Should we get behind a paperless NHS, or is now simply the wrong time to pour money and manpower on this potentially disastrous system? Matt Ng comments
A t the dawn of the computer age, experts heralded a new age of information sharing, and a world without a paper. Evidently, they were only half right. Within the hospital environment, the sight of stacked, bulging manila folders hanging out of tired old filing cabinets is familiar to any patient or doctor.
However, Health Secretary Jeremy Hunt has now laid the gauntlet down to the NHS to become a paperless organisation by 2018. A solid principle yes, but in these times of austerity and the spiraling costs of maintaining our healthcare system, are we giving our health service too much to chew on? Is a paperless NHS system a pipedream that should be consigned to the recycling bin?
The advantages are clear: streamlined appointment booking systems, paperless referrals, patients’ medical history records that can be accessed by staff in all levels of care, and a saving of over £4 billion a year reflowed back into the NHS. Text messages that can be sent instead of letters for negative test results. Clinical staff putting the patient first, instead of searching, writing and filing paper reports.
But the Health Secretary’s call to action was met with some resistance when he addressed the Policy Exchange earlier this year. Here was a fresh-faced politician barely half a year in his role, with no frontline NHS experience and a somewhat sketchy political career, telling the NHS stalwarts and old guard how to best operate.
The Connecting for Health initiative (the Labour government’s 2004 attempt to computerise the NHS) has undoubtedly left a bad taste in clinicians’ mouths that still hasn’t gone away. This was based on a now controversial centralised system that had major IT firms pulling out left, right and centre halfway through the project.
Richard Granger, who was appointed to manage the venture, became the UK’s highest paid civil servant; a man who once failed his Computer Studies course and whose own mother expressed reservations about his involvement. A damning 2009 report criticised the system, claiming that it provided little clinical benefit and in the end cost the taxpayer an eye-watering £12bn.
Privacy and security
Another big issue Connecting for Health gave cause for concern, and an immediate worry of the new system, was privacy and security. Can we give 100% assurance to patients that we can safeguard their data? An individual has a well-defined and unspoken pact with their surgeon or GP in doctor-patient confidentiality, but even a cautious person might not be forthcoming with their medical history given that it can easily be passed around and found in unwanted hands.
No organisation as large as the NHS has a flawless track record when it comes to data security. According to privacy campaigners Big Brother Watch, between 2008-11, there were 806 separate incidents where patients’ medical records were compromised, including information being posted on social networking sites, data being lost, stolen or mislaid by staff.
The Guardian issued a recent poll with 60% of its readers voting against seeing a paperless system implemented in the NHS. In a recent survey, 84% of Medical Protection Society members were concerned that more time will be spent explaining computerised records to other staff.
One teaching hospital however, that seems to have nailed it is St Helens and Knowsley, the first to go fully paperless, having recently digitised all 500,000 of its patients over the last three years. Identifying that they needed a scanning system to digitally archive paper documents and a way to capture and manage trickier live data, the hospital is now helping other practices manage their migrations.
Their doctors can make rapid decisions on patients with their full medical history available, without having to resort to multiple diagnoses, and freeing up valuable beds for vital in-patient admissions. Space is even saved from not having to maintain a dense library of physical files on-site.
However, hospitals vary far and wide, and what works for one may not be so easily implementable in the other. On a wider scale, the NHS is stretched thin as it is, with rising costs, overworked staff and budget cuts all taking its toll. And the time sapping and costly process of revalidation, which is only just gaining momentum from this year, will further hit its dwindling resources.
In a system where time and money equals lives, a fast, data-sharing system can hardly be argued as a bad thing. But it needs to be efficient, secure, and requires a substantial level of staff training. Let’s also factor in already negative and cynical attitudes to the old scheme: any new system will have to be put through its paces and be rigorously tested to be of clinical benefit before health providers start putting trust in it.
Most importantly, lessons have been learnt from the Labour government’s first woeful attempt. One thing this coalition government seems to have taken onboard is the idea of a bottom-up approach, letting individual hospitals work with local regional and practices to develop their own systems which are held locally, and allowing for cross-functionality with others.
I argue that rather than forgoing paper altogether (a brash and impulsive strategy), our goal within the next few years should be to use the current and Connecting for Health legacy systems to create more ‘paper-lite’ systems, upgrading on a modular scale, while ensuring interconnectivity between them all. Some believe that paper will always have a role in the NHS, whether it’s drawing diagrams on the go, signing for documents, or even individual creativity in providing health.
The Connecting for Health scheme was seen by many as the world’s biggest IT project, and its biggest failure. Inciting our beloved NHS like this again should not be the agenda; besides, haven’t we learnt from Francis about setting across-the-board targets? Right now our approach should be thinking of how to minimise the use of paper, and not whipping hospitals into re-inventing the wheel. Otherwise all those 0s and 1s will not be fit for purpose, and patients will suffer for IT.
We’d like to hear your views on this; email us at email@example.com and we’ll print a select few in the next issue.
Matt Ng, Assistant Editor of Orthopaedic Product News.