The head of a Government review into NHS information technology (IT) systems has said a paperless health service by 2020 “is not possible in the UK”.
Dr Robert Wachter, interim chairman of the Department of Medicine at the University of California, was appointed by health secretary Jeremy Hunt MP in February to conduct a review of computer systems across the NHS.
The review, Making IT work: harnessing the power of health IT to improve care in England, was said to be looking at ways of reaching Hunt’s target of a paperless NHS by 2020.
However, Wachter told delegates at The King’s Fund’s Digital Health and Care Congress yesterday: “A fully paperless system by 2020 is not possible in the UK.”
He reassured delegates by adding that the NHS would be able to operate “a largely interoperable system by 2020”, with systems that work well together.
Shortly after announcing the review in February, Hunt committed £1.8 billion to creating a paper free NHS by 2020.
The full review was intended for release in mid-June, but has now been pushed to 7 September.
While this meant Wachter could not discuss the report’s recommendations, he was able to give insights into the findings of the review, which strongly hint at the forthcoming recommendations.
He said: “I cannot tell you our recommendations yet. But if you read these findings you can guess at some of the directions that we’re likely to go.”
Many of the findings advised managing high expectations of new IT systems early in its implementation and warning against too much Government over-involvement.
“Be careful of overpromising,” he said. “I worry about this because there have been promises that we will put in computers and there will be massive benefits and productivity. I believe that is true but I do not believe that will happen in a year or even two years.”
He added: “You also need some tolerance for the messy early days. The first year is going to be bumpy.”
Wachter also said that a balance should be struck between non-government and government systems.
“The government’s tendency to over regulate IT should be resisted. The government is not very good at regulating technology. It changes too quickly,” he said, highlighting the government’s “key role” in security, privacy and promoting system interoperability
However, Wachter highlighted that a government subsidy to implement healthcare IT systems in America increased the proportion of practices and hospitals with systems from 10% to over 90% in six years.
On interoperability, Wachter called it “crucial” and advised system developers to “bake interoperability into the systems early”.
Wachter also stressed that IT systems should not be implemented just for the sake of digitising practices and hospitals.
He said: “The purpose of digitisation is not to digitise, not to go paperless, but to improve quality, safety, efficiency and the patients’ experience.”
Finally, Wachter emphasised the “essential” role of clinicians, including GPs, nurses and pharmacists, in successfully implementing an IT system.
“Clinician buy-in is absolutely essential,” he said. “You cannot get this work done effectively and correctly if the clinicians have not only bought in… but are engaged in the systems, using the systems and improving the systems.”
“IT systems need to evolve and mature,” he added. “And we need a workforce who understands clinical practice and understands the technology to do that.”
However, Wachter urged that workflow for GPs must be considered before implementing the systems.
On his experience in America, he said: “The most unhappy group of doctors are our GPs and part of the reason is we turned on a whole bunch of electronic tools that now allow the patients to email their doctors at all hours of day and night and we never thought about the work flow.
“So our GPs now are spending three or four hours a night doing the digital work.”
He added that without some thought about who is going look after the digital work in the UK, the NHS will “have an incredibly unhappy group of clinicians”.
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