back to article Round-filed 'paperless' projects: Barriers remain to Blighty's Digital NHS

It was hard to hear UK health secretary Jeremy Hunt’s recent backtracking over his plans for a paperless NHS by 2018, without wondering to what extent digital health documents have contributed to global forest depletion over the last decades. To some extent all tech programmes in the NHS are still overshadowed by the …

  1. monty75

    Don't forget the wonders of electronic prescriptions which are digitally transmitted to your pharmacy where they are printed out. God knows how many millions of pounds spent on essentially just lengthening the cable on the doctor's printer. Plus the added bonus that, if your pharmacy is out of stock or has already closed by the time you get there, you can't take your prescription somewhere else to be dispensed.

    1. Lars Silver badge
      Happy

      "you can't take your prescription somewhere else to be dispensed.". When, years ago, pharmacies agreed on a common data base for prescriptions that problem disappeared. Not rocket science really.

      1. Commswonk

        When, years ago, pharmacies agreed on a common data base for prescriptions that problem disappeared.

        I am genuinely unclear about what you are saying here. If an individual prescription is emailed to a specific pharmacy then the problem as originally stated exists. Are you saying that emailed prescriptions go to a "central point" from where they can be accessed by any pharmacy; the result is a large bank of prescriptions sitting somewhere at a common location from which they can be hacked. On the rare occasion I need a prescription I get a piece of paper in my grubby paw, which at least provides some degree of "privacy"; if my interpretation of your post is correct then people are risking the sacrifice of their privacy and I wonder how this sits with the DPA; do users of this service know what they are agreeing to?

        1. Lars Silver badge
          Happy

          "Are you saying that emailed prescriptions go to a "central point" from where they can be accessed by any pharmacy; ".

          Yes exactly, although I cannot understand why you think one would use emails to make an entry into a data base.

          It's a scary world, I use a bank, actually two, I drive a car and electricity enters my house.

          PS. how wide is your geographical assumption of "any pharmacy",

          PPS. "sitting somewhere at a common location from which they can be hacked". Are you serious!!.

          1. Anonymous Coward
            Anonymous Coward

            Mrs AC had a prescription just before Easter that needed filling - local chemist out of stock. She rang me at work (20+ miles away) to see what could be done. I went to local one here, found out that they had "most of that in stock", and since it was an electronic prescription, I had to ring them and say the magic words (IIRC) "release it to the spine" - they would give me a long code number, I could take it to the other chemist and they would fill it.

            Except when I did that, they turned round and told me that they didn't have that particular strength of tablets, so come back Saturday........

        2. Anonymous Coward
          Anonymous Coward

          err ... you are wrong

          Electronic Prescripitons can only currently be issued for regular repeat prescriptions excluding controlled drugs (methadone etc).

          Your GP uploads them to the NHS Spine where they are stored encrypted - they aren't "emailed to the pharmacy"

          GPs and Pharmacies have smart cards that enable them to access the Spine

          You as a customer/patient can nominate any pharmacy you whenever you like .. ie every time you request a prescription you can nominate a different pharmacy if you want.

          GPs prescribe compounds unless the drug is still on patent and branded - all pharmacies provide the same stuff and can get drugs to fill prescriptions same day if they don't hold the medicines in stock

          The conversion to electronic prescriptions has been done in phases. GPs and Pharmacies are now gearing up for phase 4 which will cover acute (one off prescriptions) and controlled drugs. Your GP will give you a token (a glorified bar code) which you can take to any pharmacy for them to download it from the Spine.

          All end users - patients - have to give informed consent and their has to be a "clearly" auditable trail. Patients can nominate a pharmacy to receive prescritpions via their GP or their pharmacy.

          All pharmacies provide the same stuff. There is no difference between the drugs at one and another.

          Prescription data has been sold to IMS and other organisations by pharmacies' systems vendors for years and years who provide a discount to pharmacies if allowed to do so.

    2. Boris the Cockroach Silver badge
      Unhappy

      Having watched

      the wonders of e.mailed prescriptions (actually held on a central spine of some sort).........

      I'm happy to stick with the green bits of paper thank you.

      "But the doctor mailed it yesterday"

      "No sign of it here"

      Cue another 10 min wait until the patient admits she spells Smith s-m-y-t-h and then the guy finds it in 2 seconds flat....

      And all the time I can see my package of heart pills and opium sitting on the shelf within 4 feet of me.....

      1. Lars Silver badge
        Happy

        Re: Having watched

        "I'm happy to stick with the green bits of paper thank you.".

        If I a want a paper one then I ask for one, no problem, thank you. But I (old man) must admit I am a bit pissed off with doctors who politely asked me if I have heard about this new exciting e-prescription system.

        "But the doctor mailed it yesterday"

        I am writing about the Internet, like with bank transactions, not mail pidgins.

        Which reminds me of a true, or not so true, story about people who tried to outrun the computer system, when the first ATMs came, by running to the next ATM in the hope they could get the same money twice.

        And there are two more advantages with the e-prescription. First should the sum of my pills exceed 640E from the start of the year then I will pay only 1.5E for my prescription at the pharmacy for the rest of the year, and that is automatic, while if I use paper stuff I have to work it out and send it in to the "NHS" my self.

        The second advantage is that if I, at the pharmacy, find out that my prescription is used up, then I can ask them to phone my doctor to extend my prescription right there and then. And in case they cannot get in tough with him they send a message to my phone when it's OK and I don't use time and energy getting that new "paper" prescription.

        I know systems are different in different countries, I did study Computer Science in England many years ago (and liked it) but I also know that the words "world leading" at times doesn't quite mean what some of you Brits think it means.

        1. Anonymous Coward
          Anonymous Coward

          Re: Having watched

          "Which reminds me of a true, or not so true, story about people who tried to outrun the computer system, when the first ATMs came, by running to the next ATM in the hope they could get the same money twice."

          There was an element of truth in that in the early days, because your balance wasn't updated on the central systems during evenings and weekends.

          That was probably the reason why UK banks had a weekly ATM withdrawal limit, which was set too low for me at least. It was frustrating to see a balance that would easily cover what you wanted but not be able to get at it.

    3. Tony S

      "Plus the added bonus that, if your pharmacy is out of stock or has already closed by the time you get there, you can't take your prescription somewhere else to be dispensed"

      Not sure about your location, but out in the sticks, the pharmacy has the ability to order and receive pretty much most medication the same day, if order placed by 2.00pm.

      It also has to be said that *if* they were using the database correctly, they could make a much better job of predicting the types and quantities of medication required (yes, I know that's big if, but one can always live in hope.)

      What does worry me, is that it's clear this is being done to allow the database to be marketed to the pharmaceutical companies, so that the government can earn money from it. The problem then is that we may start to see more aggressive action by those businesses to change what drugs are being prescribed or supplied.

  2. Commswonk

    Oink!

    Perhaps if the government took less of a "technology for the sake of it" approach to NHS digitisation policy, we might stand a chance of improving services.

    Why isn't there a flying pig icon?

    1. Anonymous Coward
      Anonymous Coward

      Re: Oink!

      Why isn't there a flying pig icon?

      The refresh of Reg icons has been promised for years and years. Despite active and enthusiastic (free) consultancy from the Commentariat, nothing has been delivered. I assume billions have been spent, in order to show that the capitalist vulture is as profligate and incompetent as the public sector.

  3. Anonymous Coward
    Anonymous Coward

    2018? Are you having a larf?

    Having experienced the NHS at first hand quite a lot recently (not me) I know that paper rules.

    I even saw one Doctor transcribing the paper notes into the computer system yesterday morning.

    Everything is on the computer but I still see my 3in thick file when I see my consultant for my annual checkup after I contracted Leukaemia. In this case he transcribes the blood test results to the paper file.

    There is no way that paper will be ousted in the NHS this side of Armageddon.

    1. shifty_powers

      Re: 2018? Are you having a larf?

      As someone who spent 10 years working and studying in the NHS I would say it very much depends on the trust. I have seen both ends of the scale; from still working with purely paper based notes to a nearly fully computerised system from end to end.

      This is part of the problem though. The NHS is not one contiguous body. It is in effect a network of networks, only made worse by the constant meddling with structure; not least the last move from PCT's to CCG's. Every trust is just a little bit different and may have a different system. And there is no central person with the ability or authority to mandate a solution that is consistent across the system.

      Frankly if they had any sense they would leave solutions alone. They would work out open standards for data structure/api's and so on. Have a legal requirement that all trusts use them but leave it up to them to get a solution that uses those standards. You'll NEVER have a central, consistent IT system in the NHS. But you might just be able to achieve some form of sensible data portability. This in and of itself would make life significantly better.

      1. Steve 114
        FAIL

        Re: 2018? Are you having a larf?

        That was the plan, at least 20 years ago - I was there trying to help, without any axe to grind. Whatever one faction tried, another faction nixed. And so it continues.

      2. Anonymous Coward
        Anonymous Coward

        Re: 2018? Are you having a larf?

        My examples were from TWO different trusts.

        At least in the former, the Hospital can access the GP's records. That saves an awful lot of time always assumig that the GP keeps the records uptodate which was not the case. i.e. The GP prescribing record online was actually different to what medicines we had in our posession. That is not good.

        The reams of paper used in the NHS is frankly astronomical. The System used in A&E is horribly inneficient in capturing the data. The UI is a dogs breakfast of inconsistencies. Some fields you could tabe between but not all of them. Watching a Nuse do data entry at 05:00 is a very revealing experience.

        The old VB6 version was a lot faster to use. The Font size is painfully small.

        IMHO it is just not fit for purpose yet they have to keep using it.

    2. AndrueC Silver badge
      Facepalm

      Re: 2018? Are you having a larf?

      I even saw one Doctor transcribing the paper notes into the computer system yesterday morning.

      Well that's completely unnecessary. My employer has been providing digital dictation software to the NHS for several years now. I help write it. It handles the workflow from audio recording through transcription to review and dispatching. Doctors have no need to type or use pen and paper.

      1. Anonymous Coward
        Anonymous Coward

        Re: 2018? Are you having a larf?

        God help us all. Dr. Siri will see you now.

        1. GrapeBunch
          Joke

          Re: 2018? Are you having a larf?

          Has comedic potential, though. Can you imagine Sid James: "No no, mate, Doctor Siri prescribed No Treatment for my lipoma, but you're saying it was Neutron Bombardment for my lymphoma?? I don't have a lymphoma!!" Or something like that.

        2. Fruit and Nutcase Silver badge
          Joke

          Re: 2018? Are you having a larf?

          God help us all. Dr. Siri will see you now.

          I see from our records that you are still using an iPhone 4. That would explain your feeling of inadequacy and general depression. I am reserving a latest top of the range iPhone for you, please go to your local Apple Store and purchase it. You will start feeling better almost immediately.

  4. davenewman

    Proven cost savings in mobile phone use

    At a Digital Health Oxford meeting, I heard from the head of one of the health trusts how they had doubled the number of community nurse visits in a day.

    They used to have to drive back to Abingdon to get the paperwork for their next health visit. Now it all comes to their iPads, so they can carry on from one visit straight on to the next. While hospitals stick to paper, these community mental health nurses do everything via an iPad.

    1. Anonymous Coward
      Anonymous Coward

      Re: Proven cost savings in mobile phone use

      They used to have to drive back to Abingdon to get the paperwork for their next health visit.

      In which case they'd fucked up their process, I suspect (since my partner has some involvement in this type of thing) under bogus "data protection" or "confidentiality" excuses.

      IT can be a solution, but a better one is to prejudicially exterminate NHS bureaucratic fuckwits.

  5. Anonymous Coward
    Anonymous Coward

    Not just a money issue

    There are real and significant implications associated with mixed paper/technology processes in the NHS. As a result of a transposition error from paper notes to an electronic prescribing system by medical staff my father was given doses of a morphine-based drug several times stronger than intended. He died three days later without regaining consciousness.

    Clearly, manual controls and checks should have been stronger but busy people having to switch input modes has to have been a contributory factor.

    1. Commswonk

      Re: Not just a money issue

      Clearly, manual controls and checks should have been stronger but busy people having to switch input modes has to have been a contributory factor

      Clearly I am sorry about your father's demise, and I accept that "switching input modes" is a point at which errors can creep in. At the same time it is all too easy to make a mistake on a keyboard entry which if not checked before "submitting" could easily lead to a similar outcome.

      I make spelling mistakes when contributing to this forum, but I try (usually successfully) to catch them at the preview stage. OK; a typo here is of little consequence as long as the meaning remains clear. Other posters (for whom I accept that English may not be their first language) may make spelling errors which they either do not spot or do not bother to look for.

      Simply using a keyboard rather than pen and paper does not eliminate mistakes, although I agree than an additional stage - converting pen and paper to keyboard - brings with it another chance to make a mistake.

  6. Anonymous Coward
    Anonymous Coward

    Somebody ...

    ... may have put the cat amongst the pigeons at the large consultancy firm for which I work for preparing a slide deck with an infographic based on a big ship. A container ship so big it wouldn't fit down the Panama canal. Which would have held about, at the time we saw the graphic, perhaps 1/4 of the UK's NHS paperwork.

    The Trusts who spend millions of pounds on shelving know fine how much paper there is. But oh, no, nobody could say to our management that it was the biggest digitizing project ever, dwarfing Google books, and "we'll outsource it" just didn't really cut it.

    At one point this chap actually had to tell someone that no, you could not store hundreds of tonnes of paper on the "now available" second floor of a standard office building --- 10kN/m^2 would probably not even be acceptable for the ground floor. He wasn't a civil engineer, and nor am I, so I'm not sure. But I'm inclined to think he'd given the matter rather more thought than the management.

    1. Andre Carneiro

      Re: Somebody ...

      The worst thing is that I very much suspect at least half of that information is just mindless duplication of the same data.

      Nurse does obs, writes them down. Doctor comes to review patient, writes same obs down (to prove he's seen them). Physio comes to see patient, writes same obs down AGAIN (for the same reason). This is just an example: the time I spend duplicating information that is already documented is utter infuriating!

      (Just one of my MANY bug bears with IT in the NHS at present)

  7. sad_loser
    Thumb Down

    there is a bigger problem

    The medical heirarchy are wedded to a 1970s vision that all data must fit insided a RDMS model.

    The dinosaurs have not yet worked out that while some structured data needs to be collected, the advances in indexing an mapping unstructured data in the last 15 years mean that they are using ancient technology to sove a problem that now does not exist.

  8. cantankerous swineherd

    the NHS could reap huge gains in productivity IF THEY JUST STOPPED FUCKING ABOUT WITH COMPUTERS.

    1. Halfmad

      Due to the number of legacy systems still in place with no retirement plans I'd say the opposite is true, they should be doing more but focusing it better.

  9. Anonymous Coward
    Anonymous Coward

    News to me.

    We've entire sections of our hospital which don't use paper at all anymore. They still have printers but the only paper you'll see in the ward is that which is being sent off to be scanned into the electronic patient record and which came from another health board or trust area.

    It can work but needs to be a locally tailored solution and we're not aiming for paperless hospitals - simply reducing the amount we need to store, which is currently an insane amount (around 7.5 million sheets of A4 are printed each MONTH) and most of that has to be stored.

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