December 19, 2014 - To save money through the closure of its large off-campus records library whilst enhancing patient care through clinical and operational efficiency, Kodak Alaris announces that Basildon and Thurrock University Hospitals NHS Foundation Trust has completed deployment of a trust-wide electronic medical records [EMR] system in a project costing a total of £6.5 million. This has seen 450,000 patient case notes digitized - around 54 million pages - with all departments now ‘live'.
Phil Burke, the trust's EMR programme manager, says, "The main thing was to install a system and scan the medical notes without disrupting the running of the hospital. The shift from paper to electronic records is a huge business change initiative. It's not just a case of introducing IT and scanning. Our transformation team has had to understand the intricacies of each medical specialty and how they interact with the notes given the patient flows around the hospital. Our system has then been designed from the ground up to meet our specific needs given there was no off-the-shelf solution that met our requirements when we first started evaluating solutions towards the end of 2009."
The new EMR solution comprises various components including Mobius medical records software from Fortrus, Laserfiche's EDMS, Adobe Livecycle workflow and eforms technology, with the actual notes scanned using both Kodak production scanners and ibml ImageTrac Lite equipment.
Easier working with clear ROI to be realised
In close collaboration with its advisory group of 14 clinicians, the EMR project team defined around 50 key [medical] document types and is using a combination of bar codes, OCR and manual input to recognise, index and date documents so that they are presented in the context of each patient episode. The EMR is also split into chapters such as correspondence, nursing, observations, investigations and so on.
Ian Linehan, lead clinician on the EMR project, says, "The big issues we have solved are first implementing a system so that historical patient information is accessible and usable, and second managing the change process carefully. We have made the records more accessible by dating and indexing documents to avoid the clinician seeing information presented in an unstructured way. System acceptance has been achieved by involving staff, avoiding a ‘big bang' roll out, testing it in restricted areas to address any issues and adding value by incorporating other benefits where we can. So, when you look at the EMR, you get immediate access to bloods, pathology and X-ray reports without having to revert to other IT systems."
The Trust expects to realise significant return on investment [ROI] by the closure of its medical records library - located three miles away from the hospital campus at Sovereign Park - which it doesn't own, thereby saving on leasing, general overhead and transport costs.
Burke adds, "By closing the leased record library and the associated health record staff savings, we are already seeing a significant return on our investment. However the business case doesn't fully reflect the cost of doing nothing. Our patient records are expanding by 20 per cent annually with new material relating to attendances. If we had not started scanning back in 2010, by now we would have outgrown our record library and would have needed to move to much larger accommodation. Our next major challenge is to move from paper lite to paperless across the Trust by enabling the direct input of patient data into our EMR."
Paper not fit for purpose in a modern health economy
Working with physical records in a hospital context presents a whole raft of issues as below which are being completely addressed and removed by shifting to an EMR system:
- Paper records can't be shared synchronously among clinicians who often work in multi-disciplinary teams to provide patient care or who need to access them remotely;
- For the very sick who visit outpatients regularly, paper records often don't keep up as they are often with the previous specialty secretary for letter typing;
- Records are not immediately available out of hours for emergency admissions.
- Records have to be retained long term - in some cases up to 30 years - yet physically deteriorate over time.
- Paperwork captured and filed is growing, driven by the need to document every patient event for clinical and legal reasons;
- Tracking, security and auditing is limited with paper compared to electronic notes.
Burke says, "Our staff are using the records for different reasons both medically and operationally and quite often a patient's notes will come under close scrutiny."
To meet BS10008 rules, the EMR team worked closely with the author of the standard to confirm that its procedures are fully in line with his guidance such that the actual paper can be destroyed once digitized. Two versions of the electronic record are available: one is a straight replica which shows the paper record as it was originally filed. The other is for clinical use with blank pages removed, misfiles sorted and everything fully indexed.
More scanning processing throughput the driver behind the ibml purchase
Utilising both its Kodak and ibml scanners, the Trust is digitising everything, adopting a mix of archive scanning to remove all records at Sovereign Park, along with forward scanning so that new medical paperwork is then processed and incorporated into the electronic patient record.
To do this, the Trust is using its scanners in different ways. The Kodak devices deal with paperwork that has deteriorated extensively given their ability to cope with a myriad of paper types and quality. Supplied by Kodak Alaris along with a comprehensive service and support contract, new ibml ImageTrac equipment has been installed to ramp up throughput capacity and put in place a solution for the future.
Historically, the EMR team was processing 40 to 50,000 sheets per day, but this was boosted to 100,000 in order to clear the library by July 2014. Ultimately, the ibml equipment will be used primarily in a forward scanning context given its throughput power to process new notes super fast and enable the EMR team to meet its internal service level agreement which is one day for inpatient material and three days for outpatients.
Ashley Keil, ibml's sales director, commented, "Scanning in a hospital environment is pretty punishing for a scanner given the volume of paper to deal with per shift. Availability is key and our scanners are designed to be robust and trouble free."
To date, 2,500 staff have had EMR training which, in addition to product training, explains how people should prepare before clinic and how notes are then to be managed.
Neil Murphy, Kodak Alaris' UK sales manager says, "In mid 2010 when Basildon and Thurrock University Hospitals formally started its EMR project, few trusts had grappled with digitising records. It was therefore a high risk, high reward project and the decision to do it well founded given Jeremy Hunt's mandate that by 2018 all trusts should be paperless."
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