“Digital services so good that people prefer to use them”, claim the Government.

“The NHS should go paperless”, says Jeremy Hunt.

But what replaces the fax machine when NHS England builds a ‘Bonfire of the faxes’?

It won’t be e-mail.

Clinicians are very familiar with email; they know how it works, and how it fails, when sending patient details between organisations. Even within NHS.net, what works in theory doesn’t necessarily work with how clinicians treat patients. If “NHSmail” is NHS England’s suggestion to clinicians as they ban fax machines, doctors may just use stamps.

Don’t subvert the Summary Care Record

A different option, being advocated by pharmacists – not just outfits like Pharmacy2U, but bodies such as the Royal Pharmaceutical Society – is that many different types of organisations should have the ability to edit a patient’s Summary Care Record.

Not only would this immediately exclude all patients who don’t have a Summary Care Record, it would simultaneously destroy any confidence in the integrity of SCR data, which may then be out of sync with clinical systems – fundamentally undermining the data quality in both, and making them untrustworthy for any purpose. As currently designed, multi-party writable SCR is a terrible idea.

What is Slack for the NHS?

If we look at what pharmacists actually need to do, they need to tell the custodian of the patient’s medical record (their GP) what they did. Maybe it was a prescription change, maybe it was a recommendation, maybe it’s other information. This doesn’t require write access to the SCR. It simply requires a reliable mechanism, knowing a patient’s NHS number (which they have), to send a message to the GP or relevant care provider, with the confidence that it has been delivered.

The NHS knows who the care provider is, so the pharmacist doesn’t actually need to. On delivery, it is up to the care provider to act on that information – or, e.g. to make a clinical decision not to act – and to update their records, which then flow through to SCR. So when the pharmacist next looks at the patient’s SCR, the relevant information should all be there. This is not therefore a matter of creating a new system, or breaking a process that works, but about using existing systems better.

Properly designed messaging can be better than fax for clinicians.

We’ve written a draft paper considering how this might be done, in the spirit of building “Digital services so good people choose to use them”. Comments and feedback welcome.