Dr Robert Wachter has said the “unrealistic” paperless 2020 goal should be discarded in his long-awaiting review into the digital future of the NHS.

The review was released overnight ahead of the American clinician, known as the ‘digital doctor’, making a speech at the Health and Social Care Innovation Expo in Manchester today.

Among his many recommendations, Wachter and his advisory board said they were concerned about the aggressive push to meet government’s key paperless 2020 goal, which underpins much of its digital strategy.

“Our advisory group was very concerned that an aggressive push to digitise the entire secondary care sector by 2020 was more likely to fail than succeed.”

Instead, the review says a target should be set for all trusts to be “largely digitalised” by 2023 rather than 2020.

“While there is urgency to digitise the NHS, there is also risk in going too quickly. The advisory group urges the NHS to digitise the secondary care sector in a staged fashion, in which trusts that are ready to digitise are prompted to do so, while those that are not ready should be encouraged and supported to build capacity, a process that will take several years.”

Health secretary Jeremy Hunt set out his initial ambition for the NHS to become paperless in a speech to the Policy Exchange think-tank in 2013. At the time, he put a 2018 date on the ambition.

This was refined by the ‘Personalised Health and Care 2020’ strategy issued by the National Information Board in 2014, to support the ‘Five Year Forward View’ plan to reform the NHS.

This set the aim of making transitions of care paperless by 2018 and for all records to be “digital, real time and interoperable” by April 2020.

In June this year, Hunt reaffirmed his “relentless” commitment to achieving the paperless 2020 goal, but he praised the Wachter review’s findings.

Speaking at the expo this afternoon, Hunt did not directly abandon the 2020 target but did seem to shift the goal posts for some trusts to meet Wachter longer timeframe.

"Our objective is to bring everyone up to the standard of the very best by 2023, as Bob recommends."

He also acknowledged some trusts would move "diffirent speeds" and should not be force into big IT project they could not handle. 

As expected, the review makes wide ranging recommendations about more clinical engagement and stresses that digital transformation does not end with an IT deployment.

However, it says that to achieve its aims, the government will need to find additional national funding, suggesting a second tranche of cash for trusts post-2020. Despite praising Watcher's comment, Hunt did not mention in his expo speech whether any further funding would be forthercoming as recommended in the review.

Recommendations include:

* Funding  digital transformation through to 2023, after which no further central funding should be available and trusts that have not full digitised will be dealt with in regulatory context.

* A new long-term national engagement strategy to promote healthcare IT.

* The appointment of national chief clinical information officer (NHS England has already appointed former Cambridge University Hospitals NHS Foundation Trust chief executive Keith McNeil).

* More power and development of clinicians with informatics training within trusts and across the NHS, with a chief clinical information officer reporting directly to the board.
Making sure that the interoperability of systems is core to the NHS digital ecosystem.

* A robust independent evaluation of how the above proposals progress.

* Proceeding with the recommendations of the Caldicott 3 report into data security, consent, and opt-outs.

* Giving the new national programme to transform digital health a name (although maybe not the National Programme for IT).

Hunt asked Wachter and an advisory board to review the NHS’s digital health in October last year, in the wake of the largely unsuccessful National Programme for IT in the NHS, or NPfIT.

Wachter is a professor at the University of California and author of ‘The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age'. In announcing the review, Hunt described Wachter as a “world expert on the promise and pitfalls of new IT systems”.

His terms of reference focused on how the NHS could reach its ‘Paperless 2020’ goal, drawing from the US experience of digital healthcare transformation.

The review found that the NPfIT was had “largely failed to meet its goals”, and had left hospitals less digitised than GPs. This new drive for digital transformation, should both learn and not “over-learn” for that failure, the review concludes.

“Although the new effort is vastly different from NPfIT (with extreme care being taken to avoid calling it a ‘national programme’ and to minimise centralisation), this does not guarantee success.”

Wachter was meant to make his review public in June but the publication had been delayed by the civil servant rules ‘purdah’ that restricted the release of reports in the lead up to the EU referendum.

Read more: about the Wachter review and its call for significant healthcare IT resources to be spent on training a new cadre of CCIOs and clinical information leaders, in Digital Health editor Jon Hoeksma's feature from Manchester this morning.