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SPECIAL REPORT

The Paperless NHS and the Role of the Electronic Board Meeting and Document Collaboration Solutions Delivering a Paperless Boardroom to the NHS Look – No Paper! Organisation and Formats Advantages of a Paperless Solution and a Few Cautionary Notes

A Paperless NHS

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

SPECIAL REPORT

The Paperless NHS and the Role of the Electronic Board Meeting and Document Collaboration Solutions Delivering a Paperless Boardroom to the NHS

Contents

Look – No Paper! Organisation and Formats Advantages of a Paperless Solution and a Few Cautionary Notes

A Paperless NHS

Foreword

2

John Hancock, Editor

Delivering a Paperless Boardroom to the NHS

3

Mike Evans, CEO of ICSA Boardroom Apps

Sponsored by

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor John Hancock Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated. Material in advertisements and promotional features may be considered to represent the views of the advertisers and promoters. The views and opinions expressed in this publication do not necessarily express the views of the Publishers or the Editor. While every care has been taken in the preparation of this publication, neither the Publishers nor the Editor are responsible for such opinions and views or for any inaccuracies in the articles.

Why Should You Evolve to Digital Board Packs? Digital Board Packs – Work Smarter Not Harder Updates at the Touch of a Button Cost Savings and Environmental Benefits

Look – No Paper!

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John Hancock, Editor

A Significant Amount of Information to Manage The Paperless Promise or the Paperless Dream Technology Fulfils the Promise and Realises the Dream Document Management is Better than Storage Alone Coming to Appreciate a Flexible and Useful System

Organisation and Formats

8

Camilla Slade, Staff Writer

A New Way of Seeing Things Whatever the Format or Medium, Things need to be Organised Capabilities That Add Value to the Meeting Content Creation

Advantages of a Paperless Solution 10 and a Few Cautionary Notes Peter Dunwell, Medical Correspondent

Advantage… Better Access, Less Time Consuming Advantage… Greater Control, Better Knowledge, Transparency Caution… Embrace the ‘Pros’ but do not Ignore the ’Cons’ NHS Committed to a Digital Path

A Paperless NHS

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John Hancock, Editor

A Compelling Case A Better Way of Working There are Already Paperless Initiatives

References 14

© 2016. The entire contents of this publication are protected by copyright. Full details are available from the Publishers. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright owner.

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Foreword W

HETHER IT’S researching for articles

describe BoardPad, produced by ICSA Boardroom

such as make up this Report, maintaining

Apps, which has been implemented successfully

medical records or preparing for meetings, we

by over 100 NHS organisations. South London and

all need information and that has meant keeping

Maudsley NHS Foundation Trust and NHS Doncaster

large stores of paper records and large libraries

CCG are two of the many BoardPad clients which

of information. However, a combination of factors

have found the paperless solution to be efficient and

is now making us question the need to retain

intuitive, as well as enabling documents to be archived

information in printed form on paper. From one

for viewing subsequently.

direction, some scientists tell us that an exponential

The following article describes how paper is already

growth in our use of information has meant that

giving way to digital and electronic media in the wider

demand for the raw material of paper (trees) is

world. It also considers the management of electronic

now outstripping the rate at which forests grow,

documents and some of the basic benefits for board

threatening to deplete tree stocks and, with them,

meetings. Next, Camilla Slade delves into the positive

their ability to remove carbon from and add oxygen

values that users derive from a paperless solution over

to the air. From another direction, as the material

and above the simple saving of weight and storage.

that people require grows ever more complex, we

Peter Dunwell sets out the main advantages that a

need to be able to find and interrogate it faster and

paperless health service will provide while sounding a

with more accuracy than ever before. It is not a

few cautionary notes: they are not reasons for inaction

moment too soon to think about a paperless health

but need to be considered. Finally, we highlight a few

service and electronic board meetings.

cases where a paperless NHS is already working and

The Report opens with an article that looks at the use of technology in the NHS and, in particular, how much time and money can be saved if NHS board packs can

how it has benefitted different levels of the service. Whatever the speed of adoption, the paperless NHS and meetings are already realities today.

be produced and delivered with the click of a button, rather than being couriered to each board member before each board meeting. The article goes on to

John Hancock Editor

John Hancock has been Editor of Primary Care Reports since launch. A journalist for more than 25 years, John has written and edited articles, papers and books on a range of medical, management and technology topics. Subjects have included management of long-term conditions, elective and non-elective surgery, Schizophrenia, health risks of travel, local health management, and NHS management and reforms.

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Delivering a Paperless Boardroom to the NHS Mike Evans, CEO of ICSA Boardroom Apps explains how the NHS can improve efficiency in the boardroom by implementing digital board packs

T

HERE HAS been a significant shift in the NHS with the introduction of the paperless target, which will save the Health Service billions of pounds each year. Health Secretary, Jeremy Hunt, wants the NHS to be paperless by 2020 and aims to provide any crucial health information to staff with the touch of a button. The use of technology to save time and money is not a new concept for the NHS. There has been a rapid uptake of portable devices, such as tablets and laptops, and healthcare professionals are now using them to receive and consume high volumes of information every day. It’s worth considering how these devices can further assist the NHS in gaining efficiencies and saving money by using them to manage meetings and papers. On average, NHS board packs are 350 pages and are couriered to each board member only a few days before meetings. Imagine how much time and money can be saved if this could be done with the click on a button! More and more company secretarial teams in the NHS are looking at a comprehensive and secure solution to help them efficiently and effectively produce and distribute board packs. Among them is South London and Maudsley NHS Foundation Trust, one of the many NHS Trusts who have implemented BoardPad, a meeting and document collaboration application from ICSA Boardroom Apps. BoardPad gives directors fast and secure access to meetings, board packs, resolutions, news and action points, from any location, online or offline. Renowned as one of the leaders in improving health and wellbeing, the South London and Maudsley NHS Foundation Trust was searching for a solution to streamline the process of securely distributing board packs. Paul Mitchell, Trust Secretary at South London and Maudsley NHS Foundation Trust, explains: “Previously we had one member of staff responsible for collating and dispatching

Helping the NHS reach its 2020 paperless target

BOARDPAD

the papers which was proving to be expensive to produce. Secondly, the security of the paper packs was another significant concern. We needed a more efficient solution that would benefit all parties involved and improve the productivity.” Due to the significant cost and time saving benefits, less than a year later, the Trust’s board meetings were transformed to fully paperless and BoardPad has now been rolled out to the entire board. Paul adds: “Efficient and intuitive, BoardPad has worked incredibly well for us. We needed a trusted solution that we could depend on and BoardPad has done the job. The directors are particularly pleased that they can view board papers at their own convenience and how they can be annotated more easily. They are also delighted that they can view archived documents securely and at ease through the BoardPad Reading Room feature.”

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Any additional updates to board packs can be actioned instantly and sent to directors, regardless of their location, to ensure they always access the most up-to-date information

Why Should You Evolve to Digital Board Packs? By pairing the latest tablet technology with the BoardPad application, a whole host of powerful features and functionalities for the board become possible. Using a portable device, directors have instant access to all of the details and documents for their board meetings plus the ability to annotate, even offline. In addition, every board pack can be made available at their fingertips. Using a digital library means that financial reports, background papers, news articles, websites, and company charters are all instantly available, accessible, and searchable. With personalisation functionalities, Trusts can decide which of the many application features and functions they want to access.

Digital Board Packs – Work Smarter Not Harder Digital board packs give both board and secretarial staff the ability to work in a quicker 4 | WWW.PRIMARYCAREREPORTS.CO.UK

and more efficient manner, cutting down on manual processes and the time it takes to collate board packs and have them couriered. For secretarial staff, digital board packs provide a streamlined and more automated way of working because they eliminate the traditional method of printing, collation and couriering, since all information is distributed to a portable device. Any additional updates to board packs can be actioned instantly and sent to directors, regardless of their location, to ensure they always access the most up-to-date information. Directors across the globe are already benefiting from digital board packs in a number of ways. They don’t need to carry cumbersome board packs around. They have fast and secure access to all documentation, anywhere, anytime. They can annotate digital documents in much the same way as traditional paper. They can be confident that the information is stored in a secure location and only privy personnel have


THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

access. When sitting on multiple boards, they can access all the content from one single app. All of these benefits and more make BoardPad an obvious choice. No matter the industry you operate in – efficiency and good governance in the boardroom applies. Meeting organisers are also benefiting from board portal solutions. The ‘behind the scenes’ work by administrators with the preparation of printed board papers is an enormous undertaking and a substantial environmental impact. Even sending papers to directors in PDF format still requires a board member to print out the papers and put them in a folder, a time-consuming task that they generally don’t have time for. Hence, the company secretary’s office, more often than not, is undertaking this tedious task and couriering the physical pack to the director. In my own experience, I can tell you that on more than one occasion a director has not received printed board papers because the courier left the package in the wrong place or delivered it to the wrong address and it has ended up in the wrong hands. This is not only inconvenient for the director, but a security breach of confidential information.

Updates at the Touch of a Button It is a feeling that I know many other executives directors share – spending several hours reading, reviewing and annotating a document, only to be told walking into the boardroom that an updated version has been prepared. This is an extremely frustrating experience. Even receiving a board pack a few hours prior to the meeting is an improvement. At least it gives one an opportunity to read, digest and think about the update. By using a digital board pack solution, directors can receive updated documents immediately and have time to consider them. It’s a far more efficient system.

Cost Savings and Environmental Benefits If we consider an average board has 14 members, plus the CEO, CFO and Company Secretary, bringing the number of board packs required to 17. Paper board packs on average consist of about 250 pages for each meeting – the secretariat would need to compile approximately 4,250 pages of written information – let’s say 2,125 pieces of paper if printed double-sided. If the board of the above example meets six times during the year it would use approximately 12,750 pieces of paper for its meetings (not counting the paper notepads used during the meetings). The figure would be even higher if, as is often the case, the board has additional meetings. In addition, it is usual for an additional pack to be prepared for record purposes or in case a board member loses or forgets his/her pack. That’s an astonishing figure for any corporation with a modest-sized board. Think of the trees that could be spared if the entire NHS Trust went digital and incorporated digital board packs? The courier costs alone would be substantially reduced (especially if some of the directors lived abroad), not to mention the sparing of the staff who often stay well after office hours to compile the paper board packs. The truth is that it is very difficult to justify the continued use of paper board packs other than the fact that directors are comfortable with paper. But which option is in the best interests of the Trust?

Reduce the time, cost and effort required to produce meeting packs

Mike Evans, CEO at ICSA Boardroom Apps 020 7497 5522 info@boardpad.com boardpad.com

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Look – No Paper! John Hancock, Editor

Going paperless is a growing choice for organisations and boards faced with the need to manage growing quantities of materials and documents

Those who might have to attend multiple meetings during a day, appreciate either not having to carry large paper files to each meeting and/or having to return to their office between each meeting to collect a new file

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A Significant Amount of Information to Manage A Health trust or hospital board meeting is much like any other board meeting except that, given the wide range of managerial, administrative, clinical and regulatory issues with which a board in the health sector has to do be concerned, it is possibly more complex and certainly very diverse in the range of topics likely to be discussed. It is also likely that board members will need, not only a copy of the agenda and a copy of the last meeting’s minutes, but also supporting material in respect of each subject to be discussed. The result is often a thick and heavy file of papers indexed with various tabs and/or post-it notes through which board members have to trawl to find each subject and then access the relevant material. What is more, each of those files has to be populated with relevant content and anything that might be needed to support discussion and well-informed decisions. Not only will there need to be as many copies as there are board members but also at least a couple of spare copies. The process of content sourcing, creation and production is labour-intensive; it uses large quantities of paper, most of which will be waste

paper after the event; and it requires a growing storage space for copies that must be retained for the record. The management of paper documentation will very quickly become a major issue for any organisation; however, it’s not just the storage space required, but also ensuring useful and easy access to the information contained in the documents. For these reasons alone, any move to an electronic board meeting will be a good thing but will be even better if achieved in the context of a paperless office and organisation. In this, the NHS is no different from any other large and complex organisation in the commercial or public sphere.

The Paperless Promise or the Paperless Dream Writing for Forbes in 2012, Venkatesh Rao summed it up nicely1, “The idea of the paperless office has an interesting history. It’s been a holy grail for so many decades that we’ve started to treat it like Godot in Samuel Beckett’s famous play. It has always seemed just around the corner.” One reason for that elusiveness might have been that, until the mid-20th century, every record that existed was committed to paper; as a result, significant amounts of capital


THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

were invested in the infrastructure to support paper records and significant expenses were predicated upon administering the processes involved. Plus, given the vast size of mankind’s accumulated libraries and filing systems, as well as the challenge of creating new content in electronic format, there was a seemingly gargantuan task of transferring legacy hardcopy content into the new electronic formats.

Technology Fulfils the Promise and Realises the Dream In all of this, technology has come to the rescue. As well as the means to create new content in electronic format from the outset, scanning technology has made feasible the rapid transfer of legacy paper records to new formats. The whole process of going paperless is becoming much more straightforward and that was reflected in the results of an Edis-Bates Associates survey reported by Alexandra Stevenson in FT.com 20122 that revealed, “40 per cent of 150 Londonlisted companies surveyed last year were using electronic means to distribute board meeting documents.” It isn’t just the growing use of creating and storing electronic material; but also because a very convenient means of using material has become available. Since the launch of the first iPad and subsequent tablets, it has become possible for board members to carry huge amounts of complex data in well-ordered and indexed files along with links to even more material available online. A combination of the Internet and Cloud storage as well as tablet devices has made paperless board meetings not just feasible but significantly better informed and resourced (not to say, tidier) than those at which paper is the medium of choice. With apps specifically designed to support meetings by bringing together relevant documentation into a single ‘book’ linked to the agenda, creating and gaining access to the information required at a board meeting has become very straightforward. Administrators appreciate the ease with which files for board members can be assembled and updated: board members appreciate being able to find the information they need quickly and easily on whatever device they are using.

Document Management is Better than Storage Alone While traditional filing systems might well have held material in some order (alphabetical by customer, numeric by account, in date order…) they could not be described as document management systems. “…a document management system is different from online storage, which simply provides a place for you to store a variety of documents. Document

management systems do much more. They’re essentially electronic libraries that can be easily searched, shared and managed.” Is how Chad Brookes explained it in Business News Daily3, ‘Document Management Systems: A Buyer’s Guide.’ The article continues with a bullet point list of 10 significant functions offered by document management systems: •S  toring various document types, including word-processing files, emails, PDFs and spreadsheets; •C  reating new files directly within the system that can be edited and shared with others; •S  earching an entire library of files by individual keyword; •S  haring documents with co-workers, departments and clients; • Restricting access to certain documents; •M  onitoring who is viewing documents and when; • Tracking edits being made to documents; •R  etrieving previous versions of edited documents; •C  ontrolling and regulating when out-of-date documents can be deleted; •A  ccessing, editing and sharing documents via mobile devices.

Immediately access the most up-to-date information

Coming to Appreciate a Flexible and Useful System All that said, modern electronic document management systems can ensure that a highquality and complete record of every board meeting is stored and will be available in whole or in part to anybody who might need it. Also, part of that document management system will be for users (board members) to either access information they need online or to safely download the documents they need for off-line reading. And if, as is often the case, there are last-minute changes to the agenda and/or the material required, those changes can be made by e-mail or, depending on the system, by the library manager who can update packages on board members’ devices. Even if some board members are initially sceptical about moving to a paperless document system, most quickly become very positive about the change, the additional scope that it offers and, in particular, those who might have to attend multiple meetings during a day, appreciate either not having to carry large paper files to each meeting and/or having to return to their office between each meeting to collect a new file. As Alexandra Stevenson (see above) put it, boardrooms are becoming “more akin to science-fiction films.” In the following article Camilla Slade will look at the practicalities of paperless content and its advantages.

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Organisation and Formats Camilla Slade, Staff Writer

Notwithstanding the benefits of paperless meetings, they will still need to be supported by a process

An item on a board’s agenda can have a link directly to material needed in discussions about that subject; and within each subject pack there might be hyperlinks to other material held within or outside of the organisation

A New Way of Seeing Things We’re all familiar with the way that we create content on paper. That is now changing and in this article we’ll be looking at digital and electronic media and formats, plus some new possibilities that they offer. However, just as there are rules with hardcopy content used at board meetings, to ensure that material is in the order in which board members will need to use it, so there are also rules around creating digital electronic content. Loughborough University has produced an excellent guide to ‘Creating documents suitable for a paperless meeting (Windows)’4 which explains the process for an environment not dissimilar to that of an NHS board meeting. It also summarises the content of this article; “In order that attendees at paperless meetings can utilise all of the functions available on a laptop or tablet computer to read and annotate documents, there are a number of steps one needs to take to optimise the agenda and associated documents.”

Whatever the Format or Medium, Things need to be Organised It’s always a good idea, whatever the medium, to use a familiar template that, not only reflects the order of the agenda, but also allows for packages of material related to various agenda items and contributions. As with any content and material, the first thing to consider is where it’s going to be kept. Officiency5 suggests a number of steps to take in order to create a paperless office and much the same applies to paperless board meetings. The first suggested step is “Before creating your electronic filing structure, you need to determine where you want to store your electronic data files on your computer.” The article continues to suggest ways of organising files, creating subcategories and developing standard naming conventions so that files relating to the same subject matter automatically group together, perhaps

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by the date they were created and then the subject. These fairly simple steps will be familiar to anybody who has organised a paper filing system. However, electronic and digital systems have further capabilities which make searching them and using them better and which will be appreciated by busy board members who have to negotiate material on multiple topics for any particular meeting.

Capabilities That Add Value to the Meeting One area where electronic content can be enhanced is that metadata can be used to identify words and properties that will be useful in the future when searching, for instance, for references to a particular item across multiple files and subjects. Electronic formats also allow the inclusion of hyperlinks to other content (copy, images, slideshows, videos…) to be embedded in documents. So, for instance, an item on a board’s agenda can have a link directly to material needed in discussions about that subject; and within each subject pack there might be hyperlinks to other material held within or outside of the organisation to which board members might wish to refer. Another enhanced function available to electronic content is file organisation software which makes possible the access and reading of not only the file you want but multiple files if necessary. Most Microsoft Windows-based systems will have Windows Explorer as their standard file organisation software but it is worth investigating others which might better match the specific needs of an organisation. All this means that, in one board meeting pack, it is possible to include specific digital content created for the meeting in one of the main formats available (see below) or to include scanned documents from non-electronic sources which, in some cases, can be made editable using text bridge software.


THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Content Creation Although, in most organisations, a lot of the content will be created in the first instance in a word processor such as Microsoft Word or in an Excel spreadsheet or PowerPoint presentation, they might not be the ideal formats in which to present information to the board, especially if the content includes a mixture of material from different sources. “PDF (Portable Document Format) is a file format that has captured all the elements of a printed document as an electronic image that you can view, navigate, print, or forward to someone else.”6 That’s how WhatIs.com describes the PDF, adding, “PDF files are especially useful for documents… in which you want to preserve the original graphic

appearance online. A PDF file contains one or more page images, each of which you can zoom in on or out from. You can page forward and backward…” as well as that PDF files are especially suitable for, “The online distribution of any printed document in which you want to preserve its printed appearance.” All of this is useful for board members who might not be dealing every day with the subjects on which they have to make decisions. But PDFs have their limitations; for instance, it is difficult, after a content pack has been delivered to board members, to then change one item of content without changing the whole file and then sending it out again with instructions to delete the old file and replace it with the new one. Not all board members will be as computer literate as those who prepare the packs and so errors might occur. Some of these limitations can be overcome using a format known as Extensible Markup Language (XML). This is not the place to delve into the intricacies of XML format which could fill its own large report but it is related to HTML, the format used to create Internet content. What it does allow is for changes to documents to be communicated to content already on users’ devices, which can be quite a time saver. In the next article, Peter Dunwell will look at the features of a paperless environment and how it can be used in meetings.

Access board papers, anytime anywhere even offline

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

Advantages of a Paperless Solution and a Few Cautionary Notes Peter Dunwell, Medical Correspondent

It doesn’t mean don’t proceed; it means proceed but in a controlled manner

Holding data in electronic format means that it can be stored in one or more places away from the offices where it is used. That has implications for faster disaster recovery, even if the ‘disaster’ is a board member’s device being lost or damaged

Advantage… Better Access, Less Time Consuming Previous articles have already alluded to the obvious advantage of a paperless meeting in that attendees do not need to carry heavy paper files around with them, leave alone shuffle back and forth through those files in order to find material being discussed. Nor do organisations need to store content in increasingly expensive ‘warehouse’ space. But paperless, digital and electronic content offers many other benefits to members of boards and to their organisations. In his article in Business News Daily, Chad Brooks7 outlined some of those advantages including that content is always accessible in or away from the office (something familiar to many NHS board members) as well as there being easy access to that content. He also referred to better collaboration, “When multiple employees are working off of one document and editing is constantly happening, document management systems ensure [they] always have the most up-to-date copy. Employees waste no time on printing revisions or double-checking to make sure they have the current version.” That might just as well refer to board members and if everybody is working off a shared platform, it isn’t even necessary to email files around, although electronic files can be emailed to recipients within seconds if needed.

Advantage… Greater Control, Better Knowledge, Transparency It is also the case that an electronic document management system allows organisations to know who is viewing a document and to control who can edit or add to a document. And, as well as saving storage space, holding data in electronic format means that it can be stored in one or more places away from the offices 10 | WWW.PRIMARYCAREREPORTS.CO.UK

where it is used. That has implications for faster disaster recovery, even if the ‘disaster’ is a board member’s device being lost or damaged. Again, in previous articles, we’ve alluded to board members being better prepared and, in Alexandra Stevenson’s FT.com article, ‘Rise of the paperless office’8 she quotes Didier Cossin, professor of finance at IMD, “The potential is there for the technology to help give the board better knowledge of the company.” As well as giving the board better knowledge of the organisation, for a public body such as an NHS board it may well be necessary for some elements of the meeting to be made publicly available and content in electronic format can easily be displayed on a website. Plus, of course, these days we cannot ignore the issue of the environment. In their sourcing (cutting down trees), production, creation with content and final disposal, paper documents can be damaging to the planet.

Caution… Embrace the ‘Pros’ but do not Ignore the ’Cons’ However, as with any technology application, making the NHS paperless or board meetings paperless will not resolve current problems; it will merely transfer them into a new format. There are some cautionary notes which will need to be considered as part of any decision process to take the organisation paperless. As far as the wider NHS is concerned, Dr Justin Whatling, Chair of BCS Health, talking to Computer Weekly9, said that, digitising documents is not the same thing as creating a true electronic patient record system. “You’re just solving a paper storage issue. Hospitals need to implement electronic patient records,” he said. The article continues to identify a number of reasons why the achievement of a truly paperless NHS


THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

might need to tackle some challenges along the way… for instance, he wonders whether clinicians will ever stop writing on a specimen tube after, say, taking a patient’s blood. Still, new solutions such as voice and handwriting recognition are regularly appearing which will improve the mixed human-digital work environment. More specifically and looking at material for meetings, freed from the constraints of paper – quantity, weight – content compilers might be tempted to include everything and anything in a meeting pack making it, if not physically unwieldy, then certainly more difficult to read and digest before or navigate during the meeting. In fact, in the FT article (see above) Professor Cossin opines that, “With new [tablets] coming in, people are swamped with documents which can be highly inefficient in terms of governance.” To address this issue, a number of companies offer properly managed digital solutions for board meetings. Furthermore, even though one organisation might have adopted a digital, ‘paper-lite’ approach, there is still the rest of the world to consider. Wikipedia10 nicely sums up the problem; “A major difficulty in ‘going paperless’ is that much of a business’s communication is with other businesses and individuals, as opposed to just being internal. Electronic communication requires both the sender and the recipient to have easy access to appropriate software

and hardware. There may be costs and temporary productivity losses when converting to a paperless office. Government regulations and business policy may also slow down the change. Businesses may encounter technological difficulties such as file format compatibility, longevity of digital documents, system stability, and employees and clients not having appropriate technological skills. And, there may be a reduction of paper, but some uses of paper will remain.” For ‘businesses’ read ‘NHS organisations’.

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NHS Committed to a Digital Path Nevertheless, none of the above cautionary notes should be reasons to delay a paperless NHS or paperless board meetings. As long ago as January 2013, the UK Health Secretary, Jeremy Hunt 11 declared that; “The NHS should go paperless by 2018 to save billions, improve services and help meet the challenges of an ageing population…” More of that in the following article but, if that objective is achieved, it would be almost impossible for NHS boards to avoid going paperless as so much of the material that they’ll need to use at their meetings will already be in a digital, electronic form. Importantly, the paper continues to assure patients that self-care does not mean being left alone but can bring enormous benefits, as the next article sets out.

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

A Paperless NHS John Hancock, Editor

Rather than the ‘whole organisation’ transfer originally intimated, paperless working is growing around the system

The trust has reduced its paper output by 100 reams a month by introducing Apple iPads to the boardroom. The board members are dispersed across the borough, which posed challenges in creating, collaborating and sharing monthly board packs that are often 600 pages long

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A Compelling Case In the previous article, Peter closed with the NHS commitment to a paperless organisation by 2018. That commitment, in turn, reflected the findings of ‘A review of the potential benefits from the better use of information and technology in Health and Social Care’12 published by PricewaterhouseCoopers in 2013 for the UK Department of Health. The review highlighted potential… risks, actions and value which amounted to cost savings of c£4.4bn per annum. That is not insignificant and combined with further savings identified in the report for the ‘National Mobile Health Worker Project’13 makes the case for a paperless NHS, including board meetings, compelling. And it isn’t just cost savings. In the article ‘Boosting workplace communication, collaboration with paperless document management’ PaperSave 14 cites a case where, while the paperless solution was initially implemented as a cost cutting measure, “Over time… employees figured out [that] the technology has several other benefits… [and] has also led to a variety of unintended advantages, such as improving collaboration and communication across the workplace…” Even if, as most commentators seem to agree, it is unlikely that the NHS will be wholly paperless by 2018, any moves in that direction will, given the size of potential savings, offer a strong ROI (return on investment) through savings in material costs (paper and printing ink), greater efficiency in production and for people being able to easily access records and material in formats that they can use, as well as the possibility to drastically reduce storage space. The same applies to board meetings, where production of printed material is expensive enough but where also, if anything changes, it is often necessary to scrap the whole pack and produce a revised copy to avoid any board members mistakenly using the wrong version. Plus, storage of electronic records

after the meeting is easy and the format makes subsequent use of the files straightforward.

A Better Way of Working Since that 2018 target date was announced, there has been some slippage with all NHS funded care services expected to have digital and interoperable systems that remove the limitations of paper records and slow bureaucratic systems by 2020. However, according to the introduction to the December 2015 conference, ‘Delivering a Paperless NHS Intelligent Electronic Document Management in Healthcare’15 the Integrated Digital Care Fund reported, “Having access to the right information at the right time enables excellence. It helps professionals document handovers accurately and makes it easier to share information quickly across multidisciplinary teams and with other providers… Access to accurate, timely and comprehensive information can transform the quality and efficiency of healthcare through improved clinical workflows, increased care optimisation and greater patient involvement. It is increasingly the hallmark of a modern, high quality healthcare system...” The timescale has moved but the commitment remains. Importantly, as far as meetings are concerned, board members should understand that electronic material can be just as easily annotated and manipulated as material printed onto paper; in fact, with the arrival of touch-screen technology, that becomes even easier. Over and above that, tablet devices offer users the facility to add ‘sticky notes’, reminders and tabs as well as the ability to add one’s own annotations to the copy and to highlight or circle in red specific blocks of text. There are also ‘briefcase’ apps that allow users to organise papers for themselves.

There are Already Paperless Initiatives Within the NHS, there are areas where the paperless future is the already here. A great


THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

many GP practices have moved to a paperless system, including the Grove House practice in Runcorn where GP David Wilson has headed up a project to digitise records. As reported by Caroline Baldwin in Computer Weekly July 201416, Grove House scanned all its legacy patient records, saving a vast amount of space and time. Receptionists no longer have to search through thousands of folders. Dr Wilson added, “We’ve not used paper records in consultation since 2000. We have 11,000 patients, and the racking space was astronomical, taking up 20 square metres. So we revamped the office space once we went live 18 months ago. Although the documents weren’t used very often, they still needed to be accessed for insurance reports or by solicitors, and medical records never get destroyed. They just grow and grow and grow,” In another article from Caroline Baldwin in Computer Weekly17, she reported on South Tyneside NHS Trust’s move of its board Meetings to the Cloud and explained, “The trust has reduced its paper output by 100 reams a month by introducing Apple iPads to the boardroom. The board members are dispersed

across the borough, which posed challenges in creating, collaborating and sharing monthly board packs that are often 600 pages long. The feedback and approval process via email only caused confusion over who had made what changes to the document. Board members can now access documents via the Cloud collaboration service securely through their tablet devices.” Martin Alexander, director of information services at South Tyneside NHS Trust, says “the organisation chose iPads because they were already used by a number of board members...” So, while the move to a paperless environment might not be as fast as the initial announcement suggested and while some areas of the NHS will not be wholly paperless in the foreseeable future, there are clearly many areas where that technology and philosophy are being embraced and where their value is being realised. Board meetings are an area where there is a clear value to be gained from a paperless solution; not only in the costs and efficiency of producing the board members’ packs but also in the better quality of access to information that a paperless environment allows.

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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

References: 1

Forbes www.forbes.com/sites/venkateshrao/2012/03/13/the-end-of-pax-papyra-and-the-fall-of-big-paper/#54fcfe6d4aca

2

Financial Times ft.com www.ft.com/cms/s/0/10f92696-7f18-11e1-a26e-00144feab49a.html#axzz40XjzWzvF (there is a simple access process for one-time use)

3

Business News Daily www.businessnewsdaily.com/8026-choosing-a-document-management-system.html

Loughborough University, ‘Creating documents suitable for a paperless meeting (Windows)’ http://www.lboro.ac.uk/media/wwwlboroacuk/content/itservices/downloads/filestorage/Creating%20Meeting%20Documents(Windows)V2.pdf

4

5

Officiency http://computerorganizing.com

6

WhatIs.com http://whatis.techtarget.com/definition/Portable-Document-Format-PDF

7

Business News Daily www.businessnewsdaily.com/8026-choosing-a-document-management-system.html

8

Financial Times ft.com www.ft.com/cms/s/0/10f92696-7f18-11e1-a26e-00144feab49a.html#axzz40XjzWzvF (there is a simple access process for one-time use)

9

Computer Weeklyy www.computerweekly.com/news/2240225054/Electronic-document-management-a-paperless-cure-for-the-NHS

10

Wikipedia https://en.wikipedia.org/wiki/Paperless_office

11

UK Department of Health www.gov.uk/government/news/jeremy-hunt-challenges-nhs-to-go-paperless-by-2018--2

12

PWC for the UK Department of Health www.gov.uk/government/uploads/system/uploads/attachment_data/file/217012/DoH-Review-of-Information-and-Technology-Use-Final-Report-V2.pdf

13 National Mobile Health Worker Project http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/health/2013/01/mobile-health-worker/ 14

Paper Save www.papersave.com/2013/03/27/boosting-workplace-communication-collaboration-with-paperless-document-management/

15

Healthcare Conferences UK www.healthcareconferencesuk.co.uk/electronic-document-management-nhs-edm-paperless

16

Computer Weeklyy www.computerweekly.com/news/2240225054/Electronic-document-management-a-paperless-cure-for-the-NHS

17

Computer Weekly www.computerweekly.com/news/2240214610/South-Tyneside-NHS-Trust-deploys-Huddle-on-iPads-for-board-meetings

14 | WWW.PRIMARYCAREREPORTS.CO.UK


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THE PAPERLESS NHS AND THE ROLE OF THE ELECTRONIC BOARD MEETING AND DOCUMENT COLLABORATION SOLUTIONS

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Primary Care Reports – The Paperless NHS & Role of Electronic Board Meeting & Document Collaboration  

The Paperless NHS and the Role of the Electronic Board Meeting and Document Collaboration Solutions - ICSA Boardroom Apps.

Primary Care Reports – The Paperless NHS & Role of Electronic Board Meeting & Document Collaboration  

The Paperless NHS and the Role of the Electronic Board Meeting and Document Collaboration Solutions - ICSA Boardroom Apps.