The deadline for NHS trusts to go paperless looks ambitious, according to many health technology leaders surveyed by the Health Service Journal.
Moving from paper to digital records is one of the biggest projects an NHS trust will have to face, as it changes the work processes for everyone in what can be highly fragmented organisations.
Finding the balance of affordable levels of file preparation to achieve acceptable clinical utility remains a challenge to be resolved. Technology can help, as can learning the lessons of other implementations.
A robust and flexible approach to project management is essential, and several years of being at the frontline of implementing electronic document and records management (EDRM) solutions has taught us the following:
- Prioritise clinical engagement. It is fundamental to ensure that your clinical community are involved from the outset. This includes providing input to the business case, supplier evaluation and selection, prototyping and implementation. A clinical advisory group should be established with representation across as many specialities as possible.
- Enlist the support of a strong chief clinical information officer. The chief clinical information officer (CCIO) will have a good understanding of how the IT strategy will support clinical practice, and what are the main drivers for implementing an EDRM.
- Assess your internal capabilities to establish the level of support you will require from your supplier. When building your internal project team, this may involve recruiting staff on a temporary or contract basis. Consider using internal trust staff that have a good understanding of operational processes to support your transformation team. Your supplier could advise on the expertise required for some of these roles, based on previous experience during deployments. The strength of your internal project team will identify the level of consultancy and support you will need from your supplier. A strong internal project team with limited supplier resources would be more cost effective.
- Get to grips with your forms/documentation. Historically, it is unlikely that your patient notes will contain much barcoded material. Technology that takes an automated approach to indexing will help, and should involve working with clinicians to identify key clinical documents, and then defining recognition rules. However, you should work with your health record committee to identify how ‘scanner friendly’ forms will be designed going forward, and how barcodes will be applied. This will make future indexing and retrieval much easier.
- Appreciate the scale and importance of the scanning challenge.The scanning function is pivotal to the success of your programme. It must be able to keep pace with your local service level agreements (SLAs). Doctors will want to access digitised patient records at least 24 hours before their clinics. New material generated from outpatient and inpatient encounters will also be required promptly. As the roll out of your electronic document and records management solution progresses across your organisation, you may require a flexible scanning arrangement that allows scaling up or down the volume of scanning required to keep in step with your implementation approach. Make sure this is agreed with your supplier. Understanding your activity levels, such as outpatient attendances per day, and the varying case note size depending upon speciality, will help determine the scanning throughput required.
- Measuring benefits. Be realistic about the savings that can be made with the introduction of an electronic document management (EDM)/ electronic medical record (EMR) solution. The following should be considered:
- Estate costs with reduced storage requirements.
- Eliminating/replacing tasks currently undertaken by admin and clerical staff associated with tracking and handling case notes. A centralised function could be established to take on responsibility for clinic preparation and achieve economies of scale.
- Reduction in health records resources versus the scanning resources required.
- Initiatives such as a centralised clinic prep service for ongoing clinic material. This may include scanning incoming referrals in advance of clinic. A number of savings could be made within such services. However, there should be provisions within your forward scanning budget for this function.
- Calculating the cost of not scanning your patients’ records. If you do not implement an EDRM solution, what would be the anticipated growth of your patients’ records and associated cost in health records staff and facilities.
- Make access to information fast and easy to locate. The clinician will not want to wait whilst large patient records/documents are loaded or spend disproportionate amounts of time trying to find key pieces of information or documents relating to last attendance. Work with clinicians to ensure your system is easy to use and performs well.
An electronic document and records management solution will enable savings to be made. However, service leads need to be actively involved in identifying and delivering savings, and a system that meets users’ needs can help make that task easier.
By Phil Burke, programme management lead of IMMJ Systems