09.04.11
Documenting efficiency
Although many trust budgets are tight, a new document management system can help generate better efficiencies further down the line, reports Richard Mackillican
One trust which has seen the benefits of an electronic document management system is the Ipswich Hospital NHS Trust, which operates across a 45-acre site and holds more than half a million case notes.
“The sheer management of this quantity of paper to make sure it is with the right clinician in the right department at the right time is time consuming and difficult,” says Neil Turnbull, head of programme delivery at the trust.
“An electronic document and records management system provided a solution to these issues in an efficient and robust way.
“The system has two main functions; simultaneous multi-user access to historical case notes and the creation of electronic discharge summaries. This has the potential to improve the efficiency of clinicians’ time whilst improving patient safety.
“An on-site scanning bureau managed by trust staff enables the scanning of case notes while preserving availability, security and confidentiality. To date we have around 10,000 sets of case notes in the system comprised of those that were required for clinic appointments, the forward scanning of new notes generated at each patient episode and those from the background task of scanning historical notes to free up space within the medical records library.
“Although the early ambitions for the system were focused on reducing the reliance on paper based case notes, the process of electronically creating patient discharge summaries and delivering them to the general practitioners within 24 hours of the discharge came to the fore. Summaries are now produced for every inpatient attendance and can be added to throughout a patient’s stay until verified on discharge. These are currently printed at a central location for delivery to the GP, but will soon be sent by encrypted email to each practice.”
Electronic document management systems have become popular amongst a variety of industries and there are now a wide variety to choose from. Because of the costs involved, trusts must make sure that they invest in a system which is right for them. So what attracted Neil’s trust to the system they are now using?
“Working with our supplier, we had to ensure that the structure of the notes was retained for familiarity and that changes could be easily made to add functionality over time or to reflect changing practices within the trust.
“It also gives us the opportunity to extend into the management of corporate records to address the storage and management issues which areas such as human resources and finance experience. This would be developed as a separate front-end but using the same core records management system.”
The size of the document management system required by a trust will depend on its own size.
“A key challenge was the scoping of the solution. When developing the custom front-end and supporting logic there was a temptation to keep adding functionality to the point where we had to remind ourselves that we were not trying to develop an electronic patient record but a means to manage our historical paper case notes.
“The other key challenge was one of engagement. Although we had been as inclusive as possible with our invitations to project meetings and communication events, the task of verifying the functionality fell to a few clinicians.
“Once the system had gone live it quickly became apparent that not all clinicians’ needs were met and there were some difficult meetings where the perceived limitations of the delivered system were discussed. Engagement is now one of the most positive aspects of the project and we have been able to deliver some very quick changes to the functionality of the system and have a long-term plan to deliver some real benefits to the key users of the system.
“The availability of PCs on which to view the records was also challenging, but as more notes are added to the system a parallel project of technology refresh and additional equipment will help increase the access to the system. Wireless network coverage is also seen as key to assist with the acceptance of the system.
“There are several benefits to the system which will increase as more notes are added: the increased availability of notes including their simultaneous viewing in multiple locations; the legibility of the scanned documents which can in some cases be enhanced by the scanning process; the security of a digital archive as opposed to a paper one; the removal of manual handling issues; enabling the trust to meet its target of sending discharge summaries to GPs within 24 hours.
“Like Ipswich Hospital most NHS trusts have the same issues with the management of their paper case notes. Many are looking at how document management can help and the approach taken by Ipswich may or may not suit those trusts, but the core challenges are the same.”
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