The patient is a national icon but showing signs of age. Suffering from chronic under-investment, and having developed a painful habit of inefficiency, it has now been told it has only a few years remaining to change its ways.
By any definition the prognosis does not look good. So, how worried should we be about data management in the NHS in an era in which government is pushing for a digital future, funding remains low – and the amount of data created is spiraling out of control?
There is no doubt that this is an important time for the industry. Few people, whether patients or clinicians, truly believe paper-based systems are the best choice in 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 by 2020.
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.
So, the diagnosis is clear, the symptoms are obvious – but we really need a different course of treatment.
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?
Medical records cannot be thinned out arbitrarily as at some point they may be needed and have to be complete. But most care will only require the most recent and relevant information - and all parts of the health care systems need to strive to make it digital at source and securely shareable.
This is already beginning to happen in some NHS Trusts and the news at the moment is mixed.
The reality is that major surgery is not going to be the best way to remove paper from the NHS. A sensible diet of good habits and localised but coordinated change including local stakeholders is more likely to succeed.
There is no single big bang technology fix available – certainly not one that is affordable - and back-file scanning of old paperwork is unlikely to be cost effective.
In that light, recognising that legacy systems and processes will be around for longer than most people would like is the key.
Joining the paper and digital worlds together is not impossible – in fact it is absolutely essential to ease the transition to fully digital patient care.
Eventually doctors can be augmented by intelligent systems which will bring a whole new set of processes and cultural challenges to healthcare worldwide - not just in the NHS. But before we get there we need to rework the NHS and all the types of information it currently uses.
Will we be paperless by 2020? It’s highly unlikely. So it’s time to live in the real world and make paper and digital work seamlessly together.
Here are ten top tips on the long road to a paperless NHS:
1. 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?
2. Analyse where digital can be most easily and effectively utilised to cope with modern demands and improve the standard of healthcare.
3. When a patient appointment is made 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.
4. Consider storing records offsite, releasing space back for core activity. Outsource the management of onsite records to an expert.
5. Convert as many physical records into digital records as possible but beware of assuming that scanning all records is the answer. This is an expensive option and, as it does not often undergo OCR/ICR (text recognition), a scan is not always searchable. Without careful indexing and metadata being added (often a costly exercise) this provides significant problems.
6. Utilise systems to link physical and digital records.
7. Utilise new systems to link consultants’ diaries to accessible patient records.
8. Think about future technology and how it might affect record keeping in years to come. Health-tracking apps and web resources offer huge potential to the health of the population. As do smart buildings and wearables with sensors built into our living environment. New systems need to be able to cope with these innovations.
9. Consider implications of the forthcoming EU General Data Protection Regulation. This regulation provides extra rights for European citizens to ask to see their data and to ask for it to be edited. So one of the biggest hurdles we face is how to make data shareable and searchable.
10. Put systems in place to prevent data breaches. Trusts probably won’t admit they lose records, but they do. Not in the sense that they are left on the streets or on the Tube - most are lost somewhere inside a hospital. Many NHS employees don’t see this as ‘lost’ or a as a data breach - but patients and the regulators may think differently.
John Culkin, Director of Information Management, Crown Records Management
Image Credit: Marbury / Shutterstock