HTN Feature: Paper free at the point of care

As we edge closer and closer to 2020,  a target for the NHS to be paperless that was set in the recent Five Year Forward View, we spoke with industry expects to find out about the challenges, progress and some of the solutions available to help organisations achieve this target.

In a much discussed topic a paperless NHS is vital for our health system to improve and operate efficiently. Patient and critical information is contained in every document, yet each piece of paper that is not digital is invisible to everyone apart from to the holder of the document or the trolley it is in.

With many talking about predictive analytics, making data driven decisions, analytics and intelligence, many Trusts are yet to digitise.

It’s easy to look at other industries for inspiration and their obsession for efficiency, such as McDonald’s who process map every step their employees make to ensure their staff don’t need to take more than two steps away from their station and don’t waste any time. We are in a world where you can shop online and track every step of a parcel being delivered to your door. Yet in the NHS people are employed to move paper around.

We spoke with Orlando Agrippa, CEO, Draper and Dash a company who help organisations with data, analytics and insight to improve productivity and efficiency to help management teams.

“Five years ago, I provided the guardian with my opinion on the then health secretary’s ambition to make the NHS paperless by 2018. Jeremy Hunt was relatively new in post and like most new health ministers, Jeremy had great plans and optimism around the pace of change in the NHS. I must admit that being an admirer of the then health minister and chumping at the bits for change in the NHS, a sector I grew up in, I truly believed that were the NHS to mobilise and focus on becoming paperless we could have genuinely achieved by the set timeframe of 2018.”

“It’s now 2018 and from my many discussions with executives on a weekly basis, the NHS only has a handful of organisations which are paperless. As I reflect on what I thought needed to happen in order to deliver against Jeremy’s ambitions and my own predictions I find myself having an “oh snap movement” the type of moment you get when you forget the one thing you went to Waitrose for and you’re now back home. Or the type of moment you get when you forget your phone charging in an Uber. Well oh snap indeed.”

“In 2013 a vast amount of hospitals were buying new EMR/EPRs, Judith Faulkner’s American leading EMR, EPIC, was new to the UK with many other clinical systems promoting the ability to help the NHS with the paperless challenge. The way this rationalised in my mind was that it would take a year for the procurement to happen, 2 years for the implementation, and another two years to embed systems and presto 5-year plan delivered. I also envisaged that in the interim the NHS would be using some great data management and analytics products to bridge the data gap. This would be vital as so many EMR implementations which fail are as a result of the data which subsequently means the firing of CEOs. Genuinely more CEOs have been fired for botched EMR implementations that have been fired for hospital performance.”

“As I reflect on the thoughts I brooded over back then, I stumble over how entranced I was and still am about the story of third world countries leapfrogging the telephone lines and poles to go straight to smartphones. Resulting in less cost and better access. I also reflect on how far AI, robotics, the blockchain explosion, analytics and digital health has gone over the past five years. We have seen Estonia, the Nordics and so many countries really show us how to be the rock stars of digital revolution.”

“So, what has stopped the NHS from delivering the five-year plan? Well the oh snap movement for me came as I watched my colleagues in the NHS fight to deliver their control totals and CIPs on the financial side. They then struggled for the past five winters with strafing and Emergency Department (ED) flow challenges, they then struggled to deliver cancer wait times and patients waiting for elective care. How could I have completely forgotten that their day job is so intense that without an infusion of new resources and dedicated investments, like those we’re seen with the GDEs and fast followers, as it would be impossible for them to do it in such a timeframe. The NHS would really struggle to prioritise the paperless agenda ahead of keeping the ship ticking over. The irony is that I’ve not met or spoken to one executive who doesn’t want this as they all do. It’s just a matter of balancing priorities and having the extra human and capital fire power to get there.”

“As I conclude on this I would say that over and above the fire power needed, The NHS needs a mindset shift which embraces a technology revolution shaking off the old boring ways of approaching this and embrace a mindset of leapfrogging the next five years. 2023 here we come.”

We spoke with IMMJ Systems a company who provides a document management system to healthcare providers to understand how their system is helping organisations

By removing historic paper patient records from circulation and capturing and ingesting day forward information, both on paper and digitally, MediViewer provides immediate access to a holistic digital health record for the patient. Its browser-based touchscreen enabled interface can be accessed by most mobile devices at the point of care.”

“Noble’s Hospital, Isle of Man has utilised the system to remove 16 million sheets or paper and provide instant access to information for their staff.”

“Ultimately, the drive towards digitisation is to improve patient safety – helping hospitals to work collaboratively, diagnose patients more effectively, reduce medical errors, and provide safer care.  EDMS solutions should aspire to providing clinical decision support rather than being merely used as a repository for scanned patient records.”

We asked IMMJ to share some lessons learned 

Perhaps the most important lesson is to engage with health professionals at the earliest opportunity and throughout the project. This means involving them in requirements gathering, listening to their concerns and understanding that every specialty works differently. We observe how clinicians work and interact with patients, provide 1:1 training and even join them in live clinics to support them through the transition. Another key lesson is understanding that a successful EDMS implementation is dependent upon three organisations working effectively in partnership; the Hospital, EDMS provider and Scanning partner.”

“In our experience, the preferred approach is to adopt a phased deployment for active patients – rolling digitization out on a specialty by specialty basis – using outpatient clinics as the trigger for scanning. From a scanning perspective this means that there will be a gradual increase in the volume of records to be scanned.  However, the challenge for the scanning provider is predicting throughput levels in advance and resourcing accordingly, ensuring they can meet agreed service levels.”

“We can provide projected scanning volumes, weeks in advance, to assist both the scanning supplier and hospital with their resource planning. Our implementation methodology facilitates close working between the three parties, leading to a positive customer experience and cost-effective outcome.”

What’s the most significant benefit of your solution?

“It is unlikely Hospitals will purchase an EDMS without clearly seeing the path to a considerable return on their investment. From project initiation, we engage with stakeholders, senior management and finance to both highlight and measure the potential benefits. Whilst carrying out transformation activities, the IMMJ team identify processes that can be streamlined to help deliver the desired benefits. The team are transparent with their findings and work closely with senior management to help them understand how they can realise true cash-releasing benefits.”

As well as document management there are many other ways to remove paper, we asked Deborah McKee, Head of EPR and Digital Transformation at University Hospitals Birmingham NHS Foundation Trust to understand how they became paperless.

“Here at University Hospitals Birmingham NHS Foundation Trust we are always looking into new technologies and how we can use them to improve patient care.  We have a number of proprietary systems developed in-house by our IT and Informatics colleagues, many of which allow us to run paper-free processes across all care settings including Outpatients and Critical Care.  Information is accessible at the point of need ensuring informed decision making leading to improved patient safety, quality of care and patient/clinician experience.”

One example is the Critical Care Unit at Queen Elizabeth Hospital Birmingham using dedicated digital screens for each bed, as a direct replacement for the previously used large paper charts.  The system is used to record data such as observations and medication. The Trust says the new digital format has already saved hours of staff time each morning across the unit, allowing more time to spend directly with the patient. Approximately 15 minutes of nursing time is saved each day per patient, which across the 80-bedded unit equates to 4.4 full time equivalent nurses.

Another example of digitisation comes from Epsom and St Helier

Pregnant women being cared for by Epsom and St Helier hospitals are now able to access all of their maternity medical notes, including details of any blood test results and reminders about their appointments (and soon, their scan reports), through a secure digital record that is available as an app.

The new digital maternity notes system, which is known as BadgerNet, is available both as a secure online portal and the ‘Maternity Notes’ app, which allow both healthcare professionals and pregnant women to access the necessary clinical information they require from anywhere there is internet  coverage – and all at the touch of a button.

In a recent opinion piece John Craig, Chief Executive of Care City Test Bed, highlighted the successes of ‘combinatorial innovation’ and why collaboration is king when it comes to embedding new technologies and services into whole systems and pathways.

“You cannot admit to many people that you are obsessed with public sector innovation before one tells you, ‘it’s a contradiction in terms’. I am always ready for them. From the eradication of smallpox to the creation of the internet to the moon landings, all the greatest innovations are public sector innovations. But, the truth is, it is not that simple. All the great innovations like these really came from collaborations that crossed every sector of society. To do our best work, humanity has to work together.”

Engaging in real-world testing

“In the discourse about health innovation, there has been a related shift in emphasis this year, from ‘push’ to ‘pull’. From the Nuffield Trust to The King’s Fund to The Health Foundation, researchers have argued that supporting innovation is less about helping innovators to make even smarter, glitzier pitches and a bit more about helping hard-pressed leaders and clinicians to work with them.”

“At the very least, customers need time to engage with complex products, but there is more to it than that. A focus on integrated care – and of course efficiency – means that products and services are judged as much by their fit with wider systems as their stand-alone performance. Innovators’ expertise has to stretch beyond their offering to implications for workforce development, governance and system change. For clinicians, more than ever, adoption is a creative act (and a time-consuming one!). Few innovations worth having will be ‘plug-and-play’. As a result, innovators need to engage in ‘real-world testing’, to ensure they deeply understand adoption and benefits realisation.”


From our interviews it is clear innovation and technology is there and we now need strong leadership and board level involvement to drive the digital agenda. It is clear executives need the head space to influence and deliver change and that collaboration is key.

We plan to explore this further when we launch our Health Tech Annual Survey in the upcoming months where we will question healthcare providers and come back to the HTN Audience with our findings. As ever we aim to share best practise and tech projects.


Sponsored by IMMJ Systems

IMMJ Systems provides complete end to end digital transformation, consultancy and implementation support services by enabling the rapid digitisation of clinical content for use at the point of care. It does this through its MediViewer electronic document management solution built specifically for healthcare providers and delivered by highly experienced ex NHS delivery teams.