Paperlight is the outcome, and not the objective, of a digital NHS
Source: NHE Mar/Apr 17
Sean Brennan, director of communications for the Institute of Health Records and Information Management (IHRIM), reflects on the drive to get rid of paper in the NHS and the place for clinical data standards in that process.
The latest in a long line of reports calling for NHS IT/technology improvement is called ‘Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England’, released in September 2016. It is a report from the National Advisory Group on Health Information Technology in England chaired by Dr Robert Wachter.
It concluded that “the NHS is poised to launch a successful national strategy to digitise the secondary care sector, and to create a digital and interoperable healthcare system.
“Getting it right requires a new approach, one that may appear paradoxical yet is ultimately obvious: digitising effectively is not simply about the technology, it is mostly about the people. To those who wonder whether the NHS can afford an ambitious effort to digitise in today’s environment of austerity and a myriad of ongoing challenges, we believe the answer is clear: the one thing that the NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.”
No one would argue with such a sensible and pragmatic conclusion. The question on everyone’s lips is: why is it taking so long? To better understand those digital challenges, it is worth looking back on the NHS’s technical legacy.
Background and legacy
Seventy years of the NHS has seen a remarkable change in the way that healthcare is delivered and yet, in some organisations, the way clinical information is recorded and stored has remained the same. Whilst GPs have had the benefit of having largely paperless practices for years, during this same time period most hospitals have lagged behind.
The reasons for this disparity are many and multi-faceted. Hospitals are themselves complex, non-standardised organisations with many different structures and specialties. They are not the same as a bank, where you could go into any branch in the UK and expect the same data requirements and data capture processes. Neither are they ‘greenfield’ sites. They are having to integrate or dispose of decades of procured IT systems, some with legacy contracts, others simply no longer fit for purpose.
The complexity arises out of the technical history: hospital IT systems were/are single stand-alone applications/systems with varying degrees of clinical functionality. While the hospital clinical IT landscape has been evolving over the years, the output – the patient record – was predominantly paper. Whilst there is a genuine (and sensible) desire to get rid of this paper, it should be the outcome of a digital programme and not the objective.
These technological developments of clinical IT with their electronic records have the potential to result in greater sharing of clinical data across the NHS, increasing the quality of clinical care being delivered. However, unchecked it also has the capacity to bring unstructured clinical data chaos with each NHS organisation naming, storing and presenting clinical information and documents in a different way.
These electronic patient record systems, however they are delivered, assemble information about a patient in one place from varied and disparate sources, regardless of data type. Some of this data may be digitally-created letters stored in a document repository (e.g. digitally-dictated letters); others will be data derived directly from integrated systems using the Academy of Medical Royal Colleges’ Standard or diagnostic reports; and some of the content will be the paper record scanned (either legacy or day forward) into a digital repository.
In the absence of a single clinical computer system for the NHS, there must be standardisation and structure to the data collected and the outputs from this disparate mix of clinical and administrative computer systems.
But how do we get there?
Adopting the standards developed by the Academy of Medical Royal Colleges, ‘A Clinician’s Guide to Record Standards’, is a place to start for any organisation intending to improve the capture and use of structured clinical data. This would not only ensure that the appropriate clinical information for specific operational tasks is captured, i.e. it identifies the information clinicians need for the discharge/handover/admission processes, but will also ensure that any digital record created would comprise structured clinical data held in an easily navigable form to ensure clinicians can easily find their way around it.
But this is only part of the solution. Left unchecked, each of the NHS trusts will implement a digital record structure that suits their own needs regardless of how that structure sits alongside other trusts and organisations in the NHS.
Digital data and the adoption of the Interoperability Standards ensures structured data can be shared across the entire NHS and stored in such a way that clinicians can make sense of it. To aid the uptake of these Record Standards, the Professional Records Standards Body (PRSB) has produced a series of toolkits available on its website (see below).
It is essential that the NHS actively addresses this transition to a digital NHS by providing clinicians with intelligent clinical systems used to capture, store and share clinical data in a structured way, adopting the appropriate standards as they are developed.
A reduction in paper production will naturally follow.
For more information
The PRSB’s toolkits can be accessed at: