Portsmouth's OpenEyes implementation reveals why healthcare digital transformation needs honest evaluation, proper clinical leadership resourcing and realistic expectations about technology efficiency promises.
Like many eye departments across the NHS, we at Portsmouth were drowning in paper. Notes went missing, handwriting was illegible and our storage rooms were becoming health and safety hazards. When we decided to implement OpenEyes the NHS 10 Year Health Plan didn't exist yet, but we knew that moving from ‘analogue to digital’ wasn't just about efficiency, it was about survival.
Six months on from going live, our experience offers honest insights for colleagues considering similar digital transformations. With the recent publication of the NHS 10 Year Plan emphasising digital transformation as central to the NHS' future [1], our early experience might help others navigate what's coming while avoiding persistent myths about technology and efficiency.
The reality of digital transformation: What our staff actually said
Our post-implementation survey revealed the complex reality of digital transformation. While initial adaptation presented challenges, the overall trajectory has been positive. One consultant captured the mixed early experience: "Possibly big benefits for the department and admin but not from a clinical point of view." However, another was more direct about temporary frustrations: "Back to paper."
The learning curve was real but surmountable. Our survey revealed predictable early challenges: 77% of staff experienced system crashes during the stabilisation period, and workflow efficiency initially decreased for some users. One colleague noted, "OpenEyes has probably reduced my productivity by 30 to 40%," during the first months. But the benefits became increasingly clear.
Record accessibility improved dramatically – 82% cited this as a transformative benefit. An optometrist told us it was "Very quick to write up notes with patient present. Very easy to see previous info." Perhaps most tellingly, the system eliminated numerous inefficiencies that paper records had created, including duplicate data entry for medical device recording, implant documentation and surgical checklists.
Why technology rarely speeds us up: The efficiency myth
Our Portsmouth experience reflects a broader pattern rarely discussed honestly in healthcare technology circles. This is particularly pertinent as the NHS embraces new technologies with promises of dramatic efficiency gains.
Technology has always promised to speed us up, but has it ever really delivered? Electronic health records were supposed to reduce documentation time, yet systematic reviews show significant increases in physician documentation post-implementation and echoed in our experience [2]. Will artificial intelligence (AI) be the magic bullet? Recent research from software development provides sobering evidence; a comprehensive study of AI coding tools found they actually slowed experienced developers by 19%, despite developers expecting 24% productivity gains [3]. This perception-reality gap pervades healthcare technology.
This matters enormously for the NHS 10 Year Plan's vision. When ambient transcription – automated generation of clinical encounter records from audio recordings – is sold as enabling clinicians to see "30% more patients," we need to ask harder questions: Do clinicians have the working memory to safely make complex decisions on 30% more patients without suffering ‘decision fatigue’ [4,5]? Are our departments (and car parks) big enough? Are waiting areas adequate? Are theatres ready for more activity? Do we have the administrative support to book 30% more patients? Do we have the failsafe mechanisms in place to avoid losing more patients to follow-up? Digital efficiency in one area often creates pressure elsewhere.
Furthermore, documentation time might be more valuable than efficiency advocates assume. Studies show documentation facilitates clinical reasoning by forcing clinicians to synthesise patient information and make explicit connections between findings and diagnoses [6]. The structured thinking required during record-keeping helps move clinicians from intuitive to analytical reasoning, reducing diagnostic biases. When we rush to eliminate ‘inefficient’ documentation time, we may be removing cognitive processes essential for patient safety.
What successful change management actually requires
The NHS 10 Year Plan emphasises clinician-led transformation, and our predominantly successful experience validates why this approach works – while revealing what it actually requires.
Clinical leadership needs protected time
Our clinical digital lead was fortunate to have digital transformation explicitly in their job plan. Digital change competes with clinical demands unless properly resourced. The NHS 10 Year Plan mentions clinical leadership extensively but doesn't adequately address sustainable funding mechanisms.
Training needs rethinking
Despite significant preparation, staff felt unprepared. One administrator noted, "Training was limiting and not the best. The push back of dates meant it was confusing and harder to commit. I felt the lower bands of admin felt left out with training before the launch." Training takes time, resource and effort, both on the part of the project team but also the end-user. Departments need to recognise this and plan accordingly.
Technical support is crucial
Multiple respondents mentioned inadequate IT support. A nurse requested "at least one person available in the department, as team leaders might not always be present to support the team and address any urgent issues."
Broader system impacts require anticipation
The implementation revealed significant unanticipated challenges, particularly around medication governance and integration with other supporting Trust services such as pharmacy, business reporting and central transcription. Adequate scoping and engagement at an early stage is essential.
Strategic capacity management and honest evaluation
Six months post-implementation, we're seeing the planned trajectory materialise successfully. A consultant reflected, "At one month it would've been significantly increased [time], three months no change and it's probably now 'somewhat decreased time'."
Our outpatient activity data demonstrates the strategic approach we took. Pre-implementation, we averaged 3538 monthly attendances. During the transition period (November 2024 – February 2025), we deliberately reduced capacity by nearly 20% to 2865 monthly attendances, allowing staff to adapt without compromising patient safety. By six months post-implementation, activity is beginning to recover as planned, showing 3276 attendances – a clear upward trend from the controlled reduction period.
Our survey showed mixed results: 41% reported improved patient care quality, 18% saw it worsen initially; 32% saw workflow efficiency improvement, 36% experienced deterioration; 82% reported significantly improved record accessibility; 77% felt data security improved substantially.
Looking forward with optimism
Our OpenEyes implementation demonstrates that specialty-driven digital transformation can deliver substantial benefits when properly implemented. We've moved from a department where notes regularly went missing to one where "all information is in one place." Virtual clinics are now routine, audit capabilities have been revolutionised, and we're better positioned for AI integration that the NHS 10 Year Plan now prioritises for ophthalmology.
The transformation required significant clinical leadership time, sustained training investment, and patience during the initial learning curve. But the results should justify the effort. One optometrist summed up the journey: "Old notes are not missing." Sometimes the simplest improvements matter most.
The future of ophthalmology and the NHS is most certainly digital, and perhaps the Government’s 10 Year Plan provides the policy framework to get there. Perhaps we will meet the Plan’s ambitious targets and avoid repeating the failures of previous national attempts to digitise healthcare [7,8]. But if so, the Portsmouth experience teaches us that we can expect frustration and inefficiencies along the way. Making it work requires clinical leaders properly supported to navigate not just technology, but complex organisational and systemic realities that determine whether digital transformation genuinely improves patient care or simply shifts problems elsewhere.
TAKE HOME MESSAGES
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Clinical leadership for digital transformation must be properly resourced with protected time, not added to existing responsibilities.
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Technology efficiency promises often ignore systemic capacity constraints – increased throughput in one area creates pressure elsewhere.
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Productivity decreases initially before improving; resist pressure for immediate gains during adaptation phases.
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Documentation time serves important cognitive functions for clinical reasoning and patient safety.
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Honest evaluation with realistic timelines is essential – the NHS 10 Year Plan's ambitious goals risk repeating historical failures without adequate implementation support.
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Successful digital transformation requires addressing organisational and resource challenges alongside technology deployment.
References
1. https://www.gov.uk/government/publications/
10-year-health-plan-for-england-fit-for-the-future/
fit-for-the-future-10-year-health-plan-for
-england-executive-summary
2. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016;165(11):753–60.
3. Becker J, Rush N, Barnes E, Rein D. Measuring the Impact of Early-2025 AI on Experienced Open-Source Developer Productivity. arXiv: 2025:2507.09089.
4. Baddeley A. Working memory: theories, models, and controversies. Annu Rev Psychol 2012;63:1–29.
5. Maier M, Powell D, Murchie P, Allan JL. Systematic review of the effects of decision fatigue in healthcare professionals on medical decision-making. Health Psychol Rev 2025;19(4):717–62.
6. Norman G. Dual processing and diagnostic errors. Adv Health Sci Educ Theory Pract 2009;14(1):37–49.
7. https://www.nao.org.uk/reports/review-of-the
-final-benefits-statement-for-programmes-previously
-managed-under-the-national-programme-for-it-in-the-nhs/
8. https://www.nao.org.uk/wp-content/uploads/2019/
05/Digital-transformation-in-the-NHS.pdf
[All links last accessed December 2025]
Declaration of competing interests: None declared.
