Experts question size of savings from NHS going “paperless”

BMJ 2013; 346 doi: (Published 21 January 2013) Cite this as: BMJ 2013;346:f438
  1. Michael Cross
  1. 1London

In his first public pronouncement on policy on information technology since taking over as health secretary for England in September, Jeremy Hunt last week urged the NHS to become a “paperless” organisation by 2018. The move would “save billions, improve services, and help meet the challenges of an ageing population,” he said.

However, recent studies by the department’s own consultants and US researchers indicate that realising “billions” from computerisation may be difficult.

In a speech to the think tank Policy Exchange, Hunt set out two sets of targets, for 2015 and 2018. For 2015 Hunt restated a commitment to allow patients to have internet access to their electronic GP records and for all referrals to be handled electronically, with “clear plans in place to enable secure linking of these electronic health and care records wherever they are held.”

By April 2018 he said that digital information on patients should be fully available across NHS and social care services, except for data on patients who opted out.

Shared electronic care records have been government policy since 1998. The present government’s plans for electronic health records were set out in the Power of Information strategy for the NHS in England, published in May last year.1 Last October Tim Kelsey, the NHS Commissioning Board’s national director of patients and information, floated the idea of a paperless NHS by 2015.

Hunt’s commitment to the idea may be based partly on the results of a study conducted late last year by the consultancy PricewaterhouseCoopers (PWC), which the department published on the same day as Hunt’s speech. It concluded that fully computerising the NHS in England could release £4.4bn (€5.2bn; $7bn) a year in cash across the health and social care system.2

However, PWC’s report urges caution on estimating financial returns, saying that “significant further work is required to further substantiate some of the evaluations of potential benefit, and especially the evaluations of potential financial benefit.” It says that this work should be carried out before the recommended actions are implemented.

PWC’s caution echoes that of the US consultancy RAND Health, which earlier this month admitted that a 2005 study of computerising healthcare had overstated the financial benefits, then estimated for the United States at $81bn a year.3 Despite large investments since then, these savings had not been realised because the systems deployed “are neither interconnected nor easy to use,” RAND said.

Meanwhile, a long term US study of people going online to view their clinical records reported last month that online access, rather than reducing demand on health services, was associated with more use of clinical services. The study, reported in JAMA, assessed use of an online patient access system called MyHealthManager at the Kaiser Permanente health organisation.4

“Contrary to expectations and the results of some prior studies,” the study authors found “a significant increase in the per-member rates of office visits and telephone encounters” by online patients. There was also a significant increase in clinic visits after hours.

The authors, Ted Palen and colleagues at Kaiser Permanente’s Institute for Health Research in Colorado, Denver, said that the size of the differences in use “appears to be clinically significant.” They said that in a health system with 100 000 adult members the increase would mean that over the course of a year the health system would need to provide 50 000 more clinic visits and respond to 30 000 more telephone calls. They said, “If these findings are evident in other systems, healthcare delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services.”

However, last week Hunt said, “The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution.”


Cite this as: BMJ 2013;346:f438


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