The Rush Towards a Paperless Health Service: Stop the Music

I have written repeatedly on the harms that bringing IT into the consultation room can bring. I carried out a trial of computerised data entry during consultations showing that it undermined the clinician/patient relationship – this was over three decades ago.[1] This finding has been replicated many times since, with vivid accounts in Bob Wachter’s outstanding book.[2] It turns out that having to use IT during consultations is one of the main causes of ‘burn-out’ among doctors in the USA. A recent NIHR Programme study, in which CLAHRC WM collaborated, showed that IT is likely undermining patient safety in some aspects of practice (diagnosis; personalised care), even as it improves it in others (prescribing error).[3] Meanwhile, Fawdry has repeatedly argued [4] that the problems in integrating computers across institutions arise not because the IT systems themselves are ‘incompatible’ or because we do not have common ‘ontologies’, but because the underlying medical logic does not synchronise when you slap two systems together. Data in records can be shared (lab results, x-rays, etc.), but that is different to sharing records. So, do not force the pace – let a paperless system evolve. Apply the CLAHRC WM test; never implement an IT system module until you have examined how it affects the pattern of clinician/patient interactions in real world settings. We are sleep-walking into a digital future and completely ignoring the cautionary evidence that is becoming stronger by the year. Remember, nothing in health care – and I really do mean nothing – is as important as the relationships between clinician and patient.

— Richard Lilford, CLAHRC WM Director


  1. Brownbridge G, Lilford RJ, Tindale-Biscoe S. Use of a computer to take booking histories in a hospital antenatal clinic. Acceptability to midwives and patients and effects on the midwife-patient interaction. Med Care. 1988; 26(5): 474-87.
  2. Wachter R. The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. New York, NY: McGraw-Hill Education. 2015.
  3. Lilford RJ. Introducing Hospital IT Systems – Two Cautionary Tales. NIHR CLAHRC West Midlands News Blog. 4 August 2017.
  4. Fawdry R. Paperless records are not in the best interest of every patient. BMJ. 2013; 346: f2064.

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