Comment

What is needed to achieve a paperless NHS by 2020?

Dr Phil Koczan, chief clinical information officer for UCLPartners Academic Health Science Network, examines what needs to happen to deliver the ‘paperless’ NHS by the end of the decade.

I have been a GP for over 20 years and, during that time, have always recorded clinical information directly into our computer system at the point of care. The problem is that data on my patients has been stuck in my GP system and only recently has it been possible to begin to electronically share these data to support the delivery of care. I am also involved in trying to achieve the targets set for the NHS to be ‘paperless’ by 2020. 

However, in order to achieve the 2020 target, there are several areas that need to be addressed in parallel. 

Data capture at the point of care 

There is wide variation between organisations in their level of computerisation and significant differences in the access that clinicians have to systems that facilitate the collection of clinical data at the point of care. Although I have been paperless for many years, many of my colleagues outside general practice are still dependant on paper notes. This is changing with greater clinical involvement in supporting this change. 

Technology to support data sharing 

There are several projects in place that are sharing data for direct care, both for delivering integrated care and supporting emergency care through sharing with the 111 systems. 

Discharge summaries are now largely sent by electronic means and other correspondence is following that route. Organisations within a local health economy are coming together to drive this change forwards. 

Use of data to improve delivery of care 

There is much to learn about how we can use data to support population health and measure gaps in care. I am involved in projects in East London that are looking at the use of data to ensure we can improve the delivery of safe, effective care whilst also supporting advances in research. 

Information governance 

The rules in this area are often seen as a barrier to information sharing requiring complex agreements and consent rules to allow data to be shared. The second Caldecott Review established the requirement to share data for direct patient care, and there is work being undertaken to develop a single approach to ensure we are able to share data to support care whilst also protecting sensitive patient information. 

Encourage technology use amongst clinicians 

Unfortunately, many clinicians are disillusioned by technology as, historically, systems have been slow, clunky and difficult to use, particularly during consultations when patients are present. Improvements in technology, mobile devices and techniques such as voice dictation are beginning to change this perception. It is also important to start with simple projects such as access to recent correspondence about the patient to show what is possible and create a pull from clinicians and patients. 

Winning hearts and minds of patients 

There is increasing realisation that allowing patients to access their records and view what is being shared about them will improve confidence, and should allow them to have greater control over who is able to view data that is recorded on the systems. 

This should lead to greater trust from the public and facilitate the wider safe sharing of information.

Collaboration is the new game in town 

Bringing all this together will need significant co-ordination at local, reginal and national levels. 

At the local level, work is currently underway as part of the Local Digital Roadmaps to understand where different local health economies are on this journey, and understand the gaps that need to be filled to achieve these ambitions. I am involved with some of this work across East London and we are beginning to see great examples of collaboration and shared working between local health and care organisations. 

In addition to the initiatives to link up local health economies, several areas across England are working on regional-wide systems and standards for data sharing. And nationally, the National Information Board has announced its new focus areas and programmes that will be responsible for delivering the national infrastructure and standards required to support different aspects of this complex journey. 

Summary 

The vision of a paperless NHS is deliverable in my opinion, but leadership, particularly clinical leadership, is going to be vital to ensure success and create a local “pull” for embracing new technology. 

The opportunities to improve care and efficiency are very significant, but it is not going to be an easy journey.  It is important that we all recognise the challenges, the potential benefits and start on the journey.

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