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Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018. According to a directive issued earlier this year, Mr Hunt 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 and 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. Although some areas have introduced systems allowing storage and audit, the majority rely on more traditional means. It is currently very difficult to identify exactly what information may be held on a given patient. Some departments compile their own copy of the patients' medical records, specific to their department's needs, with the main objective being access to information when required. This practice has resulted in falling standards for the timely filing of patient related documentation in the patient's acute medical record; increasing risk and leaving patients and clinicians at a disadvantage.

To address this, practical solutions based on established Electronic Document and Records Management (EDRM) technologies offer the chance for Trusts to evolve their practices and embrace a culture of effective and compliant information management practice to deliver 'paper lite', if not quite paperless, health care. There is no magic bullet solution - just a common sense approach which focuses the available technologies on specific processes to ensure that the solution delivers what is expected of it. The process is a migratory one which promotes a trust-wide information repository with newly created clinical documents being 'born' onto the repository whilst 'legacy' information is scanned and digitised in a staged manner.

NHS Trusts must adopt a more holistic approach for content management - to develop and provide integrated solutions that use EDRM as the underlying technology to capture and deliver electronic patient information at the point of care. The returns from investments in EDRM are being realised through careful application of this technology to address the needs of key users who deliver medical care rather than short-term measures to solve paper problems. Key users include clinicians, secretaries, administrators, etc. Each places specific demands on the medical record, and each of these demands must be addressed.

The core technology has been around for over 35 years, and is in use across many industry sectors. While this is not rocket science, its use within any particular sector cannot be generic, i.e. it is not "out-of-the-box." Consequently, its selection and implementation are complex and open to potentially costly miscalculations.

Lessons have been learnt through careful application of the available technologies. Given the consumerisation of IT, systems have become more affordable and are delivering real and measurable benefits. The key points to keep in mind are:

1. It is vital to understand that simply digitising paper records is not enough - the solution must offer facilities to stop producing new paper through generation, management, and integration of ongoing (electronic) records - in order to minimise or eliminate the paper chase.

2. Patient information resides on many disparate systems within Trusts - information that is relevant to the patient and should be presented along with the digital record, at the point of care. The electronic medical record cannot sit in a document management system that remains un-connected with other hospital systems and processes - information must be exchangeable and shareable. This includes sharing with Primary Care - access to primary care data by users in acute Trusts as well as access to the acute record by GPs.

3. Delivery: to be optimally effective the electronic record has to be delivered to key users when and where they need it. A solution which offers a standard interface for all users will provide limited functionality to most users.

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