Paperless working environment – a logistical nightmare?

I belong to a generation of psychiatrists who have learned to love the computer. We are also apparently proficient at using it and would naturally welcome the era of the electronic patient record.

Over the past few months, some trusts have introduced the RiO system, which creates an integrated electronic care record of patients across London (NPfIT; http://www.connectingforhealth.nhs.uk). The positive impact on our working lives is undeniable once the system is fully up and running: 24 h access to essential information across a wide geographical area would facilitate risk assessments and emergency care planning. We will also rid ourselves of the piles of indecipherable files cluttering our wards.

On closer inspection the trend carries practical implications that are yet to be addressed since investment in computers and related equipment has not followed. Few junior doctors have access to dedicated offices and often six to seven senior house officers share one terminal and an antiquated printer. These juniors, who already struggle to balance clinical duties and academic requirements, will have to find the time and the facilities to input information on a daily basis.

Ideally all doctors should be issued with laptops or hand-held devices. Alternatively administrative personnel could provide instant support to clinical staff. None of these scenarios is likely in the near future in a cash-strapped National Health Service. None the less imaginative solutions are required if we are to avoid the dream of a paperless work environment turning into a logistical nightmare.