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Majority of Trusts Still Using Paper Notes and Drug Charts

Only a quarter of NHS trusts have fully transitioned to electronic patient records (EPR), and most remain reliant on paper patient notes and drug charts, according to a survey. This is despite the NHS having claimed that it is investing nearly £2 billion to encourage trusts to adopt EPRs, with £440m spent last year to help hospitals install or upgrade, according to NHS England.

The survey results, published in The BMJ , raised concerns that paper records, and especially paper prescribing, were less safe and efficient. Reporting on the findings, Dr Jo Best, freelance journalist and doctor, said that "difficulties" with sharing EPR were "preventing even the most advanced trusts from realising their full potential".

For the study, 211 acute, community, and mental health trusts were asked, through either trust press offices or freedom of information requests, whether they used patient notes and drug charts in paper, electronic, or both formats. Two trusts said they were unable to provide the information and 24 failed to respond. 

Only One in Four Trusts Fully Electronic

Of the 182 that did, seven (4%) said that they used only paper notes, 45 (25%) were fully electronic, and the remaining 71% (130 trusts) used both paper notes and an EPR system. This despite 88% of trusts in England now having EPRs, according to NHS figures in May this year, and in the face of targets under the NHS Long Term Plan that stipulated that 90% of trusts should have an EPR system by the end of 2023 and 95% by March 2025. 

Asked to comment by Medscape News UK, an NHS England spokesperson said: "The NHS is investing £1.9 billion to ensure hospitals have the right digital foundations in place and almost nine-tenths (89%) of trusts use EPRs, with the NHS on track to roll them out to 95% of trusts by March 2025 in line with the Government's target."

However according to The BMJ, a report published earlier this year by the Government's Infrastructure and Projects Authority downgraded its assessment of the likelihood of the NHS hitting the deadline for the rollout of EPRs. "Delivery confidence is red [the lowest rating]," it said, as "a number of NHS trusts are reporting they are unlikely to be able to fully implement an EPR by March 2025." It forecast a new end date of 2026 for the project.

Government Has "Failed to Meet Key Targets"

Results were very similar for drug charts. Of the 172 trusts that responded to questions on whether drug prescribing and administration was done on paper, electronically, or both, 46 (27%) said they used only an electronic system, 110 (64%) used a mixture of electronic and paper prescribing, and 16 (9%) used only paper drug charts. 

Again, this is despite a Government claim that, by March 2021, 80% of hospitals had electronic prescribing and medicines administration (EPMA) in place and the NHS was "on track' to eliminate paper prescribing in hospitals.

The results accord with the verdict published by The BMJ in July  of an expert panel convened by the Commons Health and Social Care Committee, which concluded that the UK Government had "failed to meet a key target to eliminate paper prescribing in hospitals and to introduce digital or electronic prescribing across the entire NHS by 2024".

Initially, it was planned to have EPMA in all trusts by 2024; that target has now been pushed back to 2025, The BMJ said. 

Yet Government figures showed that the use of electronic prescribing could cut medication errors by 30% compared with paper prescribing. Staff also prefer it. In a survey of 250 staff by Oxleas NHS Foundation Trust after the implementation of its electronic prescribing and medicines administration (EPMA) system, 93% said that they preferred electronic prescribing over paper. In addition, 96% of respondents reported that the electronic system saved time.

Multiple System Issues Hamper Digital Transition

Key issues hampering digital transition, the report suggested, were frequent changes of Government, a succession of health secretaries with varying approaches, multiple strategies with shifting targets and priorities, outdated IT systems, and EPR systems in different trusts not being interoperable with each other or viewable by other hospitals, GPs, or third sector organisations.

The report quoted Dale Peters, senior research director at technology analysts TechMarketView, saying: "We always talk about the NHS having this unrivalled data set, but actually so much of that data is locked away in proprietary systems and in formats that aren't compatible with the other data.

"Until we have those interoperable systems, we'll never really see the benefit of having that sheer amount of data." 

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