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Paperless NHS

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9 March 2017

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When health secretary Jeremy Hunt announced his wish to make the NHS paperless back in 2013, the response in many quarters was sceptical. After all, paperless offices have been talked about for more than 15 years but if my office is anything to go by, we’re some way off. However, while there may be many
barriers to overcome in developing Mr Hunt’s vision, the healthcare sector stands to gain more than most by efficient use of technology. The challenge
is in how that is delivered across such a complex, multifaceted sector.

When health secretary Jeremy Hunt announced his wish to make the NHS paperless back in 2013, the response in many quarters was sceptical. After all, paperless offices have been talked about for more than 15 years but if my office is anything to go by, we’re some way off. However, while there may be many
barriers to overcome in developing Mr Hunt’s vision, the healthcare sector stands to gain more than most by efficient use of technology. The challenge
is in how that is delivered across such a complex, multifaceted sector.

Efforts to achieve the paperless ambition should, of course, support the wider strategic objectives the NHS faces – whether that’s in delivering the Five-Year Forward View or the more recent challenges set by sustainability and transformation plans (STPs). There is no shortage of rhetoric about the importance of IT in healthcare, with more funding announced just a few weeks ago to help fast-track IT improvements. But IT is a huge area. Budgets are limited and implementation of new systems is often fragmented.

While many are focusing on the potential benefits of innovations such as diagnostic wearable technologies, there are still gaping holes in the use of administrative IT that is fundamental to the smooth, efficient running of a modern health service. This is where clinical commissioning groups (CCGs) have

a unique opportunity to deliver both quick wins and sustainable benefits as resources are pooled and care records are integrated. By taking a proactive, locality-wide approach, CCGs are ideally placed to engage with technology partners to develop solutions that deliver far more than is possible with a fragmented approach.

Digital dictation to enable
integrated care

When it comes to delivering the paperless agenda, digital dictation has a clear role. At its heart, digital dictation is about capturing the thoughts of a clinician or other professional as quickly and accurately as possible and enabling that information to get where it needs to be efficiently and securely.

We’ve built a successful business out of demonstrating the significant benefits to practices of moving away from tapes and adopting Lexacom, which is fast, intuitive to use, efficient and secure. Secretaries can share workload. Referrals can be saved directly into the clinical system and practice managers can run reports to track and manage referrals as part of their reporting requirements. Our service also provides secure outsourcing to enable approved third-party transcription services to type documents, which has proved beneficial to practices struggling to recruit medical secretaries. The solutions are straightforward to implement and are scalable, so there are also clear advantages for CCGs and the wider NHS.

The immediate benefits of digital dictation are the tip of the iceberg, however. Our reach is growing to encompass document creation; the management of patient records and referrals; and digital and postal delivery. All are underpinned by multi-site information sharing.

With our partners, we are currently looking at ways to combine our software strengths to provide a richer audit trail and seamless communication between clinicians in primary and secondary care. Our long-term focus is on helping improve the quality, accuracy and speed of information being shared across NHS organisations. But there are efficiency gains to be had too, both in time and money, particularly when implemented across a locality.

The impact of changing infrastructure

The Five-Year Forward View is seeing the introduction of far-reaching changes, such as delivering hospital services in GP surgeries, and smaller hospitals collaborating to share back-office functions. Increasing numbers of GP practices are forming federations, and there is even talk of providers sharing back-office functions with CCGs. These changes in structure require a more flexible use of resources and a willingness to adopt different ways of working. In addressing how these relationships will work, we cannot afford to neglect the processes that are needed to underpin them.

The physical barriers between different health settings have traditionally restricted innovative ways of working and this needs to change. We are increasingly working with organisations that are looking to safely share resources and information across multiple sites where no direct network connection exists. Sharing resources in this way requires use of the cloud, and while we’ve seen positive examples of practices embracing cloud technology, anxiety still exists where there is a lack of understanding.

Challenging perceptions

In our experience, fear of a cyber-attack or data breach is one of the most commonly cited barriers to sharing information in the NHS. While every reasonable step must be taken to protect patient data, it’s important to see technology-related risks in context. For example, in the Information Commissioner’s Office latest report,1 the two main causes of data breaches in healthcare between April and June 2016 were information being posted or faxed to the wrong recipient followed by loss or theft of paperwork (over 40 incidents in both cases). Where IT-related breaches had occurred, the majority were caused by human error, such as failing to use the ‘bcc’ field in emails to preserve anonymity of users. Fewer than 10 cyber incidents  were recorded in that period. This is in no way designed to dismiss the importance of electronic data security, but merely to reinforce the point that all aspects of data security are important for the NHS.

We have become acutely aware of the need for proper education to give people the confidence to adopt a new system. One of the most important benefits of our technology is the ability it gives clinicians and admin staff to share information across sites. But Lexacom comes with safeguards that ensure information can only be shared where there has been a clear decision to do so. You cannot, for example, accidentally send a dictation to all Lexacom clients – unlike an incident recently with
@nhs.net email, when a message was sent to every NHS mail user. 

While there has been a significant step forward in partnership working across the NHS and social care sector, a one-size-fits-all solution to technology provision is not the answer. Sometimes we have found that enabling five neighbouring practices to share resources makes perfect sense. At other times, because of a difference in style or resourcing, two practices in the next town are best set up in their own group rather than lumped in with everyone else. GP practices are still effectively independent organisations. For CCGs to encourage their practices to embrace technology, it’s vital to offer choice in how technology is delivered as well as providing support to encourage new systems to be used to their full potential.

Enabling systems to work together

Of course, for choice to become a reality, technology companies need to up their game when it comes to interoperability. According to a recent survey conducted by Accenture,2 38% of GPs in England cite IT systems not talking to each other as the biggest obstacle to the paperless NHS. Speaking both as a former GP and as the head of a technology company, allowing your technology to work effectively with other systems is crucial. 

This doesn’t just apply to healthcare of course. Look at Microsoft and Apple. While interfaces between these two technology giants may fall short of perfect, both have recognised the considerable benefits of allowing customer choice. Instead of building walls between their two systems, they each focus on making their products more desirable. This is a win-win for all concerned.

Lexacom has fully integrated with the three main clinical systems – Emis, SystmOne and Vision – and remains the only digital dictation supplier approved by all three. We are also working exclusively with the leading document management system, Docman, to further improve the quality of referral processing. 

A key benefit to both GPs and patients is to allow referrals to be saved directly into the relevant clinical system. To do that, we had to be open with other companies about how to work together. It is this mindset that has also fuelled our ability to develop much broader solutions for CCGs, in partnership with other, like-minded specialists.

The role of CCGs in driving change

Practices are accustomed to reviewing and choosing their own hardware and software systems. This helps providers maintain a close understanding of the daily challenges GPs face and ensure our software evolves in a way that is mindful of changing needs.

However, when CCGs look at needs across their locality, they can deliver more meaningful and sustainable benefits by working proactively with suppliers to develop tailored solutions. 

It goes without saying that buying services in bulk for 30, 40 or 50 practices puts CCGs in a stronger negotiating position, but working with suppliers should be about much more than simply delivering a better price. The greater the geography, the greater the opportunity to deliver large-scale improvements.

For me, there is nothing more encouraging than a potential client who is willing to ask questions, challenge existing approaches and share the problems that keep them awake at night. 

That level of knowledge-sharing is what drives innovation and has enabled us to develop solutions to suit individual areas. This could include practical considerations such as helping remote sites work more efficiently and have access to greater admin support or tackling the complex challenge of improving information-sharing between primary, community and secondary care organisations.

Beyond buying and selling

Solutions need to be sustainable in the long term and also able to adapt to new challenges. The introduction of STPs is
a real example of this. NHS organisations are being asked to work together across larger geographic footprints than before and with a more complex set of partnership arrangements across organisations that rely on different processes and systems.

In the face of such ambitious targets, it is good for us all to eliminate unnecessary barriers and find ways of working that enable the sharing of high-quality, robust and accurate patient information. While I’m the first to support digital inventions that improve patient care, we must continue to challenge the reliance on outdated administrative practices that threaten to hold the NHS back in its digital ambitions. 

Dr Andrew Whiteley is managing director of Lexacom Digital Dictation and a former GP 

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