When we think about the modernisation of the NHS, we tend to think in grand terms.
For patients and their families, we think of smooth, intelligent patient experience: a genuinely national health service that understands who you are and what you need, no matter which practice you walk into on any given day.
For those of us that work with the NHS, we see an evolution of the structures behind the scenes. We see a secure, sophisticated infrastructure that puts the information clinicians need into their hands at the touch of a button.
Ironically for an industry where the future is so dependent on technology, that starts with the mundane. It starts with paper.
Government data has shown that the NHS in England spent £230m on paper patient records in 2023/24. Research from content services specialist Hyland that same year found that almost three quarters of nurses (72%) relied on paper to a “ridiculous” extent. There’s a clear view that digitising these records will lead to a big boost in productivity and a drop in costs.
Unfortunately, many of these paper records fail to reach the digital realm — lost, misread, filed away in storage, or simply not recognised as important — assuming a Trust has the tools to upload them at all. This undermines the delivery of NHS treatment. The NHS’s own watchdog has found that one in seven who need hospital care don’t receive it because their referral is lost, delayed, or rejected.
As the public clamours for public health services that run efficiently and recognise them as individuals, this situation becomes increasingly unsustainable. While effective digitisation of information and documents remains a problem for many Trusts, the financial and personal cost of relying on paper processes to compensate for ineffective investment or tech is too much to bear.
Understanding the Electronic Patient Record
To properly understand how paper processes undermine the NHS, we need to take a look at the relationship between two key elements of its digitisation: the Electronic Patient Record (EPR), and the Electronic Document Management System (EDMS).
The EPR is a secure digital platform that brings all of a patient’s medical record, from GP visits to key surgery details, into one place. It acts as a single source of truth for any clinician that you come into contact with, all of whom can benefit from a consistent summary of exactly who their patient is, and what they’re facing.
The EDMS, meanwhile, is a platform designed specifically to create, capture, store, and organise digital documents. It’s capable of digitising the physical paperwork generated across a Trust, and making it a digital document that the EPR can understand.
In an ideal world, where paper has been eliminated and the NHS is a model of organised productivity, the EPR would become the main reference point as they become less reliant on historical data. In reality, most Trusts will host a digitally generated patient record alongside an EDMS that hosts both legacy and what we call ‘day forward’ documents — documents generated from the day that you decide the Trust is going fully digital.
For a patient, the benefits of this combination are huge. It should eliminate the need to repeat their medical history to every new clinician involved in their treatment. It makes handovers between those professionals smoother, meaning less interruption to a person’s care. The elimination of so much paperwork should also mean that appointments are secured and delivered quicker, with the staff that conduct them afforded more time to focus on patients. Portals and apps also make this readily and quickly available to individuals too.
Implementing this vision relies on reliable, robust data entry. Clinicians should be capturing data at the point of care, introducing them into the EPR or EDMS immediately. Failing to close this gap is where physical records risk being lost, which risks making the EPR just another point of reference when trying to fully understand a patient’s medical history.
This is an area where every NHS Trust has unique difficulties — and what perpetuates paper-driven processes across an organisation.
The paper problem
For starters, the budget constraints that the NHS has to work within are well documented.
NHS Trusts and Integrated Care Systems (ICS) forecast an incredible deficit of around £6.6bn. With productivity issues within the NHS reportedly costing the UK around £20bn per year, the government believes that reducing this deficit requires a focus on ‘bang for your buck’ within Trusts; the NHS’s own Spending Review has made a productivity increase of 2% year-on-year a core objectives. Money is tight, and each Trust needs to maximise its resources.
This means that each Trust will take a slightly different approach to establishing an EPR. Different providers of an EPR can provide very different systems, and each Trust will inevitably have some sort of legacy technology within its tech stack. Accommodating older systems is expensive, as is removing them — and with each passing day, it’s possible that demands will be made of that budget elsewhere in the organisation.
With such inconsistent tech stacks between each Trust, it’s no surprise that organisations can struggle to speak to each other. There’s no guarantee that data can be collected at a patient’s bedside at all. What is collected can then be uploaded into divergent systems that make it inaccessible, or difficult to find. Important files can be duplicated, or deleted entirely, assuming they make it online at all.
This lack of consistency undermines staff, who can’t be expected to be trained on systems that other Trusts run, and who may well be rotating between different Trusts or hospitals. The organisation needs them to hit the ground running, but can’t equip them with the training and tools to do so given the time and fiscal constraints they’re operating under.
In short: with no consistency of approach, no guarantee that systems can talk to each other, and no guarantee of appropriate training for staff, the EPR cannot deliver on its potential.
This is why so many revert to paper processes. Can’t navigate a new system to upload some information? Write that info down and share it with staff. Can’t access a record from another Trust? Write down the instructions that need to take place. Introducing a new colleague to a new system? Write down how to use it.
This perpetuates the state of affairs that has cost the NHS, and many of its patients, so much. This has to change.
Foundations for the future
So — If we can’t yet establish a nationwide approach to this problem, how does each Trust need to tackle the road ahead?
The first step is for a Trust to establish an EPR, whatever form it takes, as the basis for consistent information. By March 2026, NHS England’s Digitisation Plan aims to have an EPR in over 95% of Trusts, with a ‘tiger team’ engaging with those that don’t make the deadline to help them deliver — so this is a realistic goal for the near future for almost all Trusts across the UK.
Once that foundation is laid, the next step is the digitisation of physical records. The huge repository of physical records that any Trust keeps needs to be scanned, digitised, tracked, and formatted within the EDMS. That digital log needs to be carefully analysed for any duplications, key omissions, contradictions, and so on and third party specialists should be brought in to assist.
As that backlog becomes smaller and smaller, the benefits of the EPR should become more and more apparent, with fewer omissions or failures to capture information. The incremental improvements in speed and efficiency will, gradually, ripple out into the day-to-day work of practitioners across the Trust, as well as the patients that they treat.
Once you have that best practice database within a Trust, the work on compatibility with others can take place. Staff should be party to this process as much as possible, being trained in the basics of EPR functionality, data hygiene and document management. Patients should feel the impact of that through the outbound mail they receive, and the platforms — like the NHS App — that could reinforce that sense of understanding and recognition.
Looking forward
The need for the NHS to digitise has been a national conversation for years. It has seen the repeated restructuring of the NHS itself, billions of pounds of investment, and any number of government initiatives and strategies.
This can only begin until there is an operational EPR, and a defined end-of-episode process for legacy records. Paper-heavy processes are too inefficient, too ineffective, and too expensive to tolerate in the modern day, and their inability to scale and their inherent lack of quality control undermine practitioners.
In digitising their incredible logs of paper records in a platform that every clinician can refer to, no matter their familiarity with a patient, they can harness the information within to help them deliver the best possible care.
Gary Day
Gary Day is Group Director of Public Sector at Apogee Corporation. With over 30 years of sales management experience within the Managed Print and IT solutions space, Gary has worked in both Corporate and Public Sector client channels. His most recent roles have been at executive level concentrating on successfully delivering sales channel integration, transformation and growth through sales team development.
