For any large organisation, going paperless is a challenge, but when it is cash strapped, under intense public scrutiny and has a dismal history of IT failure, the task looks like mission impossible, writes Michael Cross
Officially, the NHS in England is on track to meet Health Secretary Jeremy Hunt’s pledge for the service to go paperless by 2018.
Milestones for next year include all patients who wish being able to view their GP health records online and e-mails finally replacing paper referral letters from GPs. This was originally intended to happen in the late-1990s, then 2005.
By April 2018, digital information is to be fully available across NHS and social care services, barring individual opt-outs.
We have heard most of this before. A fully computerised NHS was the goal of strategies published in 1992, 1998 and 2001 – the last leading to the multi-billion-pound failed attempt to impose central systems under the NHS National Programme for IT (NPfIT).
Some critics predict that history will repeat itself. Earlier this year, a poll of NHS managers found that only 29 per cent thought the 2018 target was possible.
Meanwhile, in its final report on the NPfIT, the House of Commons Public Accounts Committee warned that making the NHS paperless “will involve further significant investment in IT and business transformation”. Yet it observed that the Department of Health “has not even set aside a specific budget for this purpose”.
The department counters that it is investing £1 billion – half from central government, the rest from local health and care budgets – to meet the paperless target. Mr Hunt contrasted this approach to the previous government’s “clunky one-size-fits-all approach from Whitehall”.
IT enthusiasts warn that bringing the entire health and social care system up to the levels of front-runners will be difficult
Dotted around the country are numerous bright spots. Pioneer Greater Manchester GP Dr Amir Hannan says that more than 2,400 of his patients – 20 per cent of his practice list – are now equipped and, importantly, trained to view their records online.
The first NHS hospital trust to announce it had gone paperless, St Helens and Knowsley, dispensed with its last paper records in 2012. All ten acute hospitals in Greater Manchester are due to have replaced their paper discharge letters to GPs with electronic messages by the end of this month.
And in the London Borough of Newham, a web-based shared information system is bridging the gap between GPs, mental health and acute hospital services.
However, even IT enthusiasts warn that bringing the entire health and social care system up to the levels of these front-runners will be difficult.
This is even the case in areas where digital systems demonstrably save lives. For example, fewer than half of hospitals have electronic prescribing systems, which can almost eliminate the errors inherent in handwritten prescriptions; medication errors are the second most common category of patient safety incidents. Under the Labour Government’s 1998 strategy, all acute hospitals were supposed to have electronic prescribing by 2005.
TechUK, which represents IT suppliers, reported last month that the 2018 paperless target was “achievable”, but that major challenges remain.
“While it is clear that some NHS providers are well underway, the majority are only just starting out on the digital health journey and there are others that are yet to start,” it said, warning: “It is vital that there is a step up in activity in 2014-15.”
However, TechUK’s progress report also notes that some timescales have slipped and ambitions have been scaled down. For example, the ambition for online medical records has been quietly scaled back to include only summary information drawn from GP computer systems.
Meanwhile, healthcare computerisation – never a popular cause among the general public – has been tainted by the botched, and now postponed, launch of the care.data programme, in which anonymised data is made available for re-use.
Privacy activist Phil Booth, who led the successful campaign against ID cards and now co-ordinates the Medconfidential group, claims public trust in the NHS is “haemorrhaging” over the care.data scheme.
Earlier this month, the NHS admitted that its next IT strategy, originally due to be published last December, is now delayed to June. “We need a bit longer to converse and draw in partners from across the wider care system,” Beverley Bryant, director of strategic systems and technology at NHS England, told a Westminster Forum conference.
No one with any familiarity with the history of NHS IT strategies will be holding their breath.
JOINED-UP CARE IN NEWHAM…
One of the central challenges of computerising the NHS is integrating the IT systems of hospitals with those of GPs, where each patient’s main medical record is held.
In Newham, East London, a web-based system is showing how this could be done. Doctors and nurses at Newham Hospital’s urgent care centre (UCC) can now view their patients’ GP records – with consent – and the GP can likewise see what hospital treatment their patients have received.
Dr Kate Corlett, associate medical director at the centre, says shared records enable more informed, efficient care for walk-in patients. “We can see the complete record, with point-of-care consent from the patient, and the GPs can see from our notes what care we have given their patients. The clinicians at the hospital love it,” she says.
The system is also helping to fight one of the NHS’s chronic problems – the increasing pressure on A&E departments. “Some parts of the inner-city population can find GP care difficult to access, which has meant increased emergency department visits,” says Dr Corlett.
The UCC is supposed to direct no more than 26 per cent of its walk-in patients to A&E. Thanks to the better knowledge of patients gleaned through shared records, the current proportion is only 20 per cent. “We have taken significant amounts of work off the emergency department,” she says.
Local GP Dr Bhupinder Kohli describes the system as the most significant IT event for the past ten years. “It is improving clinical care and patient safety, and saving time. As well as supporting vulnerable patients, who often do not know their full medical history, we can also educate them on how to best use their own GP practice,” he says.
The electronic patient record software, supplied by EMIS, is a web-based version of the NHS’s most widely used GP system. While Dr Corlett describes the software as an “excellent clinical system”, its origin in GP surgeries means it is not always ideal for use in hospitals.