Features: April 5th, 2013

How can primary care organisations, community trusts and GP surgeries get the better of vastly better-funded local Trusts? By starting to move paper to a much more seamless, integrated, mobile-friendly way of helping patients, says Brian Gannon, Head of Business Development at technology firm Kainos

The Health Secretary raised eyebrows in January when he issued a challenge to the NHS: to become ‘paperless’ by 2018. That reaction was due to the scale and ambition of what Department of Health leaders want to achieve – that two years from now everyone will be able to get online access to their own health records held by their GP. Instead of sending a letter to the hospital when referring a patient, the GP can email, and by April 2018 digital information needs to be fully available across all of the NHS and social care services, barring opt outs.

Those targets are formidable enough for the National Health Service which is also tasked with finding £20 billion internal operational savings while simultaneously moving to ‘the new NHS’ model of commissioning group-led management.

A greater challenge is in getting to a paperless NHS through the secure linking of electronic health and care records, so there is as complete a record as possible of the care someone receives – and that there should be clear plans in place for those records to be able to follow individuals, with their consent, to any part of the NHS or social care system as required.

The problem is that we’ve tried this initiative before and failed. This is the legacy of the multi-billion pound National Programme for IT (NPfIT), which while delivering useful technology for the NHS like the Spine network, had to abandon delivering a country-wide standard electronic patient record.

If in an era of full funding and confidence we weren’t able to achieve this goal, does that mean the vision of a paperless NHS is a chimera? We still have an NHS where, as the Secretary of State for Health Jeremy Hunt admits, “GPs and hospitals still struggle to share digital records.”

Can and must be built

The good news is that a paperless NHS can be built. This time, it will need to be deployed a more piecemeal way – hospital by hospital, clinic by clinic, GP practice by GP practice, in contrast with the ambitious ‘top down’ approaches like the NPfIT. Also, it will require a highly practical and proven approach which starts by removing those ubiquitous paper files from the clinical environment.

The approach relies on a technology called EDRM (electronic documents and record management), a tool that stores large volumes of paper in an easy-to-store electronic form that is highly searchable, secure and has enormous longevity.

Why is having these records on computer far better? The answer is that paper is a very poor archival medium. You can’t share documentation straightforwardly, you can’t transport it easily, it is perishable and it is easy to mislay or to misfile. It requires large numbers of people to ‘tend’ it. One of our clients, a large urban hospital, had over 80 people in its central records management library and maybe another 80 in different parts of the hospital to handle records management on a departmental level. This is not an unusual situation. One hospital in the North East I visited had an entire basement dedicated to paper files.

By contrast, computer-based document management means that data is much easier to search, retrieve, manipulate, share and transmit. Several people at different locations can look at documents simultaneously – and can gain access to information without any costly delays. You have a system in place that not only starts saving space, but also presents information in such a way, via electronic images, that it can easily be associated with a patient journey.

These images are different to work with, but we have helped create a familiar look and feel. We have worked closely with clinicians to design solutions that mimic the look of the physical paper records staff know well and know how to work with. Physical paper records are typically stored in a clinician’s folder, and we have made our electronic interface look very similar, with ‘tabs’ that organise material in the same way.

No need to hate paper!

Paper does of course have an important role to play: despite all the benefits of EDRM, clinicians and patients will still want and need paper for some time to come. The Secretary of State for Health is not on a paper witch-hunt! Rather, the ambition is that the NHS tries to reduce its huge dependence on paper and move to a predominantly electronic environment.

Transforming all that paper cluttering up organisations into something that can move us toward a paperless NHS is only part of the story here. The missing element is mobile. There is a huge demand for mobility in and it is important to offer hospital documentation systems that are designed for use on smartphones and tablets.

It’s a hugely attractive option given the portability of paper in an electronic format and it resolves many of the problems clinicians face, as they often operate on the road or from different hospital locations.

Why smart paper is so smart

What about the role of ‘smart’ paper? As a patient, you may need to be in seen at a particular clinic on a particular date. By pre-printing forms with barcodes on them that give all your details in advance, the doctor has all the medical information at their fingertips, as well as a paper-based form that can carry written patient notes. Patients may feel a lot happier seeing their doctor making notes while listening to them rather than sitting in front of a screen and entering data. As soon as the consultation has finished, the doctor can put the form into a scanning machine – and it is automatically routed, using its barcode, to the right place in an electronic document management system, or to the next destination in your journey such as the specialist or your home surgery.

In this way, you can see why talk about a completely paperless environment is not the end game. What things like EDRM, mobile access to documents, smart paper are all about is really introducing efficiency and cost savings into the NHS. One really powerful means to achieving this is by making all your paper record library electronic and cutting down dependence on paper records generally – but not eliminating paper completely.

We’ve discussed the needs of the hospital or the surgery here, but another huge part of the story is the patient – and the patient’s need and right to have access to his or her own data. There are some issues, important ones, about security, but the world is changing and the era of truly participatory health care is upon us. It won’t be long before patients ask to view their records over their smartphone and expect the medical professional to share information about their condition with them.

In the end, that may be the best reason to start moving, with the help and support of modern technology, to a Paperless NHS. Because it’s what patients not just government will soon be demanding and it’s what they deserve.

The author is Head of Business Development for technology integration specialist Kainos which has developed an EDRM system called ‘Evolve’ – now used in 16 English Acute Trusts