• Nottingham University Hospitals invests £500,000 upgrading IT equipment
  • Follows consultants’ concerns about digital health record
  • Medical director says trusts aim for paperless hospital in four years

Nottingham University Hospitals Trust has rolled out major software updates and invested £500,000 upgrading IT equipment for a system senior clinicians previously called a “disaster”.

In an interview with HSJ, trust medical director Keith Girling defended the decision, taken before he took the role, to invest £15m into the digital health record system. More than 2.6 million patient files have been sent to a document management company to be scanned with 67 million images uploaded to a viewing system.

He said: “At the time, six or eight years ago, people made the best decision they could with what they had available to them. This is a massive journey of change, we are still not complete and we still have a long way to go.”

In October, emails from senior clinicians, leaked to HSJ, revealed widespread dissatisfaction and concerns over missing records, delays and safety risks.

Since then the trust has made substantial changes to the system with several software updates since the new year. These included improving file indexing so consultants can more easily access what they need and an improved user interface. The DHR involves an average of 3,000 records a day being scanned.

The trust is also integrating the DHR with its wider electronic system Medway, which will be used as a single platform to launch different systems to access tests results, letters, patient histories and other key documents. In the past, each system had to be opened separately.

The trust has invested £500,000 since October to replace more than 380 outdated computers and install 577 dual screens in offices and clinical work areas. The aim is to have no device in the trust that is more than five years old.

Dr Girling said the trust had a four year plan to have a paperless hospital and since the complaints from consultants emerged, there had been a lot of engagement and discussion about what was needed.

He said: “We’ve done a huge amount of work around the DHR, which has had a positive response. We have listened really hard and we have taken action on the big things people raised.

“This is a big step forward. Now [consultants] go into the Medway system and they get access to everything they would need from that place. That is going to save people a lot of time. Some of the concern was that the PCs were not up to running multiple screens so we have done a lot of hardware replacements and now people have dual screens so it effectively doubles the workspace.”

He said the investment had been earmarked for spending but was brought forward and paid from other capital funding slippage.

He added: “The decision to move to a scanned record system must have been taken 6-8 years ago. Going forward we absolutely want to get into a place where clinical noting is done through the electronic clinical record. For many consultants who have grown up with the paper patient record this is a massive change.

“Scanning written records isn’t the be all and end all, but it is a way of moving from a paper record to a future digital record at a time when the technology is changing massively. Our emergency department is already paperless.”

The emergency department has migrated to a paperless record system with notes entered directly onto the system. The trust is identifying other specialties and individual clinicians prepared to work like that rather than imposing it across the board.

Some consultants have raised concerns that entering records digitally will take longer than writing a paper note, which will reduce the number of patients they can see in a clinic.

Dr Girling said the process was a “multi-year journey”. “These are big changes that some people are still not ready for,” he added.

The trust has commissioned a review by EY into the stragegy underpinning DHR following the concern by clinicians, which is due to be published next month.