All divisions of the NHS must have electronic patient records (EPRs) by 2020 or risk losing their licence – that was the message that came from the NHS’s 2020 framework, released on 13 November.
The Personalised Health and Care 2020 framework is proving it is serious about the paperless aspirations of health secretary Jeremy Hunt and turning those ideals into requirements.

Speaking to Computer Weekly, Tim Kelsey, national director for patients and information at the NHS, said the framework was finally drawing a line in the sand to stop the situation where the NHS is largely running on paper-based systems and using fax machines.
“We know that non-digital record keeping contributes to harming patients in the worst situations, but also it causes an inconvenient and disrespectful environment where people find they have to repeat endlessly their identification when they come to different departments in the hospital,” says Kelsey (pictured).
The 2020 framework sets NHS providers a deadline – 2018 for urgent and primary care, 2020 for the wider NHS – to have full digital record keeping in place, otherwise their licence to operate as an NHS provider will be in jeopardy.
“We are saying there is a hard stop, and if you don’t meet that standard then it’s unlikely you’ll be receiving NHS patients,” says Kelsey. “By 2020 we can look forward to a truly interoperable health and care service which will be capable of doing much more integrated and personalised things for patients.”
It was nearly two years ago when Jeremy Hunt stated his intentions for the NHS to go paperless by 2018 and, more recently, promising all NHS England patients would have online access to their medical records by April 2015.
He pointed out that it was “crazy” that paramedics could not access a full medical history of someone they were treating in an emergency.

Managing your digital healthcare
But an electronic patient record will also have benefits for patients in helping them manage their own healthcare. More people than ever in the UK have a long-term health condition, the treatment of which consumes the majority of NHS budgets. With an ageing population, this will only increase, putting greater pressure on healthcare services.
By 2018, Kelsey says the NHS wants to give people the opportunity to add comments to their own records, which will give them a sense of ownership of those electronic documents.
“Patients have a perfectly legitimate interest in writing comments and preferences in their own records, so that’s a really important step forward in developing a different kind of conversation between the doctor and the patient,” he says. “That’s absolutely fundamental to give people the ability to have control over their own healthcare.”
While a digital and paperless NHS will no doubt see cost savings from digital records in the long run, NHS providers and trusts will need to invest significantly in technology over the next four to six years to support it. But Kelsey says a modern digital health service is not just up to the IT department any more.
“There’s no doubt that there are incentives and consequences,” he says. “But we no longer think of this as the responsibility of the IT department; this has to be a fundamental pre-condition of a modern health service, to be built into the regulatory and commission environment.
“We recognise that hospitals and any other care providers are going to have to spend money on achieving these standards and we need to look how we can support them best,” he adds.
In April, NHS England provided an extra £230m of funding to help improve the IT systems used by GP practices, but Kelsey says the NHS Five Year Forward View made it clear that technology transformation will require further short-term investment in services.
“That’s a question for the next government, but we will be making the case for further investment to get the NHS from where it is now to where it needs to be – from the kind of paper-based health service we’ve got to the paperless future,” he says.
Learning from Care.data 
But the NHS hasn’t had the best year when it comes to patient records.
The NHS caused a furore earlier this year over its Care.data plan to extend the collection of patient care data from hospitals to include general practice. The controversy surrounding the plans to expand patient care data collection came to a head in February 2014, when the NHS’s failure to explain the benefits to the public forced it to put plans on hold for six months.
The scheme recently entered a testing phase with four clinical commissioning groups to develop the programme by testing communication strategies, though none of the groups are extracting patient data yet.

In response to the question of how the NHS plans to mitigate the mistrust and drive forward digital plans, Kelsey says the bad press around Care.data gave the organisation a chance to improve and become more transparent.
“Care.data was a moment in time which we needed to take very seriously. A lot of people understood how their data could help themselves and others when it was shared, but they weren’t satisfied there was enough clarity or safeguards for the data sharing and who exactly would be able to access it,” he explains.
“To be honest, it revealed an approach that’s been [common] across the health service for many years and hasn’t been challenged,” Kelsey adds.
He says Care.data has now been redesigned, with input from many of its critics and local communities, to develop a very different approach that balances the benefits of data sharing with mitigating the risks of doing so in a digital age.
“I think we’ve learnt an enormous amount about that and we’re now testing the redesign programme in a number of practices,” he says, adding that someone reading the new 2020 framework will see a very different approach in how the NHS details its implementation plan.
“I don’t regard Care.data as a failed thing – what I see is something we’ve really learnt from in the spirt of open, honest, transparent attempts to improve the quality of patient care in the digital age,” concludes Kelsey.

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