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This transformation will involve enormous changes in culture, structure, governance, workforce, and training.

But none of the changes are likely to be as sweeping, as important, or as challenging as creating a fully digitised sector began digitising in the 1980s, and by the mid-2000’s was nearly 100% digital.

In fact, cost savings may take 10 years or more to emerge (the so-called ‘productivity paradox’ of IT), since the keys to these gains are improvements in the technology, reconfiguration of the workforce, local adaptation to digital technologies, and a reimagining of the work.

To rectify this gap, not only will there need to be satisfying, sustainable positions available to field itself must also be strengthened and grown.

Health IT systems need to evolve and mature, and the workforce and leadership must be appropriate for this task.

While patient safety is non-negotiable, regulators and commissioners need to have a degree of tolerance for short-term slow downs and unanticipated consequences in the period following electronic health record (’s digital strategy should involve a thoughtful blend of funding and resources to help defray the costs of IT purchases and implementation, resources for infrastructure, support for leadership and informatics training, as well as support for education of leaders, front-line providers, trainees and clinician- and non-clinician informaticians.

There must be a major effort to place well-qualified clinicians with advanced informatics training in every trust.

The Advisory Group estimates that an average-sized trust needs at least 5 such individuals on staff. In considering whether to offer government money to subsidise digital implementation in a trust, close attention should be paid to the adequacy of the trust’s plan to hire and support this clinical-IT workforce.

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