Why the deadline for the NHS to go digital by 2020 is unhealthy

As the NHS battles to cope with a target to switch to Electronic Patient records by 2020, is it time to discuss whether the deadline itself is unhealthy?

There is no doubt that this is an important moment for the industry in a world in which the amount of data is exploding and demand on the health services is soaring.

Few people, whether patients or clinicians, truly believe paper-based systems are the best choice to survive and flourish in such a digital age – and yet hospitals continue to rely on the old ways despite successive government campaigns to modernise their systems.

Large technology programmes such as the NHS National Programme for IT (NPfIT) and “Care.data” have certainly not inspired confidence, with both being cancelled despite a lot of effort and money spent on them.

Now the government wants the Electronic Patient Record, once targeted for 2007, in place within four years.

Can it happen? Well, anecdotal evidence suggests a lot people in the NHS take the attitude ‘we’ll believe it when we see it’.

The first hurdle is simply getting the buy-in of key users. Many consultants and GPs remain unconvinced – patient records may be two inches thick but it is still possible to thumb through them and find what you want. An electronic record, with 200 images, is a bigger challenge.

In an ideal world, people would instantly choose the more modern and efficient electronic patient record option. In the real world of resource limitations and legacy patient records – not to mention ingrained working practices – a simple switch over is not going to happen.

The first priority should be to examine the options of “digital first”. Is it possible to combine paper and digital in the short term to future-proof data in healthcare but without making a painful impact on service?

Plenty of hospitals have had great success introducing new ways of working that use technology to facilitate patient care. But this has been led by changes in culture and processes not just by the availability of new technology.

The key is to analyse where digital can be most easily and effectively utilised to cope with modern demands and improve the standard of healthcare.

When a patient appointment is made, for instance, it can kick off a process to recall the necessary paperwork. Rather than being delivered on paper this could be scanned and made available at the necessary time. Over time only the most recent electronic records would be needed but for now a hybrid approach in some areas should not be discounted.

An argument against such an approach would be that all the information has to be available to a clinician. But, again, in the real world do they have time to read large medical files or require details of non-related conditions from previous years?

Once we concentrate on improving patient care and outcomes rather than on removing paper, it’s quite possible the paper will be reduced and eventually removed.

There will be a day when an ambulance arrives to a person in need and it will have their relevant medical history, current condition and medication details already on board. The patient may even provide additional data from a smart phone which has been monitoring their health.

With this in mind, simply changing the format of patient records from paper to a screen could potentially miss the opportunity to really change health care delivery in the future. Presenting information in clear, accurate and relevant ways should be the challenge not simply changing the format.

This is a guest article by John Culkin, Director of Information Management at Crown Records Management, a UK and global records and information management business which includes NHS Trusts on its client list. He has recently written a white paper on data in the NHS.

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