I had to go to A&E to have a cut stitched earlier in the week. I did notice that even for something minor like this, a remarkable quantity of paper seemed to be generated - and printers seemed to be lurking everywhere ready to spit out whatever was typed into a nearby computer.

The nice thing is that paper can go with the patient

Online records means that everyone in contact with the patient has to look up their records on 'the system'

So continually asking an elderly/confused/in-pain/unconscious patient their name+DOB+how do you spell that, to confirm who they are everytime anyone has to work on them

(Bonus points for a records system which doesn't flag current patients in ER so they have to search through a million Singhs or Wangs in the region)

It might be helped if a cheap tablet or ebook reader was given to each patient, or they had an id number QR code tattooed to their forehead

My wife was at A&E with her mother 2 weeks ago. Yes, the paper records were with the patient. However, they were then separated giving a further 30 minute delay to treatment.

This was for an 80+ year old with a dislocated hip who had already waiting 2 hours for an ambulance and had been waiting in a corridor for another 3 hours.

Couldn't they just have one piece of paper with basic information and a bar code or QR code to scan, which would then link to the correct record?

To easy - what profit would a consultancy get from this?

Now a tattoo on a private part of your anatomy...

Years ago, we suggested barcoding the patients.

Management wanted it in the middle of the forehead - as described in The book of Revelations.

Admin wanted it on the inside of their wrist.

Nurses wanted it on the gluteus Maximus!

Or one of those wrist bands with your patient number on it... like my local hospital already uses.....

Yep, I was given one of them too!

The bad thing about paper is that it doesn't always go with the patient.

By the late 20th century, all the printout needed was a wristband. That way, you don't need to ask "an elderly/confused/in-pain/unconscious patient their name+DOB+how do you spell that,". You can either type in the number on the band or read the QR code with the little gizmo attached to your USB port.

Managers would never allow "a cheap tablet or ebook reader" anyway. They prefer iPads. Lets use the wristband instead!

Paperless is and always has been an instrumental goal, not a terminal one. As another story reminded us not so long ago: [1]Bad software destroyed doctors memory . If they cannot do paperless right, keeping dead trees is the lesser evil.

[1] https://www.theregister.com/2023/08/16/bad_software_destroyed_doctors_memory/

The joys of IT megaprojects and creaping featurism

We need an NHS computer system to replace faxes.

Ok, sounds like email, go on

And it needs to be secure with physical access keys for doctors, but the keys have to be bypassed in an emergency by paramedica etc

The data has to be held locally for data protection but has to be instantly available everywhere in the country in case of an accident

It has to support attached medical data for everything from a blood pressure cuff to a 5d functional MRI. It needs to handle that remaining 1970s CT scanner in Stevenage that only uses 8" floppies. (Yes it would be cheaper to replace it, but that's a different budget)

The contract has to get to an approved supplier = IBM, Crapita, CapGemina.

And it has to demonstrate cost savings

"And it has to demonstrate cost savings"

Surely that should be "anticipated / modelled" cost savings? When in reality it will end up costing twice as much as the previous system.

The local health system here was the victim of a cyberattack two months ago that took out practically everything - test results, appointments, medical notes, email and even telephones. Patients presenting for urgent care were asked to bring any medical information they might have with them. Data is largely recovered and systems are coming back online but the system is still not fully operational.

While it may make sense for a health system to go paperless, it might also make sense to have the patients keep paper records, just in case...

I've just been shunted off to a new practice due to the old one closing. Three weeks after the transfer started my electronic records are still missing; apparently something to do with the Spine (how I wish I could conjure up a Spın̈al Tap joke on demand) and it strikes me that things were much quicker, easier and more efficient when they used paper records. Which also involved less paper.

You think the entire paper record couldn't get lost? Or become part of the overflow of an overflowing bin somewhere?

Well yeah, one of the local hospitals routinely has a timescale of up to a month for the paper records (or some subset thereof) to get from one end of the not-very-long corridor to the other if they don't lose it altogether. But I've noticed there seems to be even more problems with the electronic records, which are also clearly much harder to use: I've seen more than one doctor throw their arms up in exasperation during appointments.

Our envy of the modern world is giving ambulance workers time off for male menopause, rewriting documents to say chest feeding then consulting on undoing PC stupidity and absurdity, trying to figure out if males should be on female wards or not and spaffing money on agency staff because nurse training is constrained by government just to name a few 'important' things to our glorious envy of the world.

The idea they could figure out how to solve their IT issues is neigh on impossible as a comment above explains very well- https://forums.theregister.com/forum/all/2023/10/05/pick_your_year_its_time/#c_4738261

Too big to manage, too expensive to afford.

So your thesis is that the problem of NHS IT is that little-endian processors are woke ?

We know some of it's been digitised because [1]24,000 letters got lost in the system and were never sent ...

[1] https://www.bbc.co.uk/news/health-66917025

Just in case anyone has no idea how that much money could be spent on paper records, here is one answer:-

A large city centre hospital near me has no space left on site so they have a separate secure facility a few miles away, sort of an industrial estate type building. A fleet of vans, and a team of people, go back and forth 24/7 to send/retrieve patient records. How anyone thought this was cost effective/efficient/timely as the hospital expanded over the decades is hard to fathom, but here we are and hopefully their digitization process is a little more advanced than some.

Over the past few year or so my wife's cardiac and, particularly the last few weeks, blood pressure problems - together with a few of my own have given me chance to observe the local hospital trust and especially the local A&E.

Firstly they do have a trust system. It has links to a national system so they can look up NHS number from name, DoB & post code (as can online booking for flu & covid jabs). The only connected printer in evidence at A&E reception spits out a wrist band with name, NHS number and a QR code. That solves the patient ID as they're moved around. BP testing devices have an RJ45 so presumably could be networked but aren't - it would probably be impractical - so readings have to be typed in but doctors and nurse practitioners can review what's been done. The cardiac ward in the other main hospital in the trust has hand-helds which look like smartphones but I suppose might not be which are used to register the readings. I'm not sure how the doctors review this on ward rounds but in the A&E offices they can review everything without needing a paper record. On the face of it it appears that this trust is largely if not entirely paperless apart from the wrist bands, at least on a functional level although it's possible there might be a paper back-up. I don't know the origins of the system but I doubt it's written in house; it will be bought in.

Our GP also has a practice system so they also are largely if not entirely paperless, at least on a functional level. I know this is system is bought in, in fact I'm pretty sure it runs on the provider's server.

The need for paper, then, seems to be communicating between trust and GP and possibly between trusts (SWMBO was sent elsewhere for a TAVI last year). This set me thinking: bearing in mind that perfection is the enemy of the good, let alone the workable, is it possible to build a bottom-up system instead of some grand plan, especially one to be handed over to a major data-broker? How does email work, or the web, or any effective communications system? It has scarcely any central requirement other than data standards - communication protocols and defined message formats and a hierarchical, distributed registry. There's no need for everyone to use a specific client. There's no need for MSPs to use the same server software. Providing the clients and servers follow the protocols and handle the same message format everything works. It should be possible to build something on those principles.

A quick online search shows that there's a lot of information about medical exchange message formats. Pick one, preferably one that's extensible. Specify a core amount of information and a go-live date. It doesn't matter how different the internal databases of the various providers are, all they have to do is to provide an interface to read or write that subset of data to that format. Now we have to decide how to exchange data about the patient. As the system evolves extensions for extra data can be defined and added in phases.

On the basis that the patient is registered with a GP (not all patients may be but let's start with what's practical) the GP (in practice the GP's service provider) is the obvious place to exchange information; it's the GP who will refer patients a lot of the time and even if a hospital trust encounters the patient as an A&E walk in the GP will need to know eventually. Clearly a network is needed to transmit messages securely and I'm assuming that NHS.net can provide this and that most, if not all, trusts and GPs have NHS.net addresses. Again "most" can be the starting point.

What the network needs to provide is a central registry to provide identify the patient's GP and I'd be somewhat surprised if the system which already provides the lookup for NHS number didn't already include this; and a store and forward message handling system which looks remarkably like email. It may well be that the GP service providers could handle the latter

TL;DR A system could be built bottom up. No massive central contract is needed. Software would be an add-on to existing medical record systems by the providers of those systems. Not every patient nor every possible item of data might be served by this but the system could start earning its keep from go-live and grow out from there. Perfection is the enemy of the workable.

And this would be government IT outsourced to someone like Crapita. Don't assume, with upgrade costs and new software every few years, tech would cost less or work better. Consider all those letters left unsent in a folder recently. Two lots, weren't there? And scroll down for the El Reg story 'Ambulance patient records system hauled offline for cyber-attack probe'.

It is unwise to accept figures produced by journalists for headlines, but it is likely that the storage of paper records is as badly handled as everything else the government do, and could be done for a good deal less if anyone involved was competent.