Going paperless — what pressure will this put on NHS IT?
Marc Stein of Dell Software Group
reviews the changes that are taking
place around paperless and mobile working, how the Caldicott report
supports this and the measures NHS organisations need to take to
keep up in the changing environment.
11 July 2013
The Caldicott 2 report, published in April 2013, gives NHS IT
professionals an overview of how patient information can be shared
and kept secure in a changing healthcare environment. 
Alongside wider patient data concerns, the report also offers
examples, both good and bad, that cover mobile access to patient
records and the potential to improve work processes.
This report comes at the same time that NHS bodies of all sizes
are grappling with issues of providing access via NHS-owned mobile
devices and/or individuals’ own phones or tablets. Their decisions
could offer greater flexibility and productivity for clinical staff
that are increasingly called to work outside the bounds of the
hospital and in the community. However, it also requires a better
understanding of what resources and assets are currently in place,
and how these can be accessed while keeping systems secure.
Windows of opportunity
From a technology perspective, the forthcoming end of support for
Windows XP in 2014 also forces NHS IT professionals to consider
their options. Windows XP has been a stalwart operating system for
NHS bodies across both clinical and non-clinical environments, but
the fact that it will be unsupported means that migration efforts
need to be prioritised.
The overall change in approach to patient records and making the
move over to paperless systems is both a big opportunity for NHS IT
managers to rethink the delivery of services, and a significant
challenge. Going paperless provides an opportunity to reduce the
amount of time required to enter data, and to keep it in uniform
formats, but it also can lead to changes in procedures that make
overall workflows more efficient too.
For IT professionals looking at this mix of migration, management
and process update projects, change management skills will be
essential. The first consideration is, therefore, how to either
marry the technical projects like XP migration with the wider
strategic needs of the paperless NHS, or whether these should be
conducted separately so there is less risk.
Both approaches have their benefits. While XP migration is a
significant change to manage, most NHS organisations have either
embarked on their migrations already, or are planning to do so. For
those that have already embarked on the migration journey, it does
not make sense to shift resources away and risk those projects being
completed unsuccessfully. It is far better to get them completed and
then see what next is required.
For NHS bodies that have not begun their migration planning,
looking at the bigger picture of moving over to a paperless model
can provide many more opportunities to re-envision what can be
delivered. At the same time, migration away from existing platforms
can be factored into this overall strategy, so investment can go
further and more can be achieved.
Knowing your assets
Wherever NHS organisations are within their planning and
deployment schedules, the same thought is uppermost: greater insight
into where and how clinical staff are using IT assets now can assist
in planning for the future.
This should include looking at standard systems management
requirements, like the number of software licences that are in
place, how much they are used and whether users are mobile or not.
Building up this picture of what resources are being used currently
and when, can help with migration planning, but also can be used to
determine which processes and paper-based systems are still in
Conducting an audit like this does not have to be hard: automated
tools that harvest licence details and usage information over time
are available, while IT departments should already have lists of
assets that are installed in place. If these are not available, or
are not up-to-date, then getting this insight now is a priority.
Once this picture of existing assets and usage is created, the IT
department can work with the clinical and non-clinical teams to go
through what workflows are in place at the moment and how these
might be affected by migration to new systems. Decisions then can be
made around which new device form factors might be brought into the
clinical environment for staff to access patient records, and what
changes within the back-end systems would be required in order to
facilitate this access.
Security in the community
For most NHS organisations, the changing demographic of patients
and requirements for care to be delivered in patients’ homes, rather
than on-site, will lead to increased investment in tablet PCs or
other mobile devices instead of more traditional PCs being deployed.
This shift has to be coupled with an understanding of the data
security and mobile device management requirements that have to be
For NHS-owned devices, being able to wipe tablets or laptops
remotely in the event of devices being lost or stolen is a
pre-requisite if data is to be saved on those machines. However,
most NHS organisations may prefer to stop applications or data from
being saved locally and instead store all data centrally.
Restricting user access to the application level, rather than saving
data locally, helps NHS IT professionals ensure that data security
Not only should this approach reduce the potential for security
risk, it also makes it easier to support 'Bring Your Own Device'
schemes: rather than having to support specific machines and worry
about segregation of data between work and home environments, all
work material is kept separate and stored centrally. The main
requirement is therefore the control of access to applications,
rather than the full security and protection of data on the local
Maintaining productivity in a mobile environment
Thinking ahead, the role of IT within the NHS will continue to
change as staff work in more agile ways. As going paperless becomes
a reality, the emphasis on IT assets being well-managed and
up-to-date will be critical. After all, if mobile devices do not
work or perform well, then staff will be unproductive or have the
traditional fall-back of piles of paper file records.
This includes understanding how the ongoing requirements of IT
and systems management will change over time. While tasks like
patching, systems imaging and application deployment will not go
away, they will change as the range of potential devices that have
to be supported goes up.
Similarly, the increasing use of mobile devices will mean that
all approaches to systems management must encompass all the
different requirements that users may have, rather than dictating
what can and can’t be used. In this scenario, automation of support
and service tasks will be a necessary step to keep systems running
After the strategic thinking that a move to paperless systems
requires, NHS organisations as a whole will have to look at their
approach to systems management and planning in general. It has
become a truism that every business is an IT business, such is the
role that IT plays within company success or failure.
In the same way, individuals across the NHS will rely on their IT
systems being up-to-date, secure and to deliver the tools and
information that are necessary to provide the quality of patient
care that is required.
1. The Caldicott 2 Information Governance Review Report can be
Marc Stein is Executive Director of Software
Sales for Dell Software Group. He leads Dell Software Group’s
activities around endpoint systems management across Europe.