The majority of patient records in Wales remain predominantly paper-based, with mention of “hybrid but fragmented” systems across health boards, and almost a quarter of respondents noting continued use of “paper packs” at their organisation, findings highlighted.

Respondents went on to raise concerns about the potential for missed or inaccessible information, particularly highlighting staff time spent on admin, challenging transitions between services, the need to repeat patient histories, and delays in treatment.

A quarter of respondents considered their systems to be mostly electronic already, while more than half shared that their organisation is actively preparing to move away from paper records. Only 11.1 percent labelled their organisation as “not ready” to make this transition.

Access to those records is also an issue, with two thirds still having to rely on paper packs, PDFs and scanned documents, or multiple digital systems. Respondents considered risks associated with information being either missing or otherwise inaccessible, challenges in making transitions across services, and the ongoing need to repeat patient histories. Around ten percent shared worries about consequent delays to patient treatment.

Among survey respondents, the overarching sentiment around the current status of patient records in Wales is uncertainty, with the majority stating they are “not confident” about the ability of paper records to support safe joined-up care at present. The impact of this is seen in the amount of time said to be lost by clinicians to paper processes, with around a third of those who responded estimating that to be in excess of ten hours per week.

The biggest risk associated with the continued reliance on paper records in Wales is likely to be the inability to modernise services, according to more than half of respondents, with a third also pointing to concerns for patient safety. “Presently, the duplication, fear of not recording in the correct way, and rollout of new electronic systems, contribute to wasted precious staff hours. Wireless infrastructure remains poor preventing swift ability to document efficiently and therefore I would like to see meaningful financial Welsh Government funding to aid our workforce in digital transformation, making the workload easier,” suggested one respondent from Aneurin Bevan University Health Board.

Barriers to making the transition to electronic records 

Over half of those who responded considered the biggest single barrier to making the transition from paper to electronic records to be the complexity of services. Almost the same number felt national standards were needed to make EPR adoption a success, while a third highlighted the need for sustainable funding in order to advance.

Notably, respondents felt there was more to do in terms of public engagement and understanding, with over two-thirds suggesting this is currently limited. “There is an expectancy for the workforce to engage and understand electronic transition, which many staff find hard to manage (especially with a multi generational workforce),” suggested one respondent from Aneurin Bevan.

Looking ahead, suggestions covered the need for clear government strategy on funding and the approach to electronic records; the need to prioritise integrated clinical notes that can be integrated with local authority systems; and the need for health boards to “own the change”. A respondent from Welsh Ambulance Services University NHS Trust said: “There needs to be true digitalisation, not just digitisation. Sharing of patient records between healthcare providers to ensure true informational continuity of care. Every digital project moving from paper to electronic, or phone to electronic, should have an independent digital health check, possibly led or facilitated by DHCW, with follow up evaluation.”

A clear and fully funded government strategy for NHS Wales with regard to the approach to electronic records is needed, according to a respondent from Aneurin Bevan. “Welsh Government need to prioritise integrated clinical notes which integrate with local authority systems – the clinical parts must be co-designed with front line clinicians, not what IT or managers think we need, and focused on the needs of patients,” said another from Betsi Cadwaladr.

“Primary care will be the starting point, especially death records,” a respondent from NHS Wales Shared Services Partnership suggested. Another, from DHCW, pointed to the need to focus on patient safety and usability, rather than cost and timescales; and the requirement for an electronic system that meets services’ needs was emphasised by a respondent from Cardiff and Vale. Ultimately, the change should be owned by health boards and matched by digital investment, came a suggestion from a separate Cardiff and Vale respondent, who added: “Arguably there is sufficient resource in the system, but there is a failure of delivery.”