Scanning records can ensure the NHS makes best use of past information – and digitising miles of notes is less daunting than it looks. Jennifer Trueland reports
What do you do if you’ve got medical records stretching some 10 miles, taking up valuable NHS real estate over several hospital sites?
You don’t necessarily want to destroy them: even much older notes can contain vital clues to a patient’s condition today and, in any case, you’re creating new records all the time, which need to be housed and which contain information about patients that clinicians need.
The challenge for the NHS is to capture the vast amount of intelligence from the paper documents and make it useful – at the same time as releasing vital space.
A very large record store
‘We had to find a way of managing what was a very large record store – we were going to have to build another building, and didn’t have the capital to do that so we had to come up with another solution’
Aintree University Hospital Trust is one trust to take this on. “We had to find a way of managing what was a very large record store – we were going to have to build another building, and didn’t have the capital to do that,” says Mike Pearson, consultant physician and professor of clinical evaluation. “So we had to come up with another solution.”
Aintree had its medical record library scanned by Capita TDS and, using advanced optical character recognition (OCR) software, added intelligence to the data that was harvested.
The medical records are now electronic, can be accessed by more than one clinician or coder at a time (within strict governance protocols), and have been customised so that the most useful documents can be retrieved within two or three clicks.
The OCR software has allowed the most commonly used forms for each specialty to be recognised and filed so that, for example, the clinician can view the latest echocardiogram and, importantly, can then look at it in context by examining the pages that succeed and precede it in the record. This, says Professor Pearson, gives a sense of the record being in 3D rather than on a 2D screen.
At Aintree, it’s been a big success. It is also taking the trust towards the goal of, if not paperless by 2018, then certainly paper-lite.
Scanning and digitising the paper record seems an obvious thing to do, but past attempts have faltered because the technology simply hasn’t been up to it.
Better than paper
Vijay Magon, managing director of CCube Solutions (developers of the software used by Aintree), has more than 20 years’ experience in the electronic document management industry so is deeply familiar with the challenges of moving away from paper-heavy.
“To get a clinician to move away from paper, that record needs to be as complete as possible,” he says. “In fact, what you have to provide is something that is better than paper. With recognition technology, you can get the software to make sense of the data trapped within the paper record.
“The key is making that information available quickly and easily, so that you don’t have to flick through pieces of paper: you don’t have to search for a record, you don’t have to navigate through endless pages, and you don’t have to press too many buttons to get to the information you need.”
High quality scanning is of course vital, says Neil Murphy, Kodak Alaris’ UK sales manager for document imaging. “Our scanners range from low to high volume as was required on these CCube Solutions projects,” he says.
“But it’s no good having that speed if it doesn’t feed documents reliably – you don’t want documents getting jammed up. Our scanners are designed to feed documents of different lengths and different thicknesses, and are very robust at high speeds.”
Scanning just one set of notes can involve “normal” pieces of uniform A4 paper but can also include results of varying sizes and thickness and even the lengthy document of an ECG tracing. Some can also be hard to read. “We’re looking for maximum image quality,” says Mr Murphy.
He senses that the end of the National Programme for IT has led to an upsurge in interest in scanning and digitising records. “There’s a lot more of this going on now that the national programme has effectively ended. Now there’s the opportunity for individual trusts to find the solution that’s right for them. People’s needs vary, but these are exciting and interesting times, with great opportunities to improve things for clinicians and for patients.”
It can also mean significant performance gains, says Jacqui Page, divisional general manager for surgery with Milton Keynes Hospital Foundation Trust.
Ms Page, who led the trust’s move to digitise its entire patient records library, says the investment is already beginning to pay off in terms of patient safety and cost efficiencies.
‘15 to 20 patients a day were seen without notes or, on rare occasions, had to have their surgery cancelled. Since this project was put in place, there hasn’t been a single patient cancelled because of no notes; that’s a real achievement’
One of the main benefits has been in ensuring that patients attending outpatients are always seen with their notes.
“Like other trusts, our medical records retrieval rate was about 98 per cent – that meant that 15 to 20 patients a day were seen without notes or, on rare occasions, had to have their surgery cancelled. This has been a real transformational project and since it was put in place, there hasn’t been a single patient cancelled because of no notes; that’s a real achievement.”
There was also a space issue, she adds, with the library already holding 287,000 records – just three years of notes.
Previous efforts to digitise had been less than successful. “We had a cull and made the notes available on CD but it was really clunky and the clinicians hated it,” she says.
“We wanted a complete and comprehensive back scan of the records and took the decision to scan them over a nine month period. We outsourced this to Hugh Symons Information Management, but, going forward, we wanted to keep control of patient notes so we have set up an in-house scanning bureau. That means that doctors can still write on paper but it is scanned and becomes part of the electronic notes.”
The benefits are huge, she says, and some were unanticipated. “It’s had a real impact on medical secretary workload. Previously people were knocking on the door looking for medical records, but that’s not the case now.
“It’s also made it much easier to conduct research and do audits – you don’t have to spend ages gathering 200 sets of notes: they’re available on a screen.”
‘My main tip is to be brave: it is achievable, but you have to be focused on the end goals’
That also helps the business side of the trust, she adds, as it’s easier to provide evidence to commissioners. “The notes are available 24/7, 365 days of the year,” adds Trudi Mynard, the trust’s head of patients’ services. “My main tip is to be brave: it is achievable, but you have to be focused on the end goal.”
Getting everyone onside, including clinicians and senior management, is also crucial, adds Ms Page. “You can’t underestimate the amount of encouragement and persuasion; it has to come from the top, and the bottom, and meet in the middle.”
She believes it was important that the change process was led by business rather than IT – but having said that, you have to get the IT right. “Don’t go for the minimum spec, go for the spec that makes it work; you can’t skimp on IT.”
As one of the pioneers of digitised records, Neil Darvill, director of informatics at St Helens and Knowsley Health Informatics Service, is well aware of the importance of good IT.
St Helens and Knowsley Teaching Hospitals Trust began the mighty task of moving to electronic records in 2009 and in 2010 announced it was the first to stop using paper medical records in clinical practice.
Although there were the usual drivers of saving money and improving patient safety, there was another, quite pressing need to make the change: a move to new hospitals without storage for medical records. “It meant we had a hard deadline,” he says. “The logistics were challenging, but it was an incredible project to do and it’s been really quite revolutionary.”
‘We’ve had really good clinical engagement; it has to be designed by and for clinicians. Nobody would go back to the way it was before’
The service has won awards for the system that has seen the creation of an in-house scanning bureau and is now using its experience to offer a fully managed service to digitise Lloyd George records in GP practices.
“We’ve mopped up the bulk of the paper [in the trust] although nursing observations are still done on paper,” says Mr Darvill. “We’ve had really good clinical engagement; it has to be designed by and for clinicians. We’re on version four now and it’s improving all the time. Nobody would go back to the way it was before.”
So while fully digitised care records may be the future, the experience of these three trusts shows that the path to that future includes making the best of the paper records that we already have.