The NHS should be paperless by the end of 2015, the NHS Commissioning Board national director of patients and information says.
Tim Kelsey told the audience at the Healthcare Efficiency Through Technology Expo on Tuesday that the first government mandate issued to the NHS CB would contain a commitment to a “paperless NHS”.
“I’m pushing for the end of 2015 to eradicate paper from the NHS. No more referral letters or lost records because we won’t have paper anymore in the health service,” he said.
When asked whether he thought 2015 was a realistic time frame, he said the focus in the first phase will be on re-procuring Choose and Book as many hospitals are still using paper referrals.
“We will see what the mandate says in terms of the requirements to deliver against, but with hard work and commitment we can get somewhere very meaningful by 2015,” he responded.
Kelsey also talked about the launch, next April, of a new multi-channel platform that will bring together NHS Choices, NHS 111 and NHS Direct and will allow patients to order repeat prescriptions and book appointments online.
He described his role at the commissioning board as an opportunity to “finally unleash the real power of information technology for the benefit of patient care”.
“From next April we will deliver much greater routine extractions of data from primary care,” Kelsey said.
Work being done by the NHS Information Centre will see greater availability of linked primary care and secondary care data to allow patients to be tracked through the health system, he added.
NHS IC executive medical director Dr Mark Davies also spoke at the event and said the centre’s role is to turn a “tsunami of data” into a “tsunami of actionable business intelligence.”
Just last month, the centre released new practice-level prescribing data in a much greater level of detail.
Dr Davies said health and social care data has been “locked behind closed doors” for too long.
“Where we have data that’s able to be put in the public domain and not undermine patient confidentiality, we will do,” he said.
Information intermediaries can access the IC’s indicator portal to turn data into “actionable intelligence” or create useful apps.
“The answer to greater participation from individual citizens is by opening up the data and allowing this kind of analysis and allowing this kind of mature dialogue and debate,” Dr Davies explained.
“If we are looking for integrated services, we need integrated - linked - data.”
© 2012 EHealth Media.
On the lessness of paperjust_instantiate 131 weeks ago
The are only two things wrong with paperlessness as a strategic objective. The first is that it is hugely over-ambitious, especially in the strict sense that literally no paper content is created or handled. The other problem is that it is hugely under-ambitious. When all's said and done, to express the vision for what we do simply in terms of changing from one media type to another seems to me to be just a bit short of imagination. Don't get me wrong. Paperlessness is fine as a means to end, but it shouldn't be a strategic end in its own right.
An expensive pipedreamThe Luddite Insider 135 weeks ago
Tim Kelsey has not learned from the mistakes of CfH especially the EPR & SCR failures. His clarion call for a paperless NHS by 2015 is another top-down diktat that won't find much support in post-Lansely's NHS.
1. The clinical case for going paperless doesn't exist yet. A computer screen often gets in the way of eye-contact with patients. Most communication in the clinic is non-verbal. Many softwares that promote paperless records are slow, clunky and not very user friendly, not to mention the costs. Even archived medical records are not fit for purpose in a fast-paced casualty or admissions unit. I don't have 15 minutes to load up & scroll an archived TIF image of 1000 pages of which half are empty.
2. The NHS doesn't have the money or skills (technical, project management & contract negotiation skills) to develop a slick and efficient paperless system that will not interrupt clinical care.
3. Many hospitals are struggling to balance the books & make savings. As a result they will may have to merge with neighbouring hospitals. More IT spending in these straitened and uncertain times will go down the drain. We need to innovate on how to provide good clinical care rather than spend money on yet another unproven IT system. We will be better off waiting for 'health information exchanges' to be developed in the US.
A paperless NHS pipedream will be expensive and disastrous for frontline clinical care. A more realistic goal would be to use the NHS number as the unique identifier for all patient contact in England by 2015.
Paper recordsdyfthegog 135 weeks ago
We've been computerised in general practice for over twenty years. The process of taking a history from the patient has not changed from when we used paper records. I can search a patient's medical notes quickly and reading through six inches of handwritten paper records in a hurry is far more likely to produce an ommission and error. I really can't understand why paper records are still being used in secondary care.
paper recordsInfoman 135 weeks ago
I think that was the perception of Tony Blair, Richard Granger, Gordon Hextall and a raft of primary care informaticians which drove the early design of NPfIT i.e that you can apply a primary care operational design solution to secondary care. Ten years on and billions of pounds later I think we know the answer.
Good on paper but.....BeenThere 136 weeks ago
Many commercial organisations have gone paperless but there are important differences to the NHS. (1) The workers in a commercial setting are not prone to running to the press claiming "customer danger" every time somebody tries to make a change they dislike. (2) Commercial companies - although they do tend to overkill on projects - are mere amateurs at the art of Over-egging projects as compared to government departments. (3) The different bits of large commercial companies are - when faced with a top-down initiated change are not often allowed to behave like separate fiefdoms. Government funded organisations and departments very often are.
Whilst many in the NHS feel that they have been subject to large and frequent change, in fact many parts of it have successfully resisted change to a surprising degree. This will be no different.
Commercial companies no better or worse than NHSFlamingBagel 132 weeks ago
I've worked on document management projects in the NHS and in numerous private sector organisations of various sizes. I'd observe that (1) Private companies (including a number who are involved in NHS contracts) are much more able to bury their failed projects as they aren't as subject to external scrutiny as the public sector. (2) Scope-creep is more common in commercial sector projects than the public sector projects I've worked on, but see Point 1 (above). (3) Top-down change seldom works anywhere, but see Point 1 (above).
Agree with the sentiment but not the timingnike 136 weeks ago
I expect to be able to go to the bank or cash machine and access my account, or take money out, from almost any cash machine in the UK or across the world. I also expect to be able to access my account information either by walking in to any branch or over the phone or on line.
This was not always the case and I still remember my mother deciding how much cash we would need for the weekend and going to the bank on a Friday (before 3pm) to cash a cheque for the weekend if you wanted to discuss the details of your account you had to call your own branch and not a call centre.
Secure records handling without paper is possible. Whilst not life and death losing track of money is almost as serious and would invoke similar reactions if large sums of money got lost or mortgages were not paid on time or if it was easy for anyone to access your records and see how much money you have (or how little!)
This is a long winded way of saying that I agree that records should be paperless. Security of records can be as good as or better than paper. In my experience it would be very hard to find an individual patient record in a hospital but it would be very easy to pick up large numbers of patient records which are left in records trollies in wards, outside offices or on desks.
The thing that limits the ability to move to paperless is the resistance to change that is prevalent across the NHS %u213 perhaps due to concern that doing things differently would be a bad thing or could generate more work.
Whilst I am sure that the implementation of paperless systems will take a lot longer than 3 years I am sure it will come. No commercial organisation went through this process simply for the good of its customers; it is ultimately cheaper not to have to deal with paper. This is not good news for the legions of people who deal with records in our hospitals but the case for, initially EDMS, and later full EPR systems which ultimately could be fully linked is compelling.
Finally the national programme failed because one size doesn%u219t fit all and there was no power to push through sweeping change which would have been necessary to implement the vision (oh %u213and the systems didn%u219t work!) but that%u219s not to say that the vision of electronic records integrated across the country was bad.
Tim %u213 I think you risk ridicule by setting unrealistic timelines, or perhaps you just wanted to start the debate however I agree with your sentiment and think ultimately this vision will become the accepted norm %u213 just like being able to do internet banking at 2am on Sunday morning.
I thnk you do not undersatnd PDS is a messhelliewm 136 weeks ago
There are huge numbers of duplicate patients on PDS. My Mother has been to 2 Walk-In Centres each time staff claimed not to find her. WE have discovered she is now on PDS 3 times. I here the same stories from medical staff I work with. Yes my Mother gave her correct details she too is a former NHS Manager. The Walk In staff just put her on PDS again! The only way PDS will work is if patients have to have their NHS number to access care!
I discovered the error in records myself by a Subject Access Request for the SUS database and my UCLH records. So nothing to do with it being picked up by NHS staff.
The problem with my error in the SUS database was it was then sent to the DH, Strategic Health Authority PCT, DR Foster and god knows where. My MP had an enormous task getting it removed.
If it had been just paper records or a database within UCLH ONLY the mistake would have stayed with UCLH and been easy to resolve.
You only have to page back on EHI to know these databases are not accurate.
If you had to have the number you wouldnike 136 weeks ago
I Agree that PDS is flawed - but like a bank where you had to have your account number/bank card/pin to access your money it is possible to imagine that we all have to have our HNS number to access health care - perhaps not on admission to A&E in an ambulance but at all other times....
They said that the PIN would never work because the elderly could never remember them but for 99.9% its no a big issue....
You forgethelliewm 136 weeks ago
@kevinmayfield Doctors have existed for many years without access to computerised records. In my experience working with patients in the NHS, very few lie. Doctors are well trained to know when a clinical history does not make sense. As doctors would tell you there are protocols in place in A&E to cover very eventuality. I am far more concerned about wrong information being relied upon in computerised systems or by relying on a computersied system a doctor fails to take a full history and something clinically significant is missed . The larger the system the more room for error see Prof Ross Anderson's work.
All the my records where totally removed from all NHS Systems including Central Register. It was agreed by my GP, Consultants and the DH so the error does not exist. In fact I do not exist as far as the NHS is concerned! See the press coverage.
Additionally the patients who contact The Big Opt Out have serious concerns about these computerised systems. A big issue now is there far too many opt out/hurdles for people to jump to opt out. There is also a lack of balanced information by the DH/CFH.
How do you proposeeohl 136 weeks ago
To fix these patient data violations?
Removing patients from SCR/PDS doesn't, it merely reduces the visibility. The is especially true for significant number of the examples quoted on the site. E.g. Secure access codes - the failure here was the incorrect recording of information and poor trust/staff security measures. What you fail to understand it was highlighted because it was detected on the PDS probably by admin or IT staff. Arguably it could be quoted as evidence for using PDS or would you rather we disconnect everything and allow poor information security to continue?
Sweet dreamsJacquesOuze 136 weeks ago
Excellent. So Transparent Tim has a magic wand and a pocket full of fairy dust that will achieve this where letting a thousand flowers bloom and throwing large slabs of money at it failed? Or maybe he'll sit in the Commissioning Board like Captain Jean-Luc Picard, and say 'Make it so number one' in that particularly commanding way, and all will click seamlessly into place?
Come on Tim, which one is it? I'm dying to know.
re: Sweet dreamsmrtablet 136 weeks ago
Agreed Jacques - this is NPfIT writ small with a buzzword update and a thousandth of the budget.
I note three other major warning signs...
1. "Replace paper" is neither a functional specification nor a business case.
2. There is the usual conflation of document management systems, customer relations management systems, databases supporting individual patient records and databases useful for reporting purposes.
3. Terminal optimism that a significant proportion of data currently collected by the NHS is accurate, ungamed, comparable between institutions or of true business or epidemiological validity.
Until the DoH mandatory data set tail stops wagging the patient care and NHS day-to-day business needs dog this dangerous chaos will continue.