09.04.11
The electronic medical record – myth or reality?
Dr. Vijay Magon explains how NHS trusts, working closely with suppliers, can realise tangible benefits by careful use of existing technologies to successfully deliver the electronic medical record
Most NHS sites hold patient related data on a variety of different media such as paper, microfilm and digital.
Although some areas have introduced bespoke databases allowing storage and audit, the majority rely on more traditional means.
It is currently very difficult to identify exactly what information may be held on a given patient. Some departments compile their own copy of the patients’ medical records, specific to their department’s needs, with the main objective being access to information when it’s required.
This practice has resulted in falling standards for the timely filing of patient related documentation in the patient’s acute medical record, increasing risk and leaving patients and clinicians at a disadvantage.
Hospital data systems hold a wealth of patient information yet data entry is duplicated on a daily basis as secretaries have no facility to directly populate electronic documents such as letters generated on their own PCs. Using IT in this area alone would deliver real benefits to secretarial staff and improve data quality.
Is the holy grail of the single, integrated, electronic medical record achievable?
To address this, electronic document and records management (EDRM) systems offer the chance for trusts to evolve their practices and embrace a culture of effective and compliant information management practice. EDRM should be seen as a key component of the wider enterprise content management (ECM) framework which includes web content management, document and records management, electronic forms, process automation and management, collaboration and compliance processes.
ECM is essentially a conceptual framework for centralised information access, creation, management, and standardisation of business processes. There is no magic bullet solution – just a common sense approach which focuses the available technologies on specific business processes to ensure that the solution delivers what is expected of it.
The process is a migratory one which promotes a trust-wide information repository with newly created clinical documents being ‘born’ onto the repository whilst ‘legacy’ information is scanned and digitised in a staged manner. While there is some ‘lag’ time in this process, a strategically planned implementation should lead to harmonisation with minimal disruption to the day-to-day business.
EDRM facilitates the electronic transfer and storage of documents and ensure high levels of security and audit. EDRM is, however, much more than an electronic filing system - EDRM is likely to become as ubiquitous and as pervasive a part of an organisation’s enterprise application infrastructure in the coming few years as database management systems have been over the past two decades. Database management systems based on open standards enabled organisations to move away from proprietary, legacy systems and opened up options for inter-operability. Similarly, EDRM will enable organisations to minimise dependencies and process in-efficiencies due to paper and ‘information silos.’
A holistic approach…
Medical records in the health sector traditionally consist of large paper volumes and a variety of media types. Departments manage records internally using technologies such as imaging, document management and, in a few cases, work flow.
OITUK believes that NHS trusts must adopt a more holistic approach for content management - to develop and provide integrated solutions that use EDRM as the underlying technology to capture and deliver electronic patient information at the point of care.
The returns from investments in EDRM (e.g. process and staff efficiencies, standardisation, automation via workflow, etc.) are being realised through careful application of this technology to address the needs of key users who deliver medical care rather than short term measures to solve paper problems. Key users include clinicians, secretaries, administrators, etc. Each places specific demands on the medical record and each of these demands must be addressed.
The core technology has been around for over 30 years and is in use across many industry sectors. While this is not rocket science, its use within any particular sector cannot be generic, ie. it is not ‘out-of-the-box.’ Consequently, its selection and implementation are complex and open to costly miscalculations.
Selection
Following many implementations at NHS sites, through close liaison with healthcare users, OITUK believes that any solution must support the following three key components:
Document capture isn’t just about capture of paper records to cut through backfile issues. The increasing proportion of patient information received and generated electronically mandates import of electronic content from other hospital systems to eliminate document folders scattered across storage servers and ongoing generation of new clinical documents (eg. correspondence), including use of online electronic forms for capturing clinical data with little or no dependency on paper. It is vital to understand that simply digitising paper records is not enough – the solution must offer facilities to stop producing new paper through generation, management, and integration of ongoing (electronic) records - in order to minimise or eliminate the paper chase.
Management and systems integration : the document is the vehicle for content which must be searchable and integrated with the core hospital systems and practices. Its management has to encompass the document life-cycle which includes day-to-day record management (including security) as well as retention and destruction in compliance with legal guidelines.
Multiple healthcare departments are working with the public to extend healthcare services and streamline operations – but must operate within the laws of the Freedom of Information Act, the Data Protection Act, The National Archives regulations and civil procedures rules on electronic discovery surrounding the issue of storing and safeguarding crucial information applies to all businesses across all sectors.
Data merely stored on computer hard drives or paper-based filing systems are particularly vulnerable to loss or destruction. Failure to manage electronic documents as formal corporate records will mean that organisations will not be compliant with government legislation. Compliance demands at the very least a high level inventory of a company's information assets and investment and careful application of available technology.
Patient information also resides on many disparate systems within trusts – information that is relevant to the patient and should be presented along with the digital record at the point of care.
The electronic medical record cannot sit in a document management system that remains un-connected with other hospital systems and processes. A key role of any solution must be to enable exchange of patient information between various and numerous hospital systems. Consequently, the connection flexibility is essential in order to be able to adapt and send, for example, a patient test result or receive a patient order in the appropriate format from one system to another.
Delivery: to be optimally effectivethe electronic record has to be delivered to key users when and where they need it. The problem is that there isn’t a single user type within any trust. Each organisation will have many different user roles, each with their own specific requirements and, consequently, their specific need for patient information. A solution which offers a standard interface for all users will provide limited functionality to most users, especially those who work under time constraints and under pressure – these users care less about the back-end processes! IT solutions must recognize this and ensure that the patient information displayed on a screen is meaningful to the user and the user’s role. Such a model can be readily extended to include relevant third-parties engaged in delivering patient care, such as GPs, social services etc. to share and collaborate.
The clinician’s role in a time-pressed clinical environment places high demands on systems. Clinicians want integrated systems that help manage relationships with their patients and accurately track their medical history. This demands, at the very least, functionality to rapidly locate medical records, quickly navigate through records, generate and respond to alerts, consult with patients, update notes, and submit follow-up actions – all without switching between (too many) disparate systems and screens. The requirements placed on EMR solutions are challenging and demarcation-lines between systems must not present brick walls.
Implementation
The implementation approach behind any IT solution is just as important as the technology employed. Given the bad press about large scale IT implementations, two valuable lessons must be learnt:
(a) not all trusts are ready for the top end solutions – each must accommodate the technology and its implementation gradually to suit a number of local conditions including budgets, IT infrastructure, user training, etc.;
(b) a core application cannot be driven top-down without involving the people who will actually use it and held accountable!
OITUK works with companies and organisations across the public and private sectors - clients including NHS trusts, local authorities, law enforcement agencies and the private sector. The common theme running through all these customers is their need for a robust, legislation compliant information management system, which acts as a hub for vital information which can be accessed and archived at the touch of a button and deliver information to those who need it, when they need it.
An approach based on evolving long term partnerships has proved successful time and time again - to understand the objectives and requirements and liaise closely with the key stakeholders to design, build, deliver, and support successful IT solutions for the electronic medical record at a pace that suits the trust.
The underlying technology…
OITUK have an established track record in providing and implementing EMR solutions using EDRM as the underlying technology. At the core of the OITUK solutions is the award winning C-Cube suite incorporating work flow, electronic forms, electronic document, records and content management.
From hospital wards to local council planning departments to the leading edge in the fight against organised crime and international terrorism, OITUK is helping to demonstrate how EDRM is making real and lasting changes to the way information is stored and managed across the UK and beyond.
BOX OUT
The full scope of the C-Cube integrated document and records management suite includes:
■ Electronic document management & integrated workflow
■ Internet/intranet/extranet delivery
■ Standardised patient letter generation & management
■ Web based electronic forms processing
■ Electronic records management & legal compliance
■ Storage management and archiving
■ Content search & knowledge management system
■ Web portal-based solutions
■ Microfilm/microfiche handling
■ XML and HL7 based application integration
■ Collaboration facilities
T: 01908 677752
F: 01908 679444
www.oituk.com
Dr. Vijay Magon is managing director of OITUK Ltd
Tell us what you think – have your say below, or email us directly at [email protected]