Three quarters of NHS trusts reliant on paper notes and drug charts – shunning safer electronic options

Three in four NHS trusts are still reliant on paper notes and drug charts despite the availability of safer electronic options, a study reveals.

Experts say hospitals could improve patient care, reduce errors and become more efficient if they embraced electronic records and prescribing.

But new research for The BMJ shows pen and paper ‘remain prevalent’ as the antiquated health service has failed to move into the digital age.

The ‘digital transformation’ of the NHS was outlined in the Long Term Plan, which was launched by the Government in January 2019.

That same year, then-health secretary Matt Hancock called for email to replace paper and fax machines in hospitals.

Experts say hospitals could improve patient care, reduce errors and become more efficient if they embraced electronic records and prescribing

The current targets are that 90 per cent of NHS trusts should have an electronic patient record (EPR) system by the end of 2023, and 95 per cent by March 2025.

However, earlier this year a report from the Health and Social Care Committee warned that parts of the NHS lack ‘the most basic, functioning IT equipment’, with progress on digitising the health service ‘slow and uneven’.

NHS figures from May show that 88 per cent of trusts in England now have EPRs but many are failing to exploit their potential.

The BMJ asked 211 acute, community, and mental health trusts whether they used patient notes and drug charts in paper, electronic, or both formats.

Of the 182 trusts that responded to the questions on patient notes, 4 per cent (seven trusts) said that they only use paper notes, and 25 per cent (45 trusts) were fully electronic.

The remaining 71 per cent (130 trusts) used both paper notes and an EPR system.

Furthermore, the quantity of paper generated by trusts can be staggering, researchers found.

Barking, Havering, and Redbridge University Hospitals NHS Trust estimates that it creates 25 million pages of A4 a year, for example.

The study’s lead author Dr Jo Best, a junior doctor in Sussex, said paper is almost as enduring for drug charts.

Of the 172 trusts that responded to questions on whether drug prescribing and administration is done on paper, electronically, or both, 27 per cent (46 trusts) said they use only an electronic system.

A further 64 per cent (110 trusts) use a mixture of both electronic and paper prescribing, and 9 per cent (16 trusts) use only paper drug charts.

Yet in a survey of 250 staff by Oxleas NHS Foundation Trust after the implementation of an electronic prescribing and medicines administration (EPMA) system, 96 per cent of respondents found that the electronic system saved time and 93 per cent said that they preferred electronic prescribing over paper.

The use of electronic prescribing can also cut medication errors by 30 per cent compared with paper prescribing, government figures show.

Linda Karlberg, a GP trainee in Edinburgh, who has spent the past two years in a paper heavy trust said electronic prescribing is ‘definitely safer’.

Tim Ho, respiratory consultant and medical director at Frimley Health NHS Foundation Trust, agreed, adding: ‘It’s not just a patient record, it’s actually a transformational tool to change how you work.

‘Having information quite literally at your fingertips on your device means you can remotely work with information in a secure way.’

Despite the advantages of technology, Dr Best argued that sharing paper notes can sometimes be easier than sharing information over electronic systems.

Dale Peters, senior research director at technology analysts TechMarketView, said: ‘We always talk about the NHS having this unrivalled data set, but actually so much of that data is locked away in proprietary systems and in formats that aren’t compatible with the other data.

‘Until we have those interoperable systems, we’ll never really see the benefit of having that sheer amount of data.’

Without interoperable electronic systems, the NHS will also not be able to benefit from upcoming technological advances such as artificial intelligence.

Pritesh Mistry, policy fellow at the King’s Fund health think tank, says that one day EPRs might feature clinical decision support, advising doctors how to investigate or treat patients, but such advances will need robust software and information.

‘There’s a lot of potential there, but it does depend on the quality of the data and the analytical smarts of the systems,’ he said.