The NHS still relies heavily on paper notes, with experts warning they are not as safe or efficient as electronic records.

It comes after a survey by the British Medical Journal (BMJ) found the majority of NHS trusts are still using paper, despite 88% of all trusts in England being equipped with electronic patient record (EPR) systems.

Of 182 trusts, 4% said they only use paper notes, while 25% are fully electronic. Some 71% use both paper and an EPR system.

Of the 172 trusts that responded to questions on prescriptions, 9% said they only use paper drug charts, 27% are fully electronic, and 64% use a mixture.

Writing for the BMJ, freelance journalist and doctor Jo Best argued that the continued reliance on paper is less safe and efficient, while difficulties around sharing electronic records could be preventing even the most advanced trusts from realising their full potential.

The publication also said the quantity of paper generated by NHS trusts can be “staggering”.

One example is Barking, Havering, and Redbridge University Hospitals NHS Trust, which estimated it generates 25 million pages of A4 each year.

Speaking to the journal, Tim Ho, a respiratory consultant and medical director at Frimley Health NHS Foundation Trust, said electronic systems are a “transformational tool to change how you work”.

He added: “Having information quite literally at your fingertips on your device means you can remotely work with information in a secure way.”

The “digital transformation” of the NHS was outlined in the Long Term Plan, which was launched by the Government in January 2019.

That same year, then-health secretary Matt Hancock called for email to replace paper and fax machines in hospitals.

However, earlier this year a report from the Health and Social Care Committee warned that parts of the NHS lack “the most basic, functioning IT equipment”, with progress on digitising the health service “slow and uneven”.

Despite the advantages of technology, Ms Best argued that sharing paper notes can sometimes be easier than sharing information over electronic systems.

Dale Peters, senior research director at technology analysts TechMarketView, said: “We always talk about the NHS having this unrivalled data set, but actually so much of that data is locked away in proprietary systems and in formats that aren’t compatible with the other data.

“Until we have those interoperable systems, we’ll never really see the benefit of having that sheer amount of data. Without interoperable electronic systems, the NHS will also not be able to benefit from upcoming technological advances such as artificial intelligence.”

Pritesh Mistry, policy fellow at the King’s Fund, said EPRs could one day feature clinical decision support.

“There’s a lot of potential there, but it does depend on the quality of the data and the analytical smarts of the systems,” he said.

NHS England has been approached for comment.