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Achieving a paperless NHS by 2018

By Rachael HurstAndy Vernon and Mark Horncastle, PA healthcare experts

Is the NHS equipped to meet the Health Secretary's challenge of a paperless NHS by 2018? Lack of IT knowledge on the part of senior NHS leaders could be a real barrier, according to the results of the HSJ's technology survey.1 Just 29% of those surveyed believe the target of a paperless NHS by 2018 is realistic, with most saying they lack the market insight and skills to buy the right IT systems. 

The findings are a stark reminder of the difficulty that NHS trusts face over the next few years. And yet the HSJ survey contains few surprises. Electronic patient records (EPR) and other paperless technologies may be available now, but the market is still rapidly developing. Even for top IT professionals, such a market would make it incredibly difficult to reach the right decision.

The good news is that healthcare is not the first sector to try to become paperless. The NHS can draw on industry’s experience of package-based solutions to avoid some common pitfalls. In particular, the NHS can learn from organisations’ experience of enterprise resource planning (ERP) over the last 15-20 years.

In our view, this experience boils down to four key lessons.

The right ERP solution is about the supplier as much as the product 

Over the years, many ERP suppliers have come and gone. Some failures, such as the fall of ERP supplier Baan Corporation in 2003, have left companies with unsupported technologies at the heart of their business. From this, NHS leaders should remember that long-term vendor viability is critical. They should look beyond just getting the right product set. This will require a nuanced appraisal of options as today’s best ERP options may not be the right ones longer term.

Standardised processes will become the norm for ERP

Over the years, processes have changed to support products. Many of the earlier ERP failures came about when businesses tried to bend products to fit their business practice. The more successful implementations used the standard templates (now increasingly mature) that product vendors have developed.

As many EPR providers come from the US market, the NHS will need to be open to accepting change. This may extend to accepting that processes developed in other geographies will benefit NHS trusts where products do not directly fit in with business processes. As a yardstick of this trend, Cambridge University Hospitals – the first UK adopter of an Epic-based ERP solution – will be one to watch. In addition, NHS England’s agenda to build open source solutions based on NHS Vista, which itself has a US heritage, has led to several NHS trusts taking them up on the offer. 

You need to choose implementation partners wisely

Qualified implementation partners, who are able to fill the skills gaps quickly and who are 'kite-marked' by product vendors have been a key growth area in the last two decades. There will be a growing cadre of integrators who will implement solutions on behalf of electronic patient records platform providers, and increase segregation between platform developers and providers. The enterprise resource planning market is mature in this respect; the electronic patient records and wider product-enabled change market in the UK healthcare market less so.

Until a cadre of qualified integrators can take the load of the implementations required to deliver a paperless NHS, implementations will continue to be costly (using resources from the product vendors). They will also represent higher risk as a result of the skills gaps in the market. Getting the right team will be crucial, so NHS leaders will need training to critically appraise whether they are getting the “A team” or the “Z team” for their paperless implementation.

Planning not one but two steps ahead

Product vendors have extended their offerings into areas that are outside their core competence, usually through acquisition. As a result, customers have had to become more sophisticated in putting together the right overall solutions.

For the NHS, the scope of many available new products will grow into areas of business outside the NHS's traditional core. For example, we expect that products from healthcare will extend into social care settings. We are already seeing that trend with major suppliers like TPP. This has already happened in the ERP market and the results have been mixed with suppliers moving into areas such as CRM and business intelligence.

Achieving a paperless NHS means learning from the past. The HSJ survey paints a bleaker picture than we would all like but, with the right focus and attitude, a paperless NHS remains eminently achievable.

To find out how PA is helping health organisations innovate and adopt new technologies, please contact us now. 

1. HSJ, ‘Board level culture undermines paperless ambition’, 8 January 2014, available at:

Catharine Berwick
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Chris Steel
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