Electronic document management (EDM) has become something of a hot topic for many types of NHS managers, including clinical, administrative and nursing, not least because of the floor space that can be saved from dumping paper files. But there are multiple benefits that can be derived from implementing a purely electronic data capture and processing system at all points involving direct and indirect patient care.
Before a trust can enjoy the benefits of electronic collation of patient data and its metrics, however, the main thrust of any EDM system has to be the digitisation of patients' medical care records. This process is already under way at the Mid Yorkshire Hospitals NHS Trust, which was formed in the spring of 2002 from the former Pinderfields and Pontefract Hospitals NHS Trust and Dewsbury Health Care NHS Trust.
Most of the trust's service are provided through three main hospitals - Pinderfields General, Dewsbury and District, and Pontefract General Infirmary - along with a variety of day-care and out-patient services at Clayton Hospital in Wakefield.
According to Paul Curley, a consultant and the clinical lead director for information management and technology, the trust is now well into scanning the estimated 144m documents in its paper medical records library, following the signing of a contract with the EDM Group at the start of 2009.
The trust is scanning 350,000 documents per day, with the initial stages of the process concentrating on those patient records that have not been accessed for five or more years. By focusing initially on dormant records, staff do not need to access the electronic system. However, Curley says that by September or October of this year staff training on the e-records system will have started, preparing the way for increasing accesses to electronic, rather paper, patient data.
The work is being overseen by project management company Arena and split between the software company, Gateway, which is supplying its WinDIP application and EDM Group, which is providing the scanning facilities.
The project is driven by the fact that two of the trust's units, Pinderfields General and Pontefract General Infirmary, have new buildings opening in 2010-11 which will not have resources for paper medical records. Nor, says Curley, do they have room for trolleys to deliver any paper files. The units will be all-electronic, he says.
By the time 2009 ends, he adds, more and more medical record accesses will be carried out on an electronic basis, meaning there will be a reducing requirement for delivery trucks to shuttle unscanned paper records to the health units concerned.
In parallel with this gradual shift to electronic medical records, Curley and his team are overseeing the parallel planned move to electronic records at the point of input, and are helping to design the IT systems to support this brave new world. Central to the electronic capture of data at point of care and service provision will be a clinical portal, into which all data is routed or input, with staff being able to 'drill down' to specific patient services such as pathology and blood tests.
Once the migration to purely electronic collation of data for records has taken place, Curley says the trust will be able to enjoy the rich functionality of being able to capture data electronically. But, he adds, the logistics of going down this path are complex, since until a couple of years ago, the designs for the two new units at Pinderfields plus Dewsbury and District did not include a wireless data option.
Wireless data delivery, he says, is the way forward, as there are always going to be limits on the number of hard-wired points that staff can use. And, he adds, with wireless staff can start to use portable systems to access patient records at the bedside and on the wards.
Learning from Oxford
Another trust implementing EDM technology is the Oxford Radcliffe Hospitals NHS Trust, one of the largest teaching trusts in the country. For the last two years, it has enjoyed the benefits of its Electronic Immediate Discharge Documentation (eIDD) - the electronic version of the patient discharge letter and medication summary.
eIDDs are generated by all medical and non-medical prescribers, including pharmacists who transcribe, and are authorised by clinical pharmacists. After processing, eIDDs are sent to GPs through an electronic in-tray that they can access on their practice PCs.
The aim of the system is to help Oxford Radcliffe meet the target of ensuring that GPs receive a patient's discharge information within 48 hours of the patient leaving the hospital. The trust says the eIDD system provides a single, simple, swift and standard system that aims to improve both the accuracy and quality of discharge information, as well as ensuring that this information is dispatched quickly and efficiently.
Data held on each eIDD record includes lab results (bloods and x-rays), dietetic letters and data collated from paediatrics, gerontology (services for older people) and chest medicine patient care.
According to Matthew Johnson, a spokesperson for Oxford Radcliffe, the development of the eIDD system is a continuous one, with senior staff from all the health care disciplines involved in the process of adding new features, removing older ones that are not fully utilised and making its operation more efficient.
"We also have a good feedback mechanism that allows us to develop the system to everyone's benefit. We can change the system (rather than the supplier) and this is very positive," he says.
He added that the development of the eIDD system has been helped by the fact that GPs have been involved in its design and development from day one. This, he explained, is why the system has been so beneficial in bridging the gap between primary and secondary care health care provision for patients.
