Jeremy Hunt has decreed the NHS should go paperless by 2018, in order to ‘save billions, improve services and help meet the challenges of an ageing population’.
There is more. By March 2015 – that’s 25 months away – everyone in England who wants to is to be able to access their medical records online. The benefits were not described to the Department of Health through a peer-reviewed academic study but via a report from PricewaterhouseCoopers (‘a review of the potential benefits from the better use of information and technology in health and social care’). This was completed in around three weeks using NHS statistics, plus reports from ‘think tanks, charities and businesses’, providers and commissioners, and ‘interviews with selected PwC staff’. The potential savings are supposedly in the order of £4.4bn per annum.
I don’t see any academic systematic review in there. It is written in the language of commissioning, and contains an awful lot of guesstimates and extrapolation.
It is right that patients should be able to see their medical records. It is clear that useful access to medical records can be helpful to people with chronic disease – for example, Renal PatientView. What is less clear is that this is a pressing concern for most people, and whether it should be given higher priority than, say, reducing the waiting time for CBT to something less than farcical. Is it the best use of money? Is it what people would benefit from most?
As for the concurrent idea that consultations by email and Skype are inevitable, there are two problems. One is that many millions of patients do not have access to the internet; is prioritising one group going to increase health inequalities? And secondly, I am not sure what advantage either has over the telephone.
I suppose using email for quick queries that are not urgent might be more efficient, but there are other risks – for example, the missed opportunity for those ‘doorhandle moments’ that are often so critical in face-to-face consultations.
Improving the quality of care does not need an investment in technology, but in time. There is, I think, a need for better communication about prescribing between primary and secondary care. We have already spent millions on technology, and it should not be beyond us to allow patients to consent to having their current medication viewed in secondary care on primary care records.
The PwC report is something quite different. The headline that the DH used to promote it was ‘New study highlights positive impact of digital technology in health and social care’. But the NHS is already using many of the recommendations – such as text messaging for appointment reminders and negative test results – and paying for a report to tell us so is inefficient.
A cool look at the evidence with details on harm and cost-effectiveness would have been of greater use in informing DH policy than this love letter to technology.
Dr Margaret McCartney is a GP in Glasgow
