Four-fifths of NHS trusts still using pen and paper for record keeping

Twenty-five years after the government's initial push to digitize the National Health Service (NHS), a study by The BMJ reveals that only about a fifth of England's hospital trusts are employing fully electronic systems for clinical record keeping. According to responses to freedom of information requests, just 39 out of 184 trusts (21%) reported using paperless systems for documenting patient notes, while 79% still rely on pen and paper to some extent.

Only 45 trusts (25%) reported using fully electronic systems for prescribing medications. The figures have remained largely unchanged since a similar BMJ audit conducted in 2023, indicating that the push towards digitization in the NHS continues to stagnate. Many trusts that reported a hybrid system of electronic and paper patient notes are planning to transition to fully electronic systems in the future.

Despite the potential benefits of digital systems, such as easier information sharing, enhanced data security, and improved patient care, the progress towards full digital adoption remains sluggish, with some transitions spanning three decades. For instance, patient notes at Salford Royal have been digitized since 2000, while trusts in Leeds and James Paget have been in the process since 2003 and 2012, respectively.

Some fully electronic trusts still employ paper to record patient notes in specific departments. Even among trusts using fully electronic systems, nearly a third utilize two or more programs, with one trust employing six different systems. Doctors using these systems express frustration, stating that navigating multiple systems is a significant clinical and administrative burden, particularly for trainees who rotate every four to six months.

Dr. Pritesh Mistry, a fellow in digital technologies at The King's Fund, attributes the slow progress to funding constraints, complex implementation timelines, insufficient hardware, and user-unfriendly interfaces. Dr. Izzie Jordan-Evans, a Foundation Year 1 doctor at University Hospitals Sussex NHS Foundation Trust, adds that working with paper systems feels increasingly archaic and can lead to clinical errors.

The government's new 10-Year Plan for the NHS aims to shift focus towards AI-powered ambient voice technology (AVT) to automate clinical note-taking by 2035. A 2025 trial of AVT at Oxford University Hospitals reported a 87% reduction in documentation time for nearly all users, with more than half saving at least 30 minutes per day.

However, critics argue that relying on AI for documentation may shift accountability away from AI developers and onto clinicians, raising safety concerns. Regardless, the risks associated with technology failure or cyberattacks suggest that paper will likely remain an essential backup option to maintain services, even after 2035.

Both NHS England and the Department for Health and Social Care acknowledge that trusts progress at different speeds but reaffirm their commitment to digital transformation to deliver safer, more integrated care.