Comment: An NHS doctor’s top 10 tips to meeting the digital challenge

Health Secretary, Jeremy Hunt, is challenging the NHS to ditch paper processes and become fully digital by 2018. But much has been made of medical staff being sceptical of technology and the potential positive impact it could have on service delivery and the patient experience. To address the issue of whether clinicians are ready and prepared to welcome the digital age, DR PAUL SHANNON, a consultant anaesthetist at Doncaster Royal Infirmary and medical director at IT consultancy, CSC, gives his top tips for meeting the challenge, highlighting the need to utilise national tools and well as thinking outside the box

Following Jeremy Hunt’s recent challenge to the NHS to ‘go paperless’ by 2018, doctors and hospitals are going to need IT tools to co-ordinate care electronically.

A phone or fax machine may not be good enough, but there are numerous ways that the NHS can rise to the Government’s challenge

Care co-ordination is essential to avoid duplicate treatment and to prevent medical errors. Whether it is a GP, hospital, other healthcare provider or local authority, they are all at different levels of implementing IT. In fact, many are still manually posting or transporting health records to other members of care teams, which can take days. Even if a patient moves from one doctor to another down the corridor in a medical building, the patient may have to carry records in a paper folder rather than their being accessed or transmitted digitally.

It’s virtually impossible to attain the NHS standard of discharge summaries to GPs within 24 hours without using electronic systems

For healthcare providers to properly exchange information and co-ordinate care, it should be in ‘near-real time’. A phone or fax machine may not be good enough, but there are numerous ways that the NHS can rise to the Government’s challenge. Here are my top 10 priorities for embracing the digital age.

• 1. Make better use of existing, national tools that are already up and running: NHSmail is a secure, encrypted email service that can be used instead of ‘inhouse’ email systems. It means that secure emails containing patient-identifiable data (PID) can be safely sent anywhere within the NHS. NHSmail 2 is coming soon, which will have even more functionality, so there’s really no need to send letters and faxes to colleagues any more. Secondly, there is Choose and Book (CAB). About 60% of all first outpatient referrals are now done through CAB, so make it 100% to get the most benefit. Also, consider the other functionalities within the application such as the ‘Advice and Guidance’ section to avoid inappropriate referrals. Then there is the Summary Care Record. A surprising amount of useful clinical information can be found here and the more it’s used, the more useful it becomes.
• 2. Automate the discharge summary: It’s virtually impossible to attain the NHS standard of discharge summaries to GPs within 24 hours without using electronic systems. A good electronic patient record system should permit electronic discharge summaries to be sent to GP systems easily.
• 3. e-Prescribing: This is a high-impact patient safety issue; no more problems with doctors’ notorious handwriting! e-Prescribing can be ‘standalone’ or integrated into an EPR. It may be best to start with a gradual roll-out in enthusiastic areas, rather than a ‘big bang’ approach. Once the benefits are seen, clinicians will clamour for it in other areas
• 4. View results electronically instead of printing out paper: Get into the habit of accessing pathology and radiology results without printing out paper and consider using a Single Sign On tool so that you don’t have to remember multiple passwords
• 5. Exploit ‘departmental’ systems to the maximum: For example, if your trust has a theatre management system, see if you can use it to record the clinical record. A relatively easy start is the surgical operation note, but make sure that any ‘bespoke’ systems can talk to others using Health Level 7 standards
• 6. Don’t duplicate: Paper records are not more valid than electronic ones, so you don’t have to do both. If you’re told to write paper records and create electronic ones, someone’s missed the point. One consultant I heard of confiscated all the pens off her trainees when they came to her clinic

Inevitably there will be times when electronic systems are not available, so you need to have robust alternatives in place just in case

• 7. Know your ‘business continuity’ policy: Inevitably there will be times when electronic systems are not available, so you need to have robust alternatives in place just in case
• 8. Develop a ‘portal’ mentality: This means automatically pulling information from multiple sources into a single area. There are various ways of achieving this, but make sure the patient is the ‘context’, that is you only view information about one patient at a time. This is an important patient safety factor in order to avoid confusion
• 9. Find out about your trust’s IT strategy: Your IT department needs your input. Do you have a clinical lead for IT, or even a chief clinical information officer (CCIO)? Could you do it? You don’t need to be a ‘techy’ or have a Master’s in informatics; this is about improving patient care, it’s not an IT project.
• 10. Enjoy the digital revolution! The NHS is data rich, but information poor. In the era of ‘big data’, find out ways of exploiting data for patient benefit and/or professional development. For example, how do you compare against your colleagues, other trusts, international best practice? Annual appraisal and revalidation requires individual, practitioner-level information, and nobody wants to bottom of the league table!