Comment: A paperless NHS - why we can’t stop at electronic records

Tim Hawkins of Elsevier on how the digitisation of clinical reference materials should be a key element of the drive for a paperless NHS

Digitising reference materials is just as important as creating online patient records

There is more to creating a paperless NHS than introducing electronic patient records, says TIM HAWKINS, managing director of clinical solutions at Elsevier. If healthcare providers want to reap the full benefits of a paperless approach, they must also embrace a parallel journey to introduce digitised clinical reference materials and tools, ensuring the two strands are brought together in seamlessly integrated solution, he advises

The call to create a paperless NHS by 2018 aims to deliver improvements in patient safety and the experiences of patients and healthcare professionals, as well as delivering high-quality care and increasing efficiency. The focus, so far, has largely been on digitising patient records, especially with the launch of the £260m Safer Wards, Safer Hospitals Technology Fund, which will provide match funding for NHS providers in England to support the move away from paper-based systems.

Just as moving from paper-based to electronic paper records will free up rooms filled with paper files and eliminate the cost of offsite archives, digitisation of clinical reference materials will help NHS organisations to control the costs associated with providing reference information

Alongside the move to electronic patient records (EPRs), however, there has been a parallel journey taking place spurred on by an increase in demand by clinicians for more clinical evidence-based reference materials in a digital format – whether that is journals, textbooks, images, videos of procedures or other forms of information. Continuing that journey is just as important as continuing to develop EPRs: it will support healthcare professionals to gain the clinical insight needed to make more-informed decisions about patient care while addressing the challenges at an organisational level of delivering high-quality safer care to more people within budgetary constraints.

Dr Google v trusted content

Those benefits are possible because a key feature of digitisation and search technologies is that they provide clinicians with much faster access to accurate, authoritative content. It means eliminating the laborious searching of potentially-irrelevant or unreliable information from, for example Dr Google, and an end to the need to search print copies for specific articles or wait for the return of a print version of a journal or book that is out on loan.

In addition, just as moving from paper-based to electronic paper records will free up rooms filled with paper files and eliminate the cost of offsite archives, digitisation of clinical reference materials will help NHS organisations to control the costs associated with providing reference information. Within the current budgetary constraints surrounding healthcare reducing costs is imperative – for example, the NHS is under pressure to achieve a £20billion cost improvement by 2015 as part of the Nicholson Challenge.

The clinical librarian as an ally

Digitisation will also enable NHS providers to utilise limited storage space and provide the opportunity for librarians to ensure their stretched budgets can go further. In addition, it will enable clinicians to utilise the expertise and time of skilled medical librarians more effectively and rely on them as an information and knowledge manager. For example, with clinical staff increasingly able to self serve, this leaves librarians more time to concentrate on answering the complex queries to ensure the right information resources are in place. In addition, the role of the librarian has already been extended in some organisations, with many now working alongside clinicians training them on systems that will enable them to find the information they require to make the best, evidence-based decisions.

The most-significant benefit of digitisation is the impact on patient care. It will allow staff to access relevant, evidence-based, up-to-date and comprehensive clinical reference materials whenever and wherever they need them, including at the point of care. It also means that healthcare professionals can easily incorporate reviews of clinical references into their daily working lives, whether they are diagnosing and treating patients, maintaining professional development, or working with care plans. In other words, just as the move from paper to electronic patient records will change the way care is delivered, moving to electronic reference material will change when and how clinicians use the clinical insights it provides.

Meeting clinicians' real needs

One of the keys to successful delivery of high-quality care is the clinicians being able to access all the information they need in one place, seamlessly, without needing to launch a separate application. Information needs to be contextually relevant and patient-specific in addition to being fully integrated into clinical information systems. Therefore a hospital's vision for its EPR or clinical portal should include tight integration with clinical reference solutions as well, allowing healthcare professionals to begin topic-specific searches – relevant to the diagnosis or treatment of the particular patient under their review – with a single click from within the patient record. Moving forward there needs to be an integration between clinicians, IT staff and librarians to ensure a seamless system within the clinical environment. For example, by providing librarians with the ability to influence EPR projects could be key to ensuring this core element of the clinicians’ workflows are incorporated into their organisation's digitisation plans.

Moving forwards it is also essential to deploy online clinical reference solutions that meet the real needs of clinicians. For example, a survey of 2,000 clinicians carried out by Elsevier found that healthcare professionals want solutions that provide comprehensive, trusted and fast clinical answers. This means combining resources from the widest possible range of information providers to ensure clinicians are able to find everything they need to make well-informed decisions in one place; drawing on the world's-best clinical content to give clinicians the confidence they are basing decisions about patient care on high-quality, up-to-date, evidence-based content; and utilising specialised search technologies and taxonomies that help clinicians quickly identify the most clinically-relevant material, regardless of specialty.

Saving time, delivering more

The move to a paperless NHS will undoubtedly affect the way healthcare professionals want to access and use clinical reference materials as they find their working practices reshaped by the move to electronic patient records

In the drive to optimise patient safety and high-quality care, clinicians must constantly find answers to clinical questions that enable them to make quicker, more-informed decisions. It is encouraging that hospitals in the UK and around the world are already meeting clinicians’ needs through use of the technology. For example, clinical reference search engines are having a real impact. A survey by Elsevier into the use of its clinical reference solution, ClinicalKey, found it is saving clinicians several hours a month when searching for information and is helping them answer some of the two thirds of clinical questions raised by doctors across the working day which, according to a recent study, currently go unanswered. Hospital librarians add that these solutions let them provide access to a wider range of resources for the same budget. That includes being able to offer resources such as videos of procedures that it would be impossible for them to afford and maintain in a traditional library setting, but which are invaluable as teaching tools for less-experienced doctors and nurses.

The move to a paperless NHS will undoubtedly affect the way healthcare professionals want to access and use clinical reference materials as they find their working practices reshaped by the move to electronic patient records. It will also change the role of the hospital librarians, shifting them from information gatekeepers to information managers. Librarians must embrace these changes, not only within their own departments, but by taking an active role in bringing together the two strands of EPRs and digitised clinical reference materials to give their healthcare providers the best platform on which to deliver better, safer, high-quality care more efficiently.