Back in 2013, health secretary of the time Jeremy Hunt announced that the NHS would be paperless by 2018. On paper (pardon the pun), this was a highly desirable improvement both in terms of environmental impact and operational efficiency but in practice, it would appear that the timescale was too ambitious. The target date was pushed back, first to 2020 and then to 2023. With just over two months left to the end of 2023, it looks unlikely that this target will be met, either.
What are the possible causes of this delay? There’s no doubt that the unforeseen Covid 19 pandemic put extreme pressure on the NHS, but it would be too simplistic to blame the delay solely on this factor. After all, the pandemic didn’t begin until 2020, two years after the original target date.
Obstacles to a paperless NHS
It’s more likely that a combination of factors is contributing to the repeated delays. Although it may not be a complete list, we’d like to suggest the following.
A legacy of paper-based systems
A legacy of paper-based systemsThe NHS uses many traditional systems that may not be easily integrated with modern digital systems. Healthcare professionals may be resistant to change, especially if they have been using paper-based systems for many years. They may need convincing and training to adapt to digital systems.
Creating standardised systems and securely migrating data
Different parts of the NHS such as hospitals, general practitioners and pharmacies often use disparate electronic systems that may not communicate well with each other. Achieving interoperability between these systems is crucial for seamless patient care, effective data sharing and analysis. Such standardisation is complex and time-consuming.
Transitioning from paper records to electronic records often involves a complex data migration process, which must be done accurately to prevent data loss or corruption.
Connectivity in all areas
Many parts of the UK don’t yet enjoy fast or reliable internet connectivity. For some healthcare locations and professionals working in the community, this can make the transfer from paper to digital records extremely challenging.
Digital literacy and training
Patients and healthcare providers may have varying levels of digital literacy. Ensuring that everyone can access and use digital healthcare services can be a challenge, especially for older or disadvantaged populations.
Healthcare staff, including doctors, nurses, and administrative personnel, need proper training to use digital systems effectively and to ensure that data is entered accurately.
The design and usability of digital healthcare systems can significantly impact their adoption. User-friendly interfaces and intuitive workflows are critical for success.
Data protection and cybersecurity threats
Healthcare data is highly sensitive, and maintaining the security and privacy of patient records is paramount. Ensuring that electronic health records (EHRs) are secure and that only authorized personnel have access to them is a significant challenge.
In the UK, GDPR imposes strict regulations on the storage and sharing of healthcare data. Complying with these regulations while maintaining efficient digital records can be complex.
As healthcare systems become more digital they become easier targets for cyberattacks. Protecting against data breaches and ransomware attacks is a constant challenge that requires complex security measures to be built into digital systems.
Cost of implementing and maintaining a paperless system
The initial investment required to transition to a paperless system can be substantial. This includes not only the cost of implementing new technology but also that of training staff and maintaining the system over time.
Is a ‘PaperLite’ NHS a viable alternative?
One possible solution that is being adopted by some healthcare trusts is the PaperLite model. This replaces paper-based systems in some areas where the transition is relatively easy and inexpensive while maintaining paper-based systems in other areas.
What are the advantages of a PaperLite NHS?
Applying the PaperLite model to the NHS brings several advantages, including:
- a reduction in the cost of printing, distribution and storage of paper documents
- less waste paper production
- enhanced patient care within a healthcare environment
- improved patient engagement with access to healthcare services, repeat prescriptions and appointment bookings online
At the same time, PaperLite retains some paper-based systems for various reasons.
Legal
Certain legal documents such as consent forms or advanced directives may still require physical signatures and paper documentation to ensure legal compliance.
Reporting
In some situations, specific forms or reports may still be generated in paper format, especially if they need to be physically submitted to regulatory authorities or insurance companies.
External Communications
When sharing information with external organisations, such as other healthcare providers, insurers, or government agencies, paper documents may still be used for specific requirements.
Archival
While current patient records and data are primarily maintained electronically, historical medical records and archives from previous decades may still exist in paper format.
Data Preservation
In case of technical failures or data loss, healthcare facilities may keep paper copies of critical patient information as a backup.
Patient Preferences
Some patients may prefer to receive paper copies of their medical records or reports, and healthcare providers may accommodate these preferences.
Hospitals and clinics may also continue to provide paper-based brochures and educational materials to patients in waiting areas or during consultations.
Economy of scale
In some instances, the cost and time investment required to digitise a system may outweigh the benefits it brings, particularly if it faces resistance to change and unnecessarily replaces an established and efficient paper-based system.
In Conclusion
Is a paperless NHS inevitable? Not necessarily, but it’s likely to require a transitional period far more protracted and painful than originally envisioned. It may even need to wait until all healthcare professionals, patients and users of healthcare services have the minimum required IT literacy and willingness to entirely adopt digital systems.
Reliable, consistent and fast internet connectivity across the entire UK will also be required and cybersecurity must be good enough to maintain an effective barrier to the global increase in highly sophisticated and even regime-backed cyberattacks.
In the meantime, the NHS continues to use paper-based systems and in May 2023, the National Health Executive published an article that stated there is a “growing realisation that paper and digital records can live side by side to deliver optimal efficiencies in patient care.”
The hybrid solution of a PaperLite NHS is likely to be with us for a while yet.
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