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Cutting reliance on paper will make patients safer, says NHS England

• Efficiencies
• Patient safety

The NHS will urge health  and social care leaders to end the unnecessary reliance on paper in the treatment of patients and make services safer, more effective and efficient.

The NHS will announce new measures to help the patients, the public and clinicians make more use of technology to improve the health of the nation.

Tim Kelsey, NHS England’s National Director for Patients and Information and chair of the National Information Board , will make the announcement later this week when he addresses 5,000 NHS leaders at the NHS Innovation Expo Conference in Manchester .

He says: “Health and social care services in England must end the unnecessary reliance on paper in the treatment of patients.  It’s key to making services safer, more effective and more efficient.

“Every day, care is held up and patients are kept waiting while an army of people transport and store huge quantities of paper round our healthcare system.

“This approach is past its sell by date.  We need to consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trolleys groaning with patients’ notes.

“As well as saving precious resources, technology can dramatically reduce errors. Urgent action is a moral imperative where paper is the currency of clinical practice.”

He adds: “The NHS needs to get over the idea that we’ve had too many false starts and we can’t do information technology.  While bringing our own systems into the digital age, we must do more to help the public and clinicians take advantage of the game-changing opportunities on offer to improve outcomes for patients.”

The NHS is encouraging commissioners and providers to adopt modern, digital working practices by putting in place new levers and incentives and introducing new governance measures for assessing how far healthcare services are supported by effective use of technology.

To maximise the NHS’s chances of achieving its ambition to be paper-free at the point of care by 2020, local health and care organisations are required to begin work now.

By April 2016, clinical commissioning groups (CCGs), working with local authority partners and providers of care, must submit delivery plans for how they will eradicate the use of paper in the treatment of patients across all health and care services in their region by 2020.

These plans will focus local NHS leaders on the task of modernising services and allow CCGs to be held to account for meeting agreed milestones.

To provide clarity on what is expected, guidance has been produced which includes a set of key digital standards that healthcare providers must implement.

For example, from October all discharge summaries for acute or day care patients transferring from hospital to the care of their GP must be completed electronically.

Trials have shown that granting GPs instant access to discharge summaries online reduces the risk of error during ‘patient handover’ as doctors can immediately see what medicines their patients are on and what procedures they have had.  This will help to ensure that a patient’s transition out of hospital is as smooth and safe as possible and enable doctors and nurses to care for them more effectively straight away.

Next year this will be broadened out to include discharge to social care.

From 1 November 2015, clinical commissioning groups and providers will be asked to complete a self-assessment to benchmark their digital services.  The results will form a ‘digital maturity index’, giving a picture of how far the NHS has come on its mission to make effective and meaningful use of technology and highlighting areas for improvement.

NHS Improvement will play a key role in supporting providers to make progress.  Going forward, the ‘digital maturity index’ will become part of the CQC inspection regime.

Last Autumn, the NHS set out a bold vision for the future, outlining what change is needed to bring the NHS into the 21st century and support new and improved models for delivering patient care. In November, the National Information Board  in health and care published Personalised Health and Care 2020: a Framework for Action  which sets out how more effective use of technology and data will enable that vision.

The NHS is committed to making all patient and care records digital by 2020, meaning that whenever and wherever patients access services those caring for them have all of the relevant information available at their finger-tips – from diagnostic tests and clinical notes to case histories and records of personal preferences.

The evidence for this improving patient safety is clear: Electronic prescribing systems, which support clinicians to ensure the right medicine is provided to the right person in the right quantity, halve medication errors, yet only 14% of NHS hospital trusts currently use these systems.

There is also the potential to save the NHS thousands of pounds on the cost of storing and moving paper around the system.  The estimated annual cost of paper storage is between £500,000 and £1million for each Trust – money which could be spent instead on more doctors and nurses.

The NHS has been on a journey to locate useful and safe digital healthcare services and make them available to patients.

97% of GP practices now offer patients the chance to book appointments, order repeat prescriptions and access their records in summary form online. In the first quarter of this year, more than 3.7 million repeat prescriptions were ordered online and over 3 million people have registered for record access.

More than 96% of people registered with a GP now have a summary care record and more than a third of ambulance services share that patient information in real time with A&E departments and out of hours services meaning clinicians can treat patients more safely based on knowledge of their medication history and especially allergies and other likely adverse reactions to drugs.

To drive forward digital working practices in hospitals and GP practices and increase uptake of online services amongst patients, the NHS is moving forward with its bid to investigate the potential of converting the entire NHS estate into a free Wi-Fi zone.

For doctors and nurses, Wi-Fi is a key enabler of online clinical systems including remote monitoring of patients and electronic prescribing through portable devices, which dramatically reduce errors and increase efficiency.

Patients will have the opportunity to use online tools such as apps to self-monitor their health from their hospital bed.  This is an important factor for people with long term conditions – for example, a fifth of patients with diabetes will have experienced a largely avoidable hypoglycaemic episode whilst in hospital.

Patients will also be able to go online while at their GP practice to book appointments and repeat prescriptions, access their medical record, fill in the friends and family of patient satisfaction and, if necessary, make a complaint.  Where free Wi-Fi access has been already installed, patients report feeling more engaged and empowered as a result.

Mr Kelsey says: “Whether it is patient frustration about not being remembered or professional concern about managing care in the face of unknown risks, the effectiveness and safety of NHS services will be strengthened from being delivered paper-free at the point of care.

“Without fully digitised patient data that can be shared across healthcare settings, the NHS cannot modernise in the way that is required.”

This month the NHS will begin piloting a new endorsement model, that will help patients and doctors, nurses and care staff to sift through the 97,000 health apps that are currently available on the EU market and identify the ones that are most effective in managing long term conditions and increasing wellbeing.

The Mental Health Apps Library, which features online tools, resources and apps with a proven track record of effectiveness in improving mental health outcomes, was launched in March and has increased traffic towards digital provider sites meaning that more people are now receiving the benefits of online mental health services.

Building on this success, diabetes has been selected as one of the areas that will go next.  A 2015 review of diabetes self-management found that technological interventions had positive impacts on diabetes outcomes including improvements in haemoglobin A1C levels, diabetes self-management behaviours, and diabetes self-efficacy. Participants reported that they appreciated the education and personalised feedback they received through this type of treatment.

The potential impact for this is huge: 3.3 million people currently have diabetes with another 5 million at risk of developing it by 2020.  NHS England will work with relevant clinical experts and patients to develop our approach.

Apps will be promoted in other areas including obesity prevention, maternity and early years, smoking cessation and COPD.  There will also be apps to allow patients to book appointments, order repeat prescriptions and access their GP records.

• Personalised Health and Care 2020: a Framework for Action
• The National Information Board brings together national health and care organisations from the NHS, public health, clinical science, social care and local government, along with appointed independent representatives to develop the strategic priorities for putting data and technology safely to work for patients, service users, citizens and the professionals who serve them.

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Going “paperless” in an English National Health Service (NHS) breast cancer screening service: The intriduction of fully digital mammography

Objective: To test the feasibility of a fully paperless system, termed “paperlite” in a UK breast screening service. To demonstrate in NHS practice, how workload and workflow could be improved by moving to a paperless system and discovering what impact this has upon the complexity within the service. Setting: Warwickshire, Solihull and Coventry Breast Screening Service in the West Midlands of England. Methods: Quality improvement methodologies were employed, including value stream mapping, task analysis and a time-and-motion study. Results: The screening centred screened approximately 50,000 women per year. If they were to implement a paperless system, the administrative workload would decrease. The time saving per batch of screens, which could be achieved by moving to the paperless system ranged from 19 to 56 minutes (mean = 36 minutes). When calculated by batch the mean time saving per woman screened by moving to the paperless system was 42 seconds. This equates to 583 hours of administrative work per year in a centre screening 50,000 women. Conclusions: The paperless system has many benefits compared to the original system in terms of reductions in waste, time and cost. The simplification and standardisation of the process resulted in fewer tasks and interfaces where errors could occur, hence inadvertently improving patient safety. The limitation of the work is the heavy reliance on technology, live interfacing with computer databases and software stability is necessary for a paperless system to be used in NHS practice.

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NHS Liverpool University Hospital: Immersive gamified training solutions

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“We wouldn’t have had a trained, efficient, effective workforce without Attensi.” Jacqui Cooper Chief Nursing Information Officer | Liverpool University Hospital

Supporting the NHS through immersive gamified training solutions

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A transformation was required

Liverpool University Hospital approached Attensi about revolutionizing the way they provided essential IT training during the Coronavirus pandemic. Removing staff from their units to provide face to face training was no longer a possibility.

‘The gap in IT training is clinical context.’

Using the valuable insight from Liverpool University Hospital and our unique blend of human psychology and gamified technology, we created ‘Eleanor’ – a virtual patient who provided all the complexities of a real life patient.

Taking Eleanor through her journey from admission to discharge allowed teams to practically apply their new software, Paperlite, in a way that made sense to their day to day role.

A matter of life and death

In a hospital, sub standard training could literally mean the difference between life and death. When time and resources are few and far between, hospitals need learning and development that goes beyond a tick box exercise.

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Danish Ministry of Health, Danish Ministry of Finance, Danish Regions, and Local Government Denmark. A coherent and trustworthy health network for all: digital health strategy 2018–2022. 2018. https://tinyurl.com/yxlefxg3 (accessed 16 October 2019)

Greater Manchester Health and Social Care Partnership. The devolution difference. 2018. https://tinyurl.com/y48t2f65 (accessed 16 October 2019)

Kaku M. Physics of the future: how science will shape human destiny and our daily lives by the year 2100.New York (NY): Double Day Books; 2011

Klein G. History of electronic prescriptions in Sweden: from time-sharing systems via smartcards to EDI, 1st edn. Stockholm (Sweden): Springer; 2010

NHS England. NHS Long Term Plan. 2019. https://tinyurl.com/y4k3mjyw (accessed 16 October 2019)

Queen's Nursing Institute. Nursing in the digital age. 2018. https://tinyurl.com/yy8xshpz (accessed 16 October 2019)

AI and healthcare technology in India: opportunities, challenges, and emerging trends. 2018. https://tinyurl.com/y3nxbur7 (accessed 16 October 2019)

Paperlite: piloting a new way of working in community nursing

Kate Uprichard

Digital Project Nurse, Stockport NHS Foundation Trust, Manchester

View articles · Email Kate

Technology within healthcare is a growing industry, and health professionals now use technology within their everyday working life. Within hospitals, it is the norm to see staff using handheld devices to record clinical observations and patient notes being typed into an electronic system. However, the use of technology within community settings is far behind that of hospital counterparts. It has been acknowledged that the use of technology in healthcare will improve efficiency and remove some of the bureaucracy within the NHS, and community areas are beginning to pilot different ways of implementing this. This article describes a pilot trial of using technology to aid mobile working in the author's trust and discusses how district nursing can embrace the use of paperlite culture to improve efficiency and record reliability.

Society at large has become reliant on technology in a relatively short space of time, and the timescale in which technology has progressed is impressive. Consider the moon landing, which was 50 years ago; today's smartphones have far greater computing ability than the computer that aided the moon landing mission ( Kaku, 2011 ). We now live in a world where good technology is essential for good communication, creating and maintaining a community (through social media) and working efficiently, and the world of healthcare is catching up. Certain countries have been pioneers in the adoption of health technology, and have used it for many years. Denmark has been ahead of the trend for some time, introducing basic electronic prescriptions in the 1990s, and Sweden quickly followed its lead ( Klein, 2010 ). In Denmark, clinicians across all regions are able to access a patient's health records ( Danish Ministry of Health et al, 2018 ). In terms of telehealth, India is developing this area for its many rural areas that do not have regular access to doctors ( Rao, 2018 ).

The uses of health technology range from storing patient records electronically and being able to communicate with other hospitals, specialties and professionals involved in a patient's care, to allowing isolated patients to access telehealth and monitoring these patients remotely.

Increasingly, healthcare technology is now also being used in the UK. As the NHS Long Term Plan (2019) demonstrates, the health service in the UK has witnessed a mammoth change in its use of technology over the past few years, and it has been found to have a positive impact on service efficiency as well as patient outcomes. Patients can now access their primary health records online and can be informed by over 70 applications that provide health information ( NHS England, 2019 ). Some 93% of GP practices use the Electronic Prescriptions Service (EPS), with more than 67% of patients using this service ( NHS England, 2019 ). The NHS has also created Global Digital Exemplars, which are knowledge-sharing platforms using which ambulance, acute and mental health trusts will pioneer the use of technology within healthcare ( NHS England, 2019 ). However, these changes are only the beginning, and it is necessary to implement more digital services for the NHS to thrive in the future.

The main difficulty in adopting this plan to increase and improve health technology is that the NHS is made up of many different organisations and services that work in radically different contexts and use varying methods of obtaining and sharing information. A tech initiative that works within an acute ward cannot be replicated in community services, and vice versa. Thus, clinical areas must consider what health technology is beneficial to them.

One way of implementing health technology to benefit patient care and improve efficiency is developing a ‘paperlite’ culture. The term ‘paperlite’ represents the idea that most patient records can be kept within an IT system, accessed through both computers and mobile devices, and be shared among the various health professionals involved in a patient's care. Paperlite also encompasses the idea that, in other instances where paper is used in everyday working, such as printing referrals or having paper diaries, technology can be used instead. This is where the use of mobile devices comes in, replacing the use of paper.

The Queen's Nursing Institute's (QNI) (2018) report ‘Nursing in the digital age’ outlines how district nursing teams can use technology and implement a paperlite culture. One of the recommendations is to appoint a Chief Nursing Information Officer, who would lead the implementation of IT to ensure that the technology used is practical for clinical staff and to liaise with IT support. Another recommendation is to involve clinical staff in the choosing and designing of IT systems and keep them up to date with the process, which is key for a successful paperlite culture. The QNI (2018) also recommended ensuring that all staff are appropriately trained to use any IT systems or devices, with the knowledge and willingness of staff to learn being considered carefully.

Project background

The Greater Manchester area is undergoing a period of transformation, ever since Manchester's health and social care funding was devolved in 2016, allowing services to be shaped to the needs of the communities ( Greater Manchester Health and Social Care Partnership, 2018 ). In 2018, Stockport NHS Foundation Trust applied for and received funding from the Greater Manchester Digital Transformation fund, as part of the Greater Manchester devolution. This funding was awarded to enable the trust to implement mobile working across adult community health services, with the aim of the trust becoming paperlite by the end of 2020.

Prior to the pilot, paper was very much the default option within district nursing: referrals were sent by fax or post, with only some services using secure email. Teams used a paper diary to record multidisciplinary meetings or individual training dates. All resources would be printed and physically stored at the district nursing base. Every morning, staff would have to come into the base to collect their list of patients, as well as any additional information, such as key codes and referrals, or equipment for the visits, such as wound dressings. Each visit was recorded within the patient's home notes, with a carbon copy being returned when each page was filled. Only discontinued care plans, out-of-date medicine authorisations or filled medicine administration sheets were removed from patients' home notes, to be placed in office notes stored securely at base. Any referrals, pictures or letters would be placed in office notes, copied and brought to the home visit. Once the staff returned to the base, they would input the visit details electronically onto EMIS Web, thus only logging bare essential information, such as who visited the patient, what care was provided and the timing of the visit. Any health professionals using the same system (apart from GP services, as data sharing is yet to be initiated across Stockport) could also view patient records as they were updated, but required access to a computer.

Unfortunately, internal processes did not support using the full electronic clinical record. For example, a visit to re-dress bilateral leg wounds would be recorded, but, because paper notes were being used, there was no need to go into the details of the visit on EMIS web. So, there might have been a lengthy discussion about why compression bandaging was required and what options the patient would have once bandaging was no longer necessary, but this would not necessarily be recorded in EMIS; therefore, the complexity of the visit was not captured. Further, any attempt at replication could lead to ambiguous or incorrect documentation, as staff would be attempting to duplicate something they had written hours ago.

In addition, many of the district nursing bases only had a small number of computers, which used outdated technology and were not cared for by staff due to a lack of IT understanding. Since community nurses are based across the Stockport community, and not at the trust's main site, it took very long for any IT issues to be fixed. These problems often caused delays in inputting data, which, in turn, raised concerns about the accuracy of the data inputted and lengthened the task of documenting exponentially. Often, it felt like the time taken to complete paperwork amounted to more than what was being spent with the patient.

In June 2018, a pilot for the use of mobile devices in the community was introduced within one neighbourhood, encompassing two district nursing teams, and it continued for 8 months. All clinical staff were provided with a tablet equipped with the EMIS mobile app, along with many other useful apps and functions. They were also provided specialised EMIS mobile training. By using the EMIS mobile app, staff could simply sync their diary in the morning to view their visits for the day, and have any visits added or removed for any reason without much complication. The only pre-requisite was a 4G or Wi-Fi connection. Each time staff visited a patient, they could immediately input the data into the EMIS mobile app, providing real-time updates to any health professional with access and allowing the data collected to be more accurate, as it was recorded soon after the visit. Throughout the pilot, the EMIS mobile app was updated to include useful functions. For example, at first, only view a limited part of the care record could be viewed on EMIS mobile, but now, various documents, such as referrals to other services or discharge letters, can be viewed. These improvements allowed the team to become less dependent on paper. The mobile device was also equipped with other functions, such as the ability to complete a Datix, input mileage, take pictures and send and receive emails. There was also a range of reference apps available, such as the British National Formulary (BNF), Lohmann & Rauscher (L&R) hosiery selector, NHS Guide to Safeguarding and NHS Diabetes & Me apps.

In June 2018, the author was a third-year student nurse on sign-off placement and had previously been placed in a district nursing service that used mobile devices. Since the author was enthusiastic about the use of mobile devices in service provision and could assist colleagues who were less comfortable using technology, she was invited to join the first EMIS mobile training session. In September 2018, she joined the team as a registered nurse, and was asked to join a task-and-finish group, which aimed to develop and improve the existing consultation templates on EMIS Web and Mobile, as well as integrate paper-based care plans, to begin the process of being paperlite. The template in place at the time was not intuitive to the user, and did not capture the clinical data required for a paperlite system. Over the next 8 months, the task-and-finish group met regularly, carefully analysing the template to identify what was missing. The group had to consider the way the template would be used in the community, questioning whether it would be intuitive enough for staff to use, whether it captured the required data and whether it was more efficient than writing notes. It also had to ensure that the template adhered to the trust policies and guidelines, and that it worked well on both EMIS Mobile and Web. This process was completed in July 2019, and the templates were released to all district nursing staff in September 2019.

Benefits of the paperlite model/mobile working

With the introduction of mobile devices, several benefits were noted. Since staff could check their diaries from anywhere, they were able to plan their day much earlier rather than waiting until they arrived at the base. This improved efficiency and increased the number of patients being seen. It also allowed staff to become more flexible, for example, those who went home during their lunch hour could still be kept up to date on any changes to their schedule. Furthermore, contingency planning for situations such as snow days or flooding was greatly simplified with mobile devices. Staff members can receive live updates on which patients need to be visited and can be reallocated to a closer team within the trust if needed.

Although the paperlite system has not yet been fully implemented, the benefits are obvious. As stated previously, the data provided through EMIS is not 100% accurate. Once paper notes are eliminated, data will be captured more accurately. It is hoped that this will lead to more funding being made available, as accurate data about local population needs will be better captured.

From the financial aspect, the implementation of a paperlite/mobile working system requires funding up front, but the savings once the system is in place are considerable. Faxing, printing and the overall use of paper will reduce dramatically. Mileage costs will also reduce, since staff members will not have to come into the base every morning.

Issues faced

Implementing a mobile working/paperlite culture is not without its challenges. One of the main issues faced was staff engagement. Although the use of technology within the community is by no means a new phenomenon, many staff members were hesitant about it and did not feel confident. This lack of confidence meant the devices were not used as regularly as desired. Additionally, since this was a pilot trial, staff members were not explicitly required to use their devices regularly, although they were encouraged to do so. This meant that many staff member's confidence in using the devices dwindled over the course of the pilot, further causing them to avoid using the devices regularly.

Another challenge was connectivity. The area in which the pilot was conducted has a patchy mobile signal at best, which is not uncommon in many of the more rural areas. Thus, there were times when staff could not update work lists or access past evaluations to analyse any changes in the patient's condition. Furthermore, the bases that tested the devices were not set up with an accessible Wi-Fi connection for many months, so staff often could not get a reliable connection while at base.

Finally, the trust decided to use Android devices, as opposed to Windows or IOS, and although this is a cheaper option and just as reliable, staff are more familiar with IOS systems and struggled initially to get used to another operating system. Although this was a somewhat easy challenge to overcome, it was important to reflect on before the full implementation of mobile devices.

Recommendations for other adopters

On the basis of this pilot, several suggestions are available to others who wish to implement a paperlite system within community care. Firstly, a long trial period is beneficial. The initial pilot introduced the concept of mobile working, and the next 8 months were spent ironing out any issues with the system, creating customised EMIS templates and, most importantly, spreading the word among staff. Secondly, it is ideal to involve as many clinical staff members in the pilot as possible. This helps ensure that the system works in the context of the daily job, and staff members will be less hesitant knowing that one of their colleagues has had a say in the establishment process.

It is important to involve IT services at the outset. A project like this is a considerable undertaking, and IT staff members need to understand that it will be very different from their usual work of supporting trust-site staff. It should be ensured that they understand the implications of having to look after community staff; visiting the IT building is not feasible for community staff, so other options must be explored. For example, a monthly drop-in clinic could be set up for any IT issues within the community, and IT staff should moving around regularly to provide good, consistent support.

Finally, time should be set aside for less technically able staff to become comfortable with a new way of working. There will be members of staff who will struggle with the introduction of more technology, and will therefore make mistakes and feel disempowered. If left unaddressed, this disempowerment and confusion spread quickly, and cause more engaged staff to lose motivation. Extra training should be made available for those less confident, and the use of peer-teaching should be considered. Often, it is difficult for IT staff to explain how technology works within the context of community care, and tech-savvy colleagues are perfectly placed for this. Not only will this help to engage those who may be less enthusiastic about the increased use of technology, but also the staff teaching them will feel more involved in the project, improving retention.

From September 2018, Stockport NHS Foundation Trust is implementing the use of mobile devices and then a paperlite culture, across all district nursing teams.

Since the pilot ended, many aspects that were previously a challenge have now been addressed. When inputting data on EMIS Mobile, any unfinished items are saved to the device and uploaded when a suitable connection is avail. Although this may sound cumbersome, it is far more efficient than the paper alternative. Furthermore, all bases now have Wi-Fi installed, reducing the problem of data remaining not uploaded.

It is understandable that more issues are likely to arise when this initiative rolls out trust-wide, and feedback will be sought from all stakeholders. However, no new initiative is without its downfalls, and the paper system is far from perfect. The NHS seems almost obsessed with the use of paper, viewing it as a safety blanket. Significant changes have been undertaken within the health service, which were not initially well-received by staff but were eventually accepted as they understood how these changes improved practice. The paperlite system is likely to follow this trend.

• Various clinical areas of the NHS are adopting healthcare technology to improve efficiency and patient outcomes, and district nursing is catching up with this concept
• Paperlite represents a culture of reduced dependence on paper for record keeping, appointment planning, knowledge sharing, etc
• The Stockport NHS Foundation Trust is in the process of adopting paperlite culture through mobile working
• The key themes that emerged from a pilot of paperlite in the trust were peer teaching and the need for better communication and integration between IT services and clinical staff.

CPD REFLECTIVE QUESTIONS

• How do you feel about the use of health technology within community?
• What is in place at your place of work in terms of mobile working or paperlite, and how could it be improved?
• What is one aspect of your working day that could be improved by the use of a paperlite/mobile working system?

Going paper free and digital

North Bristol NHS selects CCube Solutions’ EDMS to complement and augment its Lorenzo EPR system as part of a Trust-wide paperlite strategy

CCube Solutions is pleased to announce that North Bristol NHS Trust has selected its electronic document management software (EDMS) to replace all paper case notes with an easy to use digital system providing instant access to patient medical records for 6,000 clinicians, nursing and administrative staff.

The introduction of EDMS is part of the Trust’s phased Electronic Patient Record (EPR) strategy and will facilitate a more timely and extensive move towards creating a paperlite environment which also involves developing its EPR to reduce the amount of paper created on a daily basis.

This will ensure that one of the largest hospitals in the UK serving people in Bristol, North Somerset and South Gloucestershire is paper free at the point of care – a key NHS England and Government goal. The new EDMS will enhance clinical effectiveness, reduce operational costs, ensure compliance with CQC guidance about records and data management, and ultimately boost patient safety and care.

The choice of CCube Solution’s EDMS will complement and augment the Lorenzo EPR solution – procured from CSC - which was implemented in November 2015. It is the first contract for CCube Solutions resulting from a new framework agreement with CSC announced in October 2016. This allows CSC to offer CCube’s EDMS to any Trust using Lorenzo who wishes to digitise and display information contained in paper medical records.

Paper creates huge logistical challenges

Currently North Bristol NHS Trust stores about 1.2 million medical folders off-site, with around 850 files being delivered to Southmead Hospital and other premises each day. The paperlite strategy will reduce costs and make the process more efficient.

Neil Darvill, North Bristol NHS Trust’s director of informatics, says, “The business case for the EDMS project is predicated on a scan-on- demand model where only the patient notes for people booked to attend clinic will be processed, not everything in the library. This saves a huge amount of money given the other records will be destroyed in line with our retention policies and procedures as and when they reach their expiry dates.”

Out of its total of 1.2 million folders, the Trust therefore estimates that it has 223,100 active patients who will need their records scanning. As each folder contains on average 150 sheets, this means 33,465,000 pages are likely to be scanned in total. The massive back scanning task will be outsourced to a scanning specialist.

Darvill explains, “Our analysis shows that 70% of active patients have follow up appointments after an initial consultation. Once their records are scanned, it means for any subsequent visits, their records are available on the system for clinical staff to see.”

Darvill explains, “We simply can’t afford to keep generating paper at the pace we are given the number of patients we see - around 1,300 outpatient and 200 inpatient attendances each day. The purpose of the paperlite project is to look at how we capture clinical information immediately at the point of care rather than writing notes on paper and scanning them afterwards as this clearly defeats the purpose of putting in an EPR in the first place.”

Until the paperlite initiative has evolved, so-called ‘day forward’ scanning will be managed in-house. During this period of transition, the Trust has purchased two production scanners from Kodak Alaris – the i4650 and i4850 – which process up to 130 and 150 pages per minute respectively. Kodak Capture Pro imaging software has also been selected which allows large batches of medical paperwork to be captured and indexed quickly and efficiently. It will then be imported into the CCube EDMS.

An EDMS saves money and is simple for clinicians to use Capital expenditure on the CCube EDMS, Kodak Alaris scanners and capture software along with other implementation costs total £960,000. Over a four-year period, the Trust expects to save over £1.3 million in terms of the operational expenditure associated with the running of its paper-based processes and libraries. The cost savings come from closing the off-site facilities – expected by October 2018.

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Newham Hospital postnatal care service goes paperlite  | Our news

Search the Barts Health NHS Trust website

Newham hospital postnatal care service goes paperlite .

Posted Friday, 26 March 2021 by Rachel Brooks

The maternity team at Newham Hospital will be paperlite for almost all aspects of postnatal care documentation, saving time and improving accuracy. 

The paperlite initiative will begin on 29 March 2021 and will mean all paper documentation will become digitised, excluding some drug charts charts. 

Previously, all documentation needed to be handwritten in the hand-held notes of women receiving care. Now, this information will be recorded on Cerner Millennium. 

Going paperlite will be beneficial for both staff and the women and families who are recieving care. Benefits include:

• allowing secure data sharing between healthcare professionals and women
• enabling more time to be spent with patients due to increased staff productivity
• helping to achieve more effective clinical governance 
• improving accessibility to notes

The ultimate aim will be make all maternity documentation electronic, in line with the Barts Health objective to become a paperless NHS. 

For more information, please contact  Crystal Jaiyesimi , digital midwife at Newham Hospital. 

Barts Health NHS Trust © 2024

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Paperlite: piloting a new way of working in community nursing

Affiliation.

• 1 Digital Project Nurse, Stockport NHS Foundation Trust, Manchester.
• PMID: 31800318
• DOI: 10.12968/bjcn.2019.24.12.586

Technology within healthcare is a growing industry, and health professionals now use technology within their everyday working life. Within hospitals, it is the norm to see staff using handheld devices to record clinical observations and patient notes being typed into an electronic system. However, the use of technology within community settings is far behind that of hospital counterparts. It has been acknowledged that the use of technology in healthcare will improve efficiency and remove some of the bureaucracy within the NHS, and community areas are beginning to pilot different ways of implementing this. This article describes a pilot trial of using technology to aid mobile working in the author's trust and discusses how district nursing can embrace the use of paperlite culture to improve efficiency and record reliability.

Keywords: Electronic systems; Healthcare technology; Mobile working; Paperlite culture; Service efficiency.

• Community Networks / organization & administration*
• Efficiency, Organizational*
• Electronic Health Records*
• Hospitals, District
• Inventions*
• Pilot Projects
• Reproducibility of Results
• State Medicine / organization & administration*
• United Kingdom

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• What's stopping the NHS going digital?

What's stopping the NHS going digital? 

• 19 February 2021 06 April 2023
• 5 minute read

Targets to digitise the NHS have repeatedly been scrapped because of slow progress. But why is this important? We lay out the benefits of digitisation for patients, clinicians and taxpayers, explain why the process has been so delayed and how the NHS can ensure no more targets are missed.

It was supposed to happen in 2018, but first it was pushed back to 2020 and now it’s been postponed again until 2023.

We’re talking about the paperless NHS, a long-stated ambition of the UK government.

So, what went wrong and is the new target realistic?

Might a paperlite  approach, where the use of documents is minimised, but not cut out completely, be more sensible?

While the events of 2020 will clearly have shifted resources away from certain longer-term strategic objectives, lockdown certainly sped up the digitisation of some services.

During 2019, around 90% of GP consultations were held face-to-face, but in April 2020 the NHS reported that more than 85% were now remote consultations , either by phone or videolink.

Benefits of paperless

The benefits of going paperless  are easy to understand; digitised documents mean clinical data can be easily shared across the NHS, giving clinicians access to patient records and care plans wherever they are.

That generates efficiencies and cost savings, as well as enabling higher-quality clinical care.

Substantial investment is planned (£8 billion over five years), but the NHS has been hamstrung by the wide range of different IT systems being used by different parts of the service.

Many of these can’t work together, making it difficult for hospitals to share scans with GPs, for example.

The blame for missing the target to create an integrated paperless system of digital patient records – a key principle of the NHS Long Term Plan –  has been blamed on poor planning, a lack of governance and a lack of sufficient investment.

Sudden need

Shamir Patel, consultant pharmacist at Doctor 4U, says: “The COVID-19 pandemic has highlighted the sudden need for a digital NHS with many doctors working remotely and needing access to patient records instantly.

“We’ve never experienced a health crisis as big as the current pandemic, and this could be the push we’ve needed to get the NHS digitalised to deal with these crises more effectively.

“While COVID-19 cannot be blamed for not reaching the 2020 target, it certainly hasn’t helped. Priorities have changed this year which may delay the process even further.

“This has been a problem throughout this project, other challenges arise which simply take more priority than this, and so it gets delayed again.”

Charles Cao is head of EMEA operations and Strategy at Conga, a digital document management specialist which works to simplify and automate document handling, supporting organisations’ digital transformation.

He says that the coronavirus pandemic has shone a light on the limitations of manual processes, which add unnecessary risk and limit the NHS’ ability to scale up services to meet increasing demand.

Juggling systems

He said: “Documents are the building blocks of every organisation, but when teams have to manually create, review, track, and manage those documents, it keeps them from operating efficiently.

“Healthcare providers often manage patient care through multiple manual systems. In a role that’s manual and paperwork-heavy, providers need a solution that allows them to spend more time on creating a patient-first experience, rather than chasing down paperwork and juggling multiple systems.

“With an integrated system, providers will have a 360-degree view of the patient, as well as the ability to deliver truly personalised experiences.”

And it’s not just about digitising manual processes to improve the patient experience, introducing new technologies, such as artificial intelligence (AI) , as part of the holistic IT architecture is helping to transform diagnosis and treatment of patients.

Invest enough time

So, is the NHS now on track to meet its 2023 target?

Shamir Patel questions whether even that is achievable.

He says: “We are already seeing progress in the move towards a digital NHS, particularly in GP surgeries, but making hospital trusts completely digital is a bigger task.

“This requires lots of funding, time, and investment in training all NHS staff on how to use the technology, plus 24/7 IT support in case technology fails which could seriously disrupt patient care.

“Finding the right time to change an entire infrastructure in hospitals that are overwhelmed, exceptionally busy, underfunded, and dealing with competing priorities on a daily basis is challenging to say the least.

“Yes, there are huge benefits to going digital and it will significantly improve patient care, however, if it is not implemented properly it runs the risk of doing more harm than good, so it’s important to invest enough time to get it right and set more realistic targets.”

While past experience may inspire pessimism, there is also cause to look to the future with fresh eyes.

Of course, money will always be an issue, but the pandemic helped underscore how important the NHS is to the public, and that could help protect it from unpopular funding cuts going forward.

No doubt the NHS still faces huge challenges in tackling COVID-19, and the country will have to foot the huge financial cost, but the digitisation of the NHS is too big a prize to keep postponing forever.

Find out more about how Brother is helping healthcare settings to digitise their processes here , or discover our range of specialist technology for primary and secondary healthcare .

• Productivity

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Video: Newcastle Hospitals NHS Trust’s EPR journey

Towards the end of last year, Graham King, Chief Information Officer at Newcastle upon Tyne Hospitals NHS Foundation Trust delivered a live webcast on the trust’s Electronic Patient Record (EPR) journey.

Part of our HTN Now Focus event on EPR systems, Graham’s presentation focused on the implementation and project ‘Paperlite’, to reduce Newcastle Hospitals’ reliance on paper recording.

Providing background on the North East trust, Graham first explained the scope of the organisation – which has around 1.72 million patient contacts per annum, is home to 1,650 beds, and employs 17,500 members of staff. He added that the trust generates around 7,500 clinical documents per day across its 40 sites.

Graham explained that, despite being the focus of his talk, Newcastle’s EPR journey did not start with Paperlite – it actually began way back in 2009, when the trust went live with Cerner, including Inpatient Orders and Medications, a Patient Administration System (PAS) and picture archiving. After a hiatus, digital correspondence followed in 2016 through document management, before the implementation of nursing tracking boards and electronic observations in 2017.

Due to operating in a “hybrid state of some paper, some electronic” systems, “the flow was not particularly great”, explained Graham. The trust then became a Global Digital Exemplar (GDE) site and went live with its Paperlite programme in 2019, moving clinical, nursing and Allied Health Professional documentation into a digital format.

To achieve its goals around reducing paper, Newcastle Hospitals had four ‘guiding principles’: to do it right and do it once; to implement it across the whole organisation for everyone, everywhere; to use one system; and to give people what they needed rather than exactly what was asked for.

The organisation’s reasons included – first and foremost – patient safety and patient experience, as well as to improve research and auditing, boost organisational efficiency, and to make financial savings.

Graham also explained which aspects of the EPR were Cerner’s core components, which were Newcastle’s own, and which were third-party integrated systems. The CIO then went on to detail how his team gained both clinical and executive engagement through a series of meetings and open forum events, as well as via the mapping of current processes through 77 workshops across two weeks, to show where efficiencies could be gained.

The team then went further – by conducting a week-long event to show staff what they could expect, with presentations on each functional area taking place every day, as well as break-out sessions and glimpses or ‘first looks’ at the hardware options, which then enabled staff feedback.

“It gave context to the questions that we would be asking them later on in the design sessions for each area – they needed to make their decisions about where they wanted things, how they would navigate…it was really about making sure we took them through the design process and they were fully engaged on that,” he said.

Moving on to testing, Graham highlighted the importance of the three cycles of user acceptance testing in mock environments and full dress rehearsals of what go-live would be like, so that the team could get each department to sign-off on the functionality.

“That sounds really quick and easy [but] it took a long time,” Graham said, “the key to getting a quality product is that, at a point in time, you must stop making changes to the system and say ‘that’s actually what we’re going to go live with’…that was quite a challenge.”

On training – which encompassed working with around 10-12,000 staff over 10 weeks – additional rooms and trainers were required, with online booking systems to make it simpler, as well as a library of quick video guides and pocket handbooks for each staff group. With these measures in place, the team managed to train 95 per cent of all staff before go-live.

Discussing hardware, Graham explained that “one of the key bits was changing the screen size” to 21 inches for user experience, while additional laptops, laptop carts and label printers were required, as well as PC upgrades.

“It’s not just about the system, it’s about whether all the components are there to be able to use that in a consistent way, [if] access is there, you’ve got a standardised mechanism for saying what a ward needs in terms of one cart per bay or one cart for every four cubicles, [while] critical care has a screen for each bed. You work through that until you have an agreed format,” he commented.

After taking the audience through the organisation’s control function, Graham moved on to the go-lives and their challenges, as well as early life support, which included retaining trainers for the first two weeks, having 50 floor walkers over six weeks, and using video conferencing and instant messaging technology so that floor walkers could communicate. They even had the team kitted out in their own purple branded clothes, so that they were visible to staff when they needed support, he added.

On the results, Graham noted: “Everything now is real-time reporting – you can see now in the Command Centre, [bed] capacity, occupancy, how many are closed…we’ve got real-time ED [Emergency Department] tracking and ED escalation, a Command Control screen for deteriorating patients, and we’ve continued to augment that with sepsis alerts…it’s allowed us to bring all the data to a single point and use that to manage the flow within the hospital.”

“We’ve also seen a massive reduction in the cost of the paper, we’ve closed one of the medical records libraries…post and printing costs have dropped, we’ve seen some time gain and some time losses…you can now see the record anywhere,” he added.

Graham also touched on the impact of the COVID-19 pandemic on work to make the system more efficient, explaining that the team are now going back to revisit areas. “Going live gets you to a digital record, it doesn’t mean you’ve got a good digital record – you’ve got to consistently and constantly maintain that…and constantly recycle back,” he said, noting that go-live is only the “start of the journey”.

To conclude, Graham then spoke briefly about regional cooperation through the Great North Care Record and Health Information Exchange, outlining how population health planning and a patient engagement platform have benefitted patient experience and safety, made processes easier for staff and enabled “truly integrated care” across the North East.

He then handed over to the audience for a detailed Q&A session. To watch the full session and Graham’s answers to the audience questions, view the video below:

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Securing The Future.

A Paperless NHS: Why The Delay & Is There An Alternative?

• October 17, 2023
• Uncategorized

Back in 2013, health secretary of the time Jeremy Hunt announced that the NHS would be paperless by 2018. On paper (pardon the pun), this was a highly desirable improvement both in terms of environmental impact and operational efficiency but in practice, it would appear that the timescale was too ambitious. The target date was pushed back, first to 2020 and then to 2023. With just over two months left to the end of 2023, it looks unlikely that this target will be met, either.

What are the possible causes of this delay? There’s no doubt that the unforeseen Covid 19 pandemic put extreme pressure on the NHS, but it would be too simplistic to blame the delay solely on this factor. After all, the pandemic didn’t begin until 2020, two years after the original target date.

Obstacles to a paperless NHS

It’s more likely that a combination of factors is contributing to the repeated delays. Although it may not be a complete list, we’d like to suggest the following.

A legacy of paper-based systems

The NHS uses many traditional systems that may not be easily integrated with modern digital systems. Healthcare professionals may be resistant to change, especially if they have been using paper-based systems for many years. They may need convincing and training to adapt to digital systems.

Creating standardised systems and securely migrating data

Different parts of the NHS such as hospitals, general practitioners and pharmacies often use disparate electronic systems that may not communicate well with each other. Achieving interoperability between these systems is crucial for seamless patient care, effective data sharing and analysis. Such standardisation is complex and time-consuming.

Transitioning from paper records to electronic records often involves a complex data migration process, which must be done accurately to prevent data loss or corruption.

Connectivity in all areas

Many parts of the UK don’t yet enjoy fast or reliable internet connectivity. For some healthcare locations and professionals working in the community, this can make the transfer from paper to digital records extremely challenging.

Digital literacy and training

Patients and healthcare providers may have varying levels of digital literacy. Ensuring that everyone can access and use digital healthcare services can be a challenge, especially for older or disadvantaged populations.

Healthcare staff, including doctors, nurses, and administrative personnel, need proper training to use digital systems effectively and to ensure that data is entered accurately.

The design and usability of digital healthcare systems can significantly impact their adoption. User-friendly interfaces and intuitive workflows are critical for success.

Data protection and cybersecurity threats

In the UK, GDPR imposes strict regulations on the storage and sharing of healthcare data. Complying with these regulations while maintaining efficient digital records can be complex.

As healthcare systems become more digital they become easier targets for cyberattacks. Protecting against data breaches and ransomware attacks is a constant challenge that requires complex security measures to be built into digital systems.

Cost of implementing and maintaining a paperless system

The initial investment required to transition to a paperless system can be substantial. This includes not only the cost of implementing new technology but also that of training staff and maintaining the system over time.

Is a ‘PaperLite’ NHS a viable alternative?

One possible solution that is being adopted by some healthcare trusts is the PaperLite model. This replaces paper-based systems in some areas where the transition is relatively easy and inexpensive while maintaining paper-based systems in other areas.

What are the advantages of a PaperLite NHS?

Applying the PaperLite model to the NHS brings several advantages, including:

• a reduction in the cost of printing, distribution and storage of paper documents
• less waste paper production
• enhanced patient care within a healthcare environment
• improved patient engagement with access to healthcare services, repeat prescriptions and appointment bookings online

At the same time, PaperLite retains some paper-based systems for various reasons.

Certain legal documents such as consent forms or advanced directives may still require physical signatures and paper documentation to ensure legal compliance.

In some situations, specific forms or reports may still be generated in paper format, especially if they need to be physically submitted to regulatory authorities or insurance companies.

External Communications

When sharing information with external organisations, such as other healthcare providers, insurers, or government agencies, paper documents may still be used for specific requirements.

While current patient records and data are primarily maintained electronically, historical medical records and archives from previous decades may still exist in paper format.

Data Preservation

In case of technical failures or data loss, healthcare facilities may keep paper copies of critical patient information as a backup.

Patient Preferences

Some patients may prefer to receive paper copies of their medical records or reports, and healthcare providers may accommodate these preferences.

Hospitals and clinics may also continue to provide paper-based brochures and educational materials to patients in waiting areas or during consultations.

Economy of scale

In some instances, the cost and time investment required to digitise a system may outweigh the benefits it brings, particularly if it faces resistance to change and unnecessarily replaces an established and efficient paper-based system.

In Conclusion

Reliable, consistent and fast internet connectivity across the entire UK will also be required and cybersecurity must be good enough to maintain an effective barrier to the global increase in highly sophisticated and even regime-backed cyberattacks.

In the meantime, the NHS continues to use paper-based systems and in May 2023, the National Health Executive published an article that stated there is a “growing realisation that paper and digital records can live side by side to deliver optimal efficiencies in patient care.”

The hybrid solution of a PaperLite NHS is likely to be with us for a while yet.

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North Bristol NHS Trust aims for paperlite patient records ahead of 2020 deadline

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The deadline does move around a bit so it could well change again after the June General Election. Health secretary Jeremy Hunt initially talked about a rather ambitious 2018 deadline, which he wants everybody to forget. Professor Robert Wachter then carried out a review of healthcare IT, which called for a more sensible-sounding timeframe of 2023.

But irrespective of the moving deadline, sensible NHS organisations are pursuing digital records projects for the many benefits on offer, rather than waiting to be given a final date.

Neil Darvill, CIO and Director of Infomatics at North Bristol NHS Trust, is currently leading a scan-on-demand project at the trust to get rid of its paper libraries and introduce paperlite strategies.

The plan is to carry out a major record digitization project, and then roll out software that can provide hospital staff with a view into the electronic record before the patient comes to the hospital. As soon as an appointment is made, that will trigger a process where the record is digitized by the scanning system, and is put online for viewing.

The software will also support advanced searches, so hospital staff do not need to click through a hefty PDF in the hope of finding the one useful piece of information they were after, and better navigation will ensure each outpatient consultation does not take an hour. Darvill says:

I’m not really reinventing any wheels for this one. This project is very similar to the one I did quite a few years ago now back up at St Helens. I’m repeating much of that here, it all gets wrapped up in the patient electronic records category. All NHS organisations think they’re very special, but in fact you’ll find we all have very similar problems indeed. One solution is reasonably appropriate for many. The reality is the cost saving and business benefits of taking your paper library and putting it online are quite significant on their own. Even if we didn’t have a wider transformation plan it’s just a good thing to do. It sorts out a lot of logistical and operational things, and reduces quite a lot of risk.

Track record

While North Bristol has yet to start the records digitization process yet, Darvill has form in this area. He joined North Bristol from St Helens & Knowsley NHS Foundation Trust, where as far back as 2009 as head of informatics, he introduced digital medical records using electronic document management software from CCube Solutions and an in-house scanning bureau.

The project saw impressive results: £1.4 million annual savings from a £1.2 million investment; 500 doctors and 130 secretaries trained after a staged 22-month rollout; and over 135,000 medical records digitized preventing 7,000 files per week from being hand delivered.

Darvill is hoping for even bigger benefits at North Bristol, noting that his new trust is a much larger organization than St Helens, and so the potential cost savings are greater.

North Bristol employs about 8,000 staff, compared to St Helens’ 4,500 employees. The health records library is also larger in Bristol, and because it is offsite and with rent being paid on the facility, there are more savings to be had. The overall project costs will not be that much different, but because it is on a larger scale, the benefits are likely to be bigger. However, the project encountered a rocky start, as Darvill explains:

When I started here - I’ve been here about 18 months - I inherited a project that had undertaken procurement that we failed to award, for both the software and digitization services. The project I inherited had been running for some time, but wasn’t in a position to be able to be delivered. I’ve started over. I started it from scratch about 18 months ago. We entered into negotiations for the procurement for some software services, which we managed to do through our contract with DXC (formed from the merger of CSC and the Enterprise Services business of Hewlett Packard Enterprise). We just bought it through a framework that involved using our EPR supplier DXC, and they subcontracted it.

North Bristol chose scanning software from the same company Darvill worked with at St Helens, CCube, and the trust has a preferred bidder for the digitizing of its records. Darvill explained that it is now in the last throes of tweaking the contract to be signed, and hopes to be able to recommit to a go-live date imminently. It has had to push back the date as the contract procurement process took longer than anticipated. He adds,

We’re trying to do our digitization services with another NHS organization so it’s not quite as cut and dry as if it was solely through a commercial procurement. I definitely believe it’s a really sound model that the NHS should be doing more of, to keep the money in the NHS. If you can find an NHS partner who needs to cover their costs but operates in a not-for-profit way, it means that every pound we spend doing this potentially has better value for money and a better impact for the NHS.

Going back to square one also allowed Darvill to overhaul the scope of the project.

The scope of the original project was to digitize our entire health records library, to scan everything. Obviously that was a fairly substantial undertaking with a lot of associated cost. If you go scan on demand, we can spend all the money we need on digitizing the records our clinicians will need, and those that are not requested we can provide a value-for-money storage option until they subsequently expire, in which case they’ll be securely destroyed as they would be. It saves us spending money on digitizing something that potentially won’t get looked at.

The trust has provisioned for around 350,000 records to be scanned, which it expects will take around two years – although Darvill expects the vast majority will be digitized within year one.

The trust’s current records library is housed in a warehouse on the outskirts of Bristol, and is designed to make every record easily available and obtained. Once it moves to the scan-on-demand system, it will be able to store them where they are much more difficult to retrieve, with significantly less cost.

Darvill said there is a time pressure on this factor, as the trust has a lease on the facility that expires in about 18 months to two years, and a key objective is to try and avoid renewing that lease to take advantage of the potential cost-savings. Security will also be improved via the move to a digital system, according to Darvill.

It’s much, much safer to have it online than to have one paper copy in a warehouse or being handed around an organization. You don’t have any backup with a paper copy, it can only be in one place at one time, and you only get it back into storage when people remember. Digitizing it and keeping it securely online – I don’t mean on the internet, I mean within our secure hospital network – and having copies for backup means that if you have a catastrophic failure of the infrastructure, we won’t lose records; if we had a fire in the library, we don’t have another version of that paper document.

National IT Programme legacy

Darvill cited the failure of the National Programme for IT (NPfIT) as part of the reason for North Bristol to lag almost a decade behind St Helens when it comes to digitizing medical records, explaining that the trust had to replace its EPR system, which only went live 18 months ago.

When NPfIT was around, lots of trusts were in lots of deals. When that ended, most trusts really needed to get out of that contract. So there was a timing thing. And when you’re implementing a new EPR and going back to basics with your patient administration system, that does tend to preoccupy you for a year or so. If you take the NHS as a spectrum, some organizations are well ahead in one respect and not necessarily in others. I wouldn’t say that North Bristol is particularly behind. In terms of the priorities and other initiatives undertaken, it hasn’t chosen this one. It’s very right we catch up in this particular field, but there are so many different components. This organization has had some significant reorganisation to deal with, moving two hospitals into one, having a large PFI building, and all those logistical things had an impact.

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Paper-Lite NHS – How Can We Help?

Posted on March 21, 2017 - Company Blog

In this time of austerity, especially where the NHS are concerned, what can be done to help reduce costs? Aiming for a paper-lite NHS could be a good start.

With an esignature pad on their desk, and Diktamen installed on their PCs or mobiles, doctors will see an increase in their productivity, meaning they can deal with patients without having to constantly stop to type up notes, and without having to deal with printers for prescription slips.

Unsure what esignatures are? Find out here.

Instead, any notes the doctor wishes to make will be made verbally, with Diktamen whisking away their words to a transcription team who will type them up and apply them to the correct patient file; and any letter or prescription that needs to be signed can be dealt with electronically, allowing for faster communication between the doctors and the pharmacists, or the doctors and their patients, since letters and prescriptions can now be emailed to their final destination, instead of having to rely on the postal service, or sending out a member of staff in their car.

Learn more about Diktamen here.

Our esignature solutions could also be installed at the pharmacists, meaning that any prescriptions can now be created, sent, dispensed, and signed by both doctor and patient, all electronically. This completely cuts out printing costs, and increases the speed at which a prescription can be dispensed.

All of our esignature solutions are legally binding, capable of being held up as evidence in court. Click here to learn more about esignatures and their legality .

So not only would a paper-lite NHS make life easier for your doctors, and the pharmacists, but streamlining the care process will also mean your patients are happier and, we hope, healthier.

If you are still unsure if this is the right path for you to take, might I recommend you take a look at one of our other articles –  The Paper-Lite Office ? It goes into a bit more detail about why you should consider reducing your paper usage.

Based on England’s North East coastline and in operation since 1993, Steadlands represent and distribute for some of the industries largest and most respected names in the Electronic Component, Automotive Technology and Information Technology Sectors.

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• restore records management
• Digital Transformation

Author: Stefan Chetty

Job Title: Director of Public Sector Services

Company: Restore Records Management

Published: May 22nd 2023

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Getting your physical solution ‘digital ready’ is the key to the age-old dream of a paperless NHS

The idea of a paperless NHS has been around a long time, but in 2023 there is a growing realisation that paper and digital records can live side by side to deliver optimal efficiencies in patient care.

If that sounds like a disappointing ‘big reveal’ for those who dreamt of an entirely digital service by 2020, then it shouldn’t do – because it’s a solution routed in reality and one which sets us on a smoother path to a digital future.

Nobody is saying that ‘paper is best’ but physical storage can still be part of a digital solution and in reality, there is no ‘one size fits all’ solution for going digital.

That’s because there are significant differences between NHS Trusts in where they stand on the paperless journey.

There are excellent examples of Trusts which have gone digital and are reaping the benefits of doing so. If it is done properly, going digital is the correct thing to do and delivers long-term efficiencies.

But for others, especially those which still have a large paper inventory, optimising their physical records to get them ‘digital ready, is a more cost-effective and realistic way forward.

What’s the dream looking like now?

Our estimate is that reliance on paper in the NHS has gone from 70% to 40% in recent years, but it certainly hasn’t gone away.

The focus has been on ‘going digital’ but that can mean different things to different people – and the same solution does not necessarily work for all Trusts.

For most Trusts it would not be cost effective to scan all their records, not least because many of those records are rarely required and do not need to be scanned. Most Trusts have at least a million records – and the larger ones considerably more, so there is a cost implication, too.

What’s important is that any hybrid solution is properly thought through.

Even for Trusts that want to go fully digital, they also need to be able to create electronic records from the start. A step-change needs to take place in which clinical staff move away from paper records. A hybrid system can be that steppingstone.

Because if there is one rule of going digital it is to understand what you have before deciding what should be scanned.

What about early adopters?

Trusts who were ahead of the game and who jumped on the digital bandwagon were lauded, deservedly so. But technology has moved on significantly since then – and what looked like a perfect solution in 2013 can now, already, seem out of date.

Some of those who in the past wanted to be exemplars of going digital didn’t think about data capture carefully. They scanned records to view on a PDF on a screen without maximising the value from this process.

The reality is it can be even more clunky than having a paper folder.

You have a 200-page PDF to search through on screen, which isn’t easy – and as a result, many clinicians still prefer a paper folder. So, despite previous digitisation projects taking place, in many cases physical documents have not gone away.

A scan on demand service for the most-requested files is better and cheaper – because many legacy records stored are never or rarely needed

Paperless Dream Timeline

2013: The Health Secretary challenges the NHS to go paperless by 2018

2016: The NHS sets itself a target to be a paperless service by 2020 and commits £1.8bn towards achieving that target

2017 : A report from Digital Health Intelligence suggested there was little chance of achieving that target before 2027

2019: Just one in 10 Trusts are fully digitised

2022: The government launches its Plan for Digital Health & Social Care. It sets a target of 75% of adults registered with the NHS app by 2024

2023 : NHS Digital and NHS England merge.

How reliant is the NHS on physical records? We estimate there are over 100 million records still stored by NHS Trusts across the country, many of them housed in medical libraries sat right in the centre of hospitals – in prime clinical space that could be better used for direct patient care.

So, why do medical libraries still exist?

It’s a good question, because many people hoped that digitisation would have transformed the way the NHS stores and accesses patient records by now. But change has been slower than hoped due to a myriad of factors -  from the cost of going digital to overcoming a deep-set reliance on paper.

Many Trusts still manage libraries themselves, often with high costs attached and limited tacking systems. It’s not unusual for documents to be misfiled.

With a heavy focus, quite rightly, on saving lives and treating patients, it’s understandable that the medical library can sometimes be overlooked when it comes to strategic thinking. But it’s time to put that right. Outsourcing and updating physical storage is the answer for Trusts that need to consider how physical records are dealt with as part of their digital strategy.

How can NHS Trust find an effective hybrid solution?

The first step is for NHS Trusts to look at their patient records inventory and consider how best it can be optimised, putting aside a narrative that an entirely digital solution is the only way there.

Many Trusts have made giant strides in the digital field and seen improvements in patient care as a result. But the historic pressure to scan everything and remove paper altogether is flawed and has lacked a cohesive vision.

The cost of scanning, and the sheer volume of physical patient records, mean it would be prohibitively expensive to take that route for many Trusts, especially in the current climate, and that’s without taking into consideration the cultural changes required to make it happen.

Cultural change will come organically over time, doctors, nurses and clinicians already live in a digital world and are increasingly comfortable with it. But money in the NHS will be a perennial issue – and nobody can deny that.

Some of the benefits of outsourcing storage of physical records include:

• Space taken up by the medical library is freed up, now available for patient care.
• Legacy records which are rarely required can be kept in physical format and given a secure destruction date.
• Fast retrieval process can be put in place so that records can be delivered on demand.
• Clinic prep is made more efficient, with a clear user guide developed to standardise the process and standardise each patient record. This can make future digitisation more cost-effective.
• Patient records are bar-coded and logged – so you always know where they are.
• Significant cost savings can be made simply by outsourcing physical records prior to going digital – as well as helping the change management process.
• The thickness of files can be monitored so that they are always manageable (with only up to date records delivered).
• Scan on demand solution can be implemented (if required) once the Trust has an Electronic Patient Record system in place.
• Additional targeted scanning can take place for record sets that have high activity.
• Newly created paperwork (day-forward) can be scanned until this transitioned to being born digital.

What a hybrid system looks like in real life

The best way to explain how a hybrid system works is to look at one in action.

On-demand scanning can deliver the same end user experience as scanning everything.

It is also possible to destroy paper records in line with retention policies, or once they have been scanned, reducing inventories.

Restore Records Management worked with County Durham & Darlington NHS Foundation Trust (CDDFT) recently to digitise the Trust’s records.

CDDFT had a ‘paperlite’ vision rather than ‘paperless’ and we were able to provide advice on how that should look and exactly how many of the Trust’s records should be scanned, and how many left in physical form (until the expiry of their retention period).

Find out how we delivered that solution, here:

Cost-effective digitisation and a ‘paperlite’ vision at County Durham & Darlington NHS Foundation Trust

County Durham and Darlington NHS Foundation Trust (CDDFT) is one of the largest integrated care providers in England, serving a population of more than 600,000 people and offering further community services to more than 1.2 million people.

Restore has been providing records management services to CDDFT since 2013 and took on a new contract to manage the digitisation of the Trust’s records.

Top of the wish list was cost savings, standardisation of the record archive and to achieve paperlite operations throughout the Trust.

What were the challenges?

• Patient files were stored in different filing systems across five locations, all at full capacity. With over 890,000 paper-based records stored in all, a centralised digital system was required to enable clinicians to rapidly retrieve and transfer medical files at the point of care.
• All staff within the Trust required continued access to all necessary documents and resources during the project, with an average 2,000 file retrievals per day. Needless to say, safeguarding patient data and maintaining quality of care was crucial.

To empower a more cost-effective solution, a two-stage process was put in place:

Stage One – Physical Storage

Restore engaged with the Trust’s existing records management employees, acting in a consultant position to support in:

• Developing a full understanding of the archive, allowing for identification of records essential for digitisation.
• Implementation of records management system, O’Neil, including correct application of barcoding technology across the archive to allow for accurate, live tracking of all records
• Consolidating the archive where possible, minimising the overall required storage space
• Uplift of records, where required, to either Restore’s off-site or alternative Trust premises
• Implementing industry best standard for record storage to increase the longevity of paper records

Stage Two – Digitisation

Our specialists worked alongside the Trust to ensure a fully electronic Clinical Document Management System was developed.  This ensured all records were searchable.

A database was then developed to ensure records would be digitally accessible whenever needed across the Trust. All systems and process were BS10008 accredited – Best practice for the implementation and operation of electronic information. This approach was developed to minimise overall costs while maintaining efficacy, and included:

• Scan-on-demand – physical records which were requested following a certain date were sent for scanning, ensuring they were available digitally
• Day-forward scanning – records were immediately scanned upon creation from the contract go-live date, supporting immediate access to new records across the Trust

The Results

• 43,500 boxes of the Trust’s physical records, across 45 departments, are now stored offsite at a Restore facility. These patient records are predominantly legacy notes, stored and then destroyed in line with the retention policy. Boxes are consolidated to optimise space usage. This element of the project took nine months to complete
• Digitisation commenced at a rate of 2,000 files per day, and within 12 months we scanned 366,000 patient files.
• Record retrieval volumes have reduced significantly since the on-demand scanning went live - and are now at approximately 42 files per day. Saving money in the process.
• As a result of the project, CDDFT gained a centralised electronic system which has given medical staff quicker access and transferability of patient information - improving the speed of decision-making. The coordination of care and support between health providers has improved, providing the patient with a better experience.
• Staff costs were reduced with savings reinvested into patient care. Real estate was repurposed for more productive frontline patient care services, and data security improved with fully auditable databases that comply with data governance.
• Labour costs have been reduced for CDDFT, together with savings on internal transportation costs. The Trusts receives monthly Management Information reports and service metrics giving them a full audit of their patient’s records.

“Restore has saved us money and vital space for clinical care. We now have quicker access to patient information providing the patient with a better experience” Mark Herkes, Head of Health Records, County Durham & Darlington NHS Foundation Trust Conclusion

The paperless dream has been around a long time, and until every NHS Trust has gone fully digital it’s a topic that will always make headlines.

But it isn’t the most important measurement of how well an NHS Trust optimises or looks after its patient records.

Ultimately, what is most important is how a Trust can best manage those records cost effectively – and in a way that helps to improve patient care.

The solution is unlikely to be the same for everyone because each Trust has a different range of challenges and different heritage systems to consider.

A hybrid solution, which retains some level of physical storage but creates a steppingstone to digital through scanning, fast retrieval and integrated clinic prep systems, can be the way forward. For Trusts that currently rely on a large paper inventory, a hybrid model is a strong solution which can help them get ‘digital ready’ for the future.

Find out more:  www.restore.co.uk/records

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40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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