A paperless NHS by 2018? Could it ever happen?

By Tony Collins

The NHS should go paperless by 2018 to save billions, improve services and help meet the challenges of an ageing population, Health Secretary Jeremy Hunt will say today.

In a speech to the Policy Exchange this evening, the Health Secretary will say that patients should have compatible digital records so their health information can follow them around the health and social care system.

This would mean, says the DH, that in most cases, whether patients needs a GP, hospital or a care home, the professionals involved in their care could see patient histories “at the touch of a button”.

Hunt’s speech comes as two reports are also published which – says the DH – demonstrate the potential benefits of making better use of technology.

The DH says a report by PriceWaterhouseCoopers on the potential benefits of better use of IT “found that measures such as more use of text messages for negative test results, electronic prescribing and electronic patient records could improve care, allow health professionals to spend more time with patients and save billions”.

But the DH press release – and coverage of it by the BBC – does not mention the reservations in Pwc’s report.

Pwc says it could take 10 years or more for the NHS to derive the full benefits from some of the priority actions and further actions mentioned in its report.

Pwc also says that “significant further work is required to further substantiate some of the evaluations of potential benefit, and especially the evaluations of potential financial benefit. This work should be completed before the broad implementation of the recommended actions commences…”

A National Mobile Health Worker report, also published today, was a pilot study on introducing laptops at 11 NHS sites.

On the way towards the 2018 goal, Hunt will say that he wants to see:

– By March 2015 – everyone who wishes will be able to get online access to their own health records held by their GP.

– Adoption of paperless referrals – instead of sending a letter to the hospital when referring a patient to hospital, the GP can send an email instead.

– Clear plans in place to enable secure linking of these electronic health and care records wherever they are held, so there is as complete a record as possible of the care someone receives.

– 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.

– By April 2018 – digital information to be fully available across NHS and social care services, barring any individual opt outs.

The NHS Commissioning Board is leading implementation and it has set a clear expectation that hospitals should plan to make information digitally and securely available by 2014/15.

This means that different professionals involved in one person’s care can start to safely share information on their treatment. This is set out in the NHS Commissioning Board’s recent publication ‘Everyone Counts: planning for patients in 2013/14′.

Hunt says:

“The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution.

“It is crazy that ambulance drivers cannot access a full medical history of someone they are picking up in an emergency – and that GPs and hospitals still struggle to share digital records.

“Previous attempts to crack this became a top down project akin to building an aircraft carrier. We need to learn those lessons – and in particular avoid the pitfalls of a hugely complex, centrally specified approach.

“Only with world class information systems will the NHS deliver world class care.”

The Government recently announced it would be making £100 million available to NHS nurses and midwives to spend on new technology.

Challenges

The Pwc report is not an analysis of the costs of introducing shared electronic records across the NHS. But it does mention some of the challenges. It says:

“There are delivery risks to be addressed before the potential benefits can be realised.”

This is Pwc’s list of challenges of introducing better IT in the NHS, especially a shared electronic patient record:

– “The realisation of the potential benefits will depend on the concerted action and commitment of bodies from across the health and social care system.”

– “… the maximum possible benefits presented by this review will not be realised unless key supporting elements are put in place and unless appropriate and timely investments are made.”

–  “The availability of funds to cover one-off investment costs in technologies, information gathering or reworked organisational processes.”

– “The willingness of system bodies to adopt the technologies or commit to information gathering and use.”

–  “The clear and concise documentation of the benefits achieved and challenges faced by pilot programmes or early adopters of technologies or information protocols, to support other organisations in implementing actions in a cost-effective and efficient way.”

– “Strong and positive leadership to promote use of information and technology, and prioritise the commitment of resources and time to it and commitment of bodies from across the health and social care system.

– “The incentivisation of the adoption of the proposed actions, particularly when coordinated system-wide action is required.”

– “Measures to make contracting for the provision of systems and services as easy, quick and cost-effective as possible; and

– “The development of new or revised robust governance processes to not only support programme delivery but scrutinise the delivery of benefits.”

Comment:

On the face of it Hunt’s good intentions and the DH’s press release on his speech are little more than political rhetoric.

Indeed it appears that Hunt commissioned the Pwc report to give an independent voice to a political announcement. Pwc concedes in its report that it was commissioned to highlight the “potential benefits that could be achievable through the more efficient and effective use of information and technology in the NHS and social care before any action is taken”.

It is inconceivable that the NHS will be paperless or have shared electronic patient records by 2018. Each ward in every major hospital has a range of paper forms. These will take an unknown number of years to standardise for the purposes of electronic records; and shared electronic records will not take place across the NHS without enormous changes in culture and practice, and initial investments.

Nearly every secretary of state for health, shortly after coming to the post, is given a draft speech by his officials about the NHS’s having shared electronic patient records by a distant date.  A new government will be in power by 2018 and Hunt’s promise in January 2013 will have long been forgotten.

Yet Hunt’s announcement is still welcome because it will continue to add energy to the very slow move to shared electronic records.

It is astonishing in a technological age that patients with chronic diseases such as diabetes, or have complex health problems, can be treated at different specialist centres in various parts of the UK without their records being shared. A patient can be seen within a week in two different hospitals without each hospital sharing the patient’s most recent notes and diagrams.   This problem has to be grabbed by the throat – but not with a centralised system or database as proposed in the NPfIT.

Hunt recognises this. He talks of the need for records to be linked – from where the data currently resides. But Hunt needs to say how it will happen, and provide some limited investment for it to happen – tens and not hundreds of millions of pounds.

The political will is there – but without the means to achieve a shared electronic record it may never happen.

Pwc report

Jeremy Hunt challenges the NHS to go paperless by 2018 – DH press release

Going paperless would save the NHS billions – BBC online