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The need for an efficient and effective information management system manifests itself across all levels of modern healthcare provision. It encompasses everything from consultants and surgeons accessing x-rays and scans from workstations across a hospital complex, ending the need for cumbersome transfer of paper records from site to another, with the incumbent risk of them being misplaced or lost or misused; to administration staff using systems that help automate selected processes, saving time and money.

Add a dose of security and audit, and suddenly, the prospect of a system that mandates governance and eliminates un-scrutinised misuse, becomes quite real. This has been achieved in some NHS Trusts who took the bold step to deliver change some years ago and are now leading the way forward including lessons learnt. Two key points should be emphasised here:

Firstly, paperless healthcare is not a dream: it is real, has been done in the NHS - more than once - and it does deliver real and measurable benefits. There is plenty of evidence from sites where 'paper-lite', if not paperless, healthcare has been achieved over the last 5 to 6 years - there is a good and positive track record for all to see and learn from. In other words, it is eminently do-able - and doing nothing is an expensive option!

Secondly, the focus should not be on the technology; or at least, technology plays a small but important part in meeting the enormous challenges imposed by transformation to digital healthcare - it is about managing that transformation. Actually, it's all to do with very careful application of the available technology, to solve defined problems and then build on that success to tackle other problems, but at your pace.

The key message is that careful application of established technologies is delivering measurable improvements and benefits. These must be applied to address strategic requirements, rather than as a short-term measure to 'solve paper problems'. The technology is not rocket-science, but has evolved gradually as customer demands, interoperability, and web accessibility have evolved. To ensure a successful transformation to digital healthcare, such lessons must be embraced.

MAKING DIGITAL HEALTHCARE WORK
Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018, having said that going paperless would 'save billions.' In a directive issued in 2013 Hunt said that he wants patients to have digital records so that their information can follow them. But unlike previous large scale, top-down directives, he wants this driven bottom-up so that by 2018 any crucial health information should be available to staff at the touch of a button.

Most NHS sites hold patient related data on a variety of different media, for example, paper, microfilm and digital. It is currently very difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient's acute medical record; increasing risk and leaving patients and clinicians at a disadvantage. Furthermore, there are many well-known issues related to paper-based delivery of care, such as:

• Physical handling and transport of paper records
• Lack of audit on who looked at any record
• Only one person can see a record at any time
• Cannot easily share records without copying
• Lost records
• Escalating costs associated with handling physical records

Health and IT professionals nonetheless remain deeply sceptical that the NHS can actually be paperless by 2018: a large percentage of healthcare professionals engaged in this work feel that the 2018 goal is "a great ambition, but unrealistic." A recent survey ('The Struggles of Going Paperless', August 2015), completed by 877 people - including healthcare leaders, clinicians and IT professionals - showed that more than 73% identified operational areas that could benefit from going digital. The key concerns expressed in the survey included:

• Incompatible IT - a lack of interoperable systems, and cost of replacing legacy systems
• Costs, timescales, technology, and cultural changes
• Insufficient information about the potential benefits from improved IT systems

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