Why was change needed?

Lewisham Sexual and Reproductive Health (SRH) service is one of the largest in the UK with approximately 60 000 attendances a year. It works from four centres spread across a deprived inner-city area of London. In 2008 we changed to an electronic patient record for the following reasons.

▸ We ran out of space. In 2007 it became obvious that the approximately 80 000 sets of paper notes that were kept in the four centres were presenting an insuperable storage problem. We also had the occasional misfiled set of notes, which presented a clinical governance risk.1 ,2

▸ We needed to be able to produce data for audit and mandatory reports more flexibly than was possible with paper records. Our previous system of recording data (on an optical reader sheet that was scanned and then analysed) was far too time consuming and could not be changed as requirements altered.

▸ We needed to be able to see all our records in all four of our centres. Many of our patients use our centres interchangeably and this led to frustrations and inefficiencies, not least because of the time taken for notes to be transported between clinics. Our senior nurses now lead more clinic sessions; telephone advice from senior doctors is safer if the doctor can see the complete record from a distance.

▸ We needed to employ staff more efficiently. One important consideration for us was that the administrative staff could be freed up from mundane chores such as preparing blank sets of notes, and be able to devote more time to front-of-house work and to managing our increasing numbers of pathology results (e.g. those from the chlamydia screening programme); 38 hours of results management per week were gained in this way.

What changes did we make?

We investigated several information technology (IT) systems …