficiency, such as a digital whiteboard that helps staff respond better to patients and to streamline patient flow. It has now digitised 50,000 patient records in preparation for implementing a new electronic patient record system, which will both provide efficiency benefits and reduce storage costs – its new Royal Liverpool hospital, due to open in 2017, does not have the capacity to store patient records.
Castle-Clarke, co-author of the Nuffield Trust’s briefing on digital requirements for new primary care models, accepts that there are challenges in making the transformation to paper-free, including concerns about information governance and a lack of interoperability between different clinical systems.
“None of this is easy,” she says. “It is not about replicating paper processes in a digital format. The work must be completely reimagined to make the most of digital tools. This is a wholesale transformation programme that requires constant evaluation and evolution.” At a time when the NHS is already under financial strain, she adds, the scale of the challenge should not be underestimated.
Andrew Harvey, head of information governance for West Sussex hospitals NHS foundation trust, agrees: “I think we are working towards a version of a paperfree NHS by 2020, but I don’t think we’ll achieve everything by then. In any case, nothing stands still, especially not IT, and the NHS will have to continue to respond to changing technologies and changing demands.”
On top of that, the move to digital has been backed by cash – including specific technology funds – and policy directives, such as the requirement for local NHS organisations to produce a digital roadmap.
And Baker, while arguing there must be safeguards to protect patient confidentiality, firmly believes that the future of the NHS is digital: “Technology has an important role to play in enhancing the care we provide to patients across the NHS, and efforts to make the health service paperless can play a key part in achieving this.”
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