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Most NHS sites hold patient related data on a variety of different media, for example paper, microfilm and digital. It is currently very difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient's acute medical record; increasing risk and leaving patients and clinicians at a disadvantage. Furthermore, there are many well-known issues related to paper-based delivery of care, such as:

• Physical handling and transport of paper records
• Lack of audit on who looked at any record
• Only one person can see a record at any time
• Cannot easily share records without copying
• Lost records
• Escalating costs associated with handling physical records

Still, many health and IT professionals remain deeply sceptical that the NHS can be paperless by 2018 - a large percentage of healthcare professionals engaged in this work feel that paperless by 2018 goal is "a great ambition, but unrealistic." A recent survey in the Health Service Journal completed by 573 people - including healthcare leaders, clinicians and IT professionals - showed that more than seven out of 10 supported the paperless NHS concept but felt it was unrealistic. The key concerns expressed included:

• Lack of joined up working between different parts of the NHS
• Lack of interoperability between different vendors and systems
• The variety and diversity of clinical systems
• Insufficient information about the potential benefits from improved IT systems

However, on a more positive note, the majority expressed a need to improve their understanding of the key issues and learn from other organisations that have successfully used IT to achieve 'paper lite' healthcare if not paperless healthcare.

A number of Trusts took the bold step towards paperless healthcare some years ago. These Trusts achieved 'paper lite' health care using Electronic Document and Records Management (EDRM) technologies - not just by installing IT, but by paying great attention to the underlying processes. Cost effective solutions based on established EDRM technologies offer the chance for Trusts to embrace a culture of compliant information management practice to deliver 'paper lite' health care if not paper less!

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.

The core technology has been around for over 35 years, and is in use across many industry sectors. Lessons have been learnt through careful application of EDRM technologies. 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, and administrators. Each places specific demands on the medical record, and each of these demands must be addressed slightly differently.

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