Prof Jonathan Kay, clinical informatics director, NHS England: The term “paperless” works in describing a vision, but once you get to the details of what has to be done, it’s better to think of patient safety and process efficiency, which are the two benefits that computerisation can bring to clinical practice.
Prof John Williams, director of the health informatics unit, Royal College of Physicians: To make records available immediately, wherever the patient is seen; to make clinical processes more efficient, especially communications; to enable patients to access their record; to enable structured, coded clinical noting, to yield aggregate data for multiple purposes; to enable effective integration of data held in different systems and locations; to enable links to other information that will support clinical decisions.
Natalie Bateman, head of health and social care, techUK: The technology is available and the paperless agenda should be a priority. However it’s important not to overlook the reason why we’re doing it. It’s not simply about automating tasks, but about creating safer and more efficient health and social care services, based on digital platforms that allow for the transformation of the health and social care sector, for the benefit of the healthcare professionals and patients.
Helen Glenister, chief operating officer, the Learning Clinic:Visibility of just in time data, eg vital signs data, for a patient wherever members of a healthcare team are working in a hospital. Paper charts are only accessible where they are located – usually in one place. More accessibility with proper controls leads to more informed and quicker decision making. Technology can help the healthcare professional to deliver the right care to the right patient at the right time by prompting and warning when assessments and checks need to be carried out and alerting if early warning scores show signs of deterioration.
Will it happen?
Dr Andrew Whiteley, GP and managing director of Lexacom Digital Dictation: The success or otherwise of such an undertaking will depend on the ability of the user to be able access the information they need, when they need it and more easily than they currently can do. A common failing of NHS IT projects is that they often forget that IT solutions are meant to save the users time improve their situation, not the opposite.
Mike Morris, sales and commercial director, Tiani Spirit: the digitising of existing paper records would provide a cheaper means of archiving information, but the information on scanned paper is rarely of great use as it is not electronically searchable. Furthermore it would be very important to link together all the various parts of a patient’s record held in different organisations so that clinicians can get a clear, holistic view of the patient prior to making diagnosis.
Jon Atkin, business development manager, Fortrus: It is critical that the IT system is designed around the user, and not the user having to learn complex systems. The process of user experience design addresses this need.
Tony Yeaman, head of healthcare, Weightmans LLP: Clearly in implementing a paperless NHS, regard should be had to:
• Data protection [Data Protection Act 1998] and other relevant legislative requirements must be understood and complied with
• Current contractual arrangements with other organisations , including commissioners, providers, the private sector and IT providers need careful review
• Procurement issues and clarity of contracting is very important
• Confidentiality and consent issues, including patient consent, data privacy, authorised access
• Availability of records in a legal context many years into the future for litigation
• Clear contractual and indemnity provisions with suppliers and maintainers of systems
Glenister: One of the barriers to the paperless NHS is clinicians failing to adopt technology. Adoption will be a challenge if technology is seen as an extra task – eg writing information on paper then having to enter it to a PC. Technology needs to be designed so that it is part of the process of care and accessible at the bedside.
Yeaman: I agree and think there are significant issues around education and training of all those involved in the process to ensure they understand the benefits and how it can assist them and aid the patient. This will need commitment across the whole organisation from board down. Whatever is put in place must be clear, as user friendly as possible and well understood, otherwise it will not be used
Bateman: I would argue that there’s also a need to educate and raise awareness of the real benefits of technology adoption. It’s vital for those involved in delivering/implementing the digital agenda to demonstrate the tangible benefits, and improved care that it can offer, not just to a specific organisation but the NHS as a whole. And the only way healthcare professionals can do this is by believing in it – they too need to see and understand the value-add that tech can bring the health and social care.
Williams: In the care of the individual patient, especially where there are multiple problems looked after in many different settings, we must clearly combine the use of new communications media with more formal structured noting, and find a way to effectively and safely to integrate the two.
Bateman: There’s a need for a culture change within the NHS. It reminds me of the quote from Henry Ford: “If I had asked people what they wanted, they would have said faster horses.” The only way we can encourage behaviour change is by winning the hearts and minds of the people that are crucial to the implementation and success of digitisation. And to win their confidence they need to see the real benefits of investment versus the status quo.
Glenister: We need to recognise that paper, although a hard act to follow, is not perfect. Sometimes, it cannot be read, there are opportunities for error and it does not give the visibility of what is going on in a hospital, a weakness identified by [Robert] Francis. Technology is used in other industries to provide just in time information for delivering quality and efficient services – this is a must for the NHS.
Yeaman: As a new generation of healthcare professionals and managers come into the service who have grown up in the information age and with their use and dependence on social media, email and the web, we will see more and more decision makers and shapers with the skills to lead and be advocates for what can be achieved with this technology across the whole NHS from board down and from clinicians up.
Atkin: Human nature tends to favour the way things have always been done, because it’s familiar. People are comfortable with paper records, but if end users could see the amount of paper records that are lost, misfiled and forgotten, and also the incredible cost of running medical records libraries, the risk/reward argument leans heavily towards digitisation.