{"id":37473,"date":"2016-09-27T15:10:14","date_gmt":"2016-09-27T14:10:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37473"},"modified":"2016-09-27T15:11:44","modified_gmt":"2016-09-27T14:11:44","slug":"matthew-honeyman-saving-paper-saving-money-or-transforming-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/27\/matthew-honeyman-saving-paper-saving-money-or-transforming-care\/","title":{"rendered":"Matthew Honeyman: Saving paper, saving money, or transforming care?"},"content":{"rendered":"

Yesterday\u00a0we published\u00a0a briefing<\/a> on the digital agenda that has been pursued by the NHS since 2013 \u2013 the year Secretary of State for health Jeremy Hunt challenged the NHS to “go paperless.” We chart progress made to date and look at some of the barriers and opportunities presented.<\/p>\n

This comes two weeks after the Wachter review of health IT<\/a> was published. Much of the commentary on Wachter\u2019s review has been focused on its messages about unrealistic timetables and insufficient funding. But it also calls for a re-launch of the government\u2019s digital agenda with a new name by the end of this year. Could the “paperless” branding finally end up in the bin?<\/p>\n

While this term has often been used to provide clarity around some of Jeremy Hunt\u2019s desired outcomes, it gets in the way of articulating a more fundamental case for change. It begs the question “what for?” And that\u2019s something we think continues to be a challenge for national NHS bodies. Wachter\u2019s review agrees:<\/p>\n

“The campaign needs to emphasise that the goal is not to \u2018go digital\u2019, \u2018go paperless\u2019, or even \u2018save money\u2019. Instead, digitisation is an essential tool for meeting the needs of patients, their families, healthcare professionals, and the entire nation\u2014in short, to improve the way care is delivered in the NHS.”<\/p>\n

Mixed messages on central funding have also undermined credibility. The government announced \u00a34.2 billion funding<\/a> in January, but there has been little clarity about when and how this money will be allocated\u2014and with the funds being backloaded to the end of parliament this could potentially slow down progress.<\/p>\n

Signals that central funding will be allocated to digital roadmaps and\u00a0sustainability and transformation plans<\/a> that aim to support quality improvement have been superseded by messages that plans to save money and reduce demand will be favoured. It\u2019s the former that the case for change should be based on, but the latter reflects the competing priorities facing the NHS.<\/p>\n

With little immediate prospect of more funding from the Treasury, and in the unlikely event that this would be directed to the digital agenda, what else can be done to make progress in this area?<\/p>\n

As we\u2019ve argued before<\/a>, engagement of clinicians is a point on which all successful healthcare transformation hinges. It is emphasising quality improvement<\/a> and benefits to patients that will bring clinicians on board. Wachter has proposed that a cadre of information-specialist clinicians trained at a new digital academy should drive the development and roll-out of technology in such a way that it fits better into clinicians\u2019 ways of working. He\u2019s probably right in that that this could help, but training takes time and such a proposal must be a viable career path for clinicians.<\/p>\n

As well as building that workforce, making progress on updating or adopting systems so that they share information in a standardised way<\/a>\u00a0is a must. Carrots are being offered to secondary care through the \u00a3100+ million funding announced for the “exemplar” trusts who are expected to lead the way and spread good practice\u2014including on ensuring interoperability within their region. Sticks are also sternly recommended by Wachter, which would see penalties eventually implemented for “suppliers, trusts, GPs and others” for obstructing interoperability in exchange for relaxing the timetable. Those incentives in acute care and industry-led initiatives such as the growing new group INTEROPen<\/a> might be an opportunity to avoid getting those sticks out, as long as ambitious words are matched by deeds.<\/p>\n

The ambitions of the government\u2019s digital agenda have always commendably gone beyond simply making the system paperless, and include:<\/p>\n