NHS IT experts say the government’s ambition of a paperless NHS by 2018 will be a struggle to achieve.
Health secretary Jeremy Hunt announced the aim in a speech to think-tank Policy Exchange this month, saying better use of technology will help NHS trusts achieve the efficiency savings being demanded of them.
Hunt highlighted King’s College Hospital NHS Foundation Trust as being “on track” to becoming paperless by the end of the year, having rolled out e-prescribing.
Colin Sweeney, director of ICT at King's, said Hunt’s target was “ambitious.”
“It’s a good ambition and certainly something we have embraced, but it’s not easy and not as straight forward as you think because people are quite keen on retaining their paper.”
He said there were numerous things that people used paper for in a hospital. Some cannot be easily digitised, such as signatures and diagram-drawing.
While King’s had been working towards an electronic patient record system for 14 years and had a good relationships with clinicians, Sweeney questioned how trusts not in that position could realise the target.
“I think it’s going to be a struggle for a lot of people to achieve,” he said.
Oxford University Hospitals NHS Trust chief clinical information officer Dr Paul Altmann said storing and sharing health information electronically was the right approach and would improve care for patients.
However, he described the aim of a paperless NHS by 2018 as exceptionally ambitious: “Given that there are millions of paper records held by multiple organisations in the NHS who may or may not be in the process of considering how to procure electronic patient record systems, let alone get them fully deployed and adopted.”
A managing director of The Advisory Board Company, Jonathan Edwards, described Hunt’s announcement as a “statement of platitudes with no money, power, incentives or guidance”.
“There are so many opportunities for IT leaders at NHS trusts to deploy IT to improve care quality and efficiency, coordinate care across local health communities, and unlock the potential of data to improve performance,” he said.
“Regardless of this empty announcement, they should forge ahead.”
Read more expert reaction to Hunt's announcement in Insight.
© 2013 EHealth Media.
Accountability of full audit trailNHS Slave 115 weeks ago
I agree with a paperless solution, technically quite easy but the change management and buy in is a nightmare. Total transparent audit trails therefore accountability need not be something to be afraid of. I wonder if there is any hard evidence that this would improve patient safety and in the long term reduce medical negligence litigation?
Documents for flows, data to reuseIan Swanson2 115 weeks ago
It is not for health IT professionals to roll up their sleeves and solve the problems, it is for clinicians to direct and agree developments that will benefit them.
As a high level standard, documents and identities and IG will enable most clinicians to view other material, and that will create rapid flows and rapidly available information at service points with technology that most clinicians can be trained in easily.
Then add some time - find the low hanging fruit where data flows will give real benefit (clinicians will be able to tell you - and the prescribing/allergies may well be a key like pictures). Standardise this data first. Clinicians will be even more imaginative when they can see the pre-existing document flows
Instead we tend to try for everything in one go and take control away from the front line who are going to use systems.
Culture or right systems & standardsNeelam Dugar 116 weeks ago
What do doctors & patients need:
Patients need personalised quality care.
Good communication is essential for this (between primary, secondary & tertiary care.) in a highly specialised & fragmented medicine.
For electronic communication we need common document standards, integrated document & image display & transport--CDA, XDS & XDR as standards.
When I talked about PACS in 2002, I was told it was the doctors who would not give up films. Medical profession adopted filmless without any problems, as it was fit for clinical purpose & DICOM was a robust standard.
90% pperless can be done NOW...ehealthsolutions 116 weeks ago
What can be done electronically NOW?
1. Record patient demographics and next of kin
2. Record patient family and social history
3. Record patient allergy / intolerance information
4. Record patient active medical problems list
5. Record patient examinations, signs and symptoms
6. Order radiology, pathology investigations and receive/review results
7. Refer to clinical support service. Physio, dietitian, SALT etc
8. Prescribe medication
9. Administer medication
10. Create integrated care plan
11. Monitor and update integrated care plan
...the list goes on
IMO, the main problem is that Hospital Chief Executives and Heads of IT don't really understand the complex clinical processes involved and seem to be "scared off" from going out to tender for a fully integrated EPR/EMR.
Information Sharing between primary and secondary caregeorge385 116 weeks ago
.....the problem comes when we want to share that information between - say primary care and the acute sector.
For example - When a patient is admitted to hospital is would be desirable to be able to pick up the medication profile and known allergies from the GP system for that patient.
Being able to view it on another screen isn't the answer - it needs to be in electronic format and importable - conforming to a standard to be of any value to any acute sector ePrescribing system. The reverse is also true (acute sector system to feed the GP system with equally useful information).
…just using ePrescribing as my example.
It should be easy to import/export coded clinical information...ehealthsolutions 116 weeks ago
GP clinical systems and most hospital clinical systems contain coded data information. Read, ICD-10, OPCS, SNOMED CT, dm+d etc so that the import on admission/export on discharge of important patient SUMMARY information should be relatively easy.
I understand that Read codes are already mapped to ICD-10 and SNOMED and hospitals are begining to install e-Prescribing systems which are dm+d compliant.
It is time for all healthcare IT professionals to roll up their sleeves and get on with integrating healthcare delivery.
Paperless is possibleNeelam Dugar 116 weeks ago
In 2007 NHS went filmless. The underpinning reason for success-common vendor neutral standard of DICOM which allows
Of medical images irrespective of the vendor.
Same could happen with medical documents using 3 standards
1. CDA for storage & display
2. XDS for indexing
3. XDR for transport
These are vendor neutral standards from HL7 & IHE for doument storage & exchange.
Canada, Netherlands, USA etc are all moving towards global standards for documents & document exchange. XDS based Vendor Neutral Archiving---VNAs make Paperless NHS from being speculation to reality.
EHI--It would be helpful if we could be more positive about being paperless.
What does paper free actually mean?mrtablet 116 weeks ago
Are they expecting
1. paper free in the sense of a document management / human communications system where scanned or [at best] semi-structured documents are sent / shared in a point to point individual patient level?
2. "Paper free" in the sense of machine readable data at individual level
3. "Paper free" in the sense of machine readable / queryable / reportable at aggregated level
4. "Paper free" in the sense of live clinical database capable of being edited and shared in real time across different institutions, users and use cases?
The first would be hard and expensive enough.
The others raise far more fundamental questions than "is there enough time and money to throw at this right now?".
I'm pretty certain the DOH has it's sights firmly on 3 with a strong element of 4.
Give your granny an iPad with N3 connection!Sceptical Technophile 116 weeks ago
Simple, why don't we give all our old folks without internet connection an iPad with N3 connection.
One condition, they have to do an e-learning module on information governance every year. If they fail the test, the data protection police will arrive at their house within 30 minutes to confiscate the iPad, the NHS number card etc.