St Helens and Knowsley Teaching Hospitals NHS Trust has been prompted to move to electronic records by its large scale rebuilding programme. It currently has around 1m case files in its health records library, containing an estimated 250m paper pages, and expects the gradual transfer of records to the electronic system to pay for itself within two and a half years.
Neil Darvill, the trust's director of informatics, told SmartHealthcare.com that the project's priority is quality of care, through ensuring records are available virtually all the time. "Logistically, it's difficult to get all the paper in the right place at the right time," he said, with paper records being available around 98% of the time, at great cost in transporting the files. Although the project fits well with the move to new buildings, "we would have done this anyway".
In the departments where it has been introduced, Darvill says the scanned records are available nearly 100% of the time. The EDMS, which uses Eastman Kodak scanners and OITUK software, is provided to staff through laptops issued to every consultant and on powered trolley computers with screens large enough to show A4 pages at full size. It is hosted on two independent systems and can be powered through the hospital's emergency generator.
When someone is due to have an outpatient's appointment their paper record is retrieved and scanned, with staff inserting barcode pages to mark the start of sections of the record. From then on it is an automated process: the software reads the barcodes and creates a structure for each patient's file.
The trust has so far scanned 50,000 records. The process was first introduced in the respiratory, dermatology and ophthalmology departments, and has since been taken on by rheumatology, cardiology and gynaecology. Accident and emergency will follow, along with a data entry interface allowing new electronic records to be added to the system.
Two GP surgeries out of 92 using IT supported by the trust are also piloting the system. "The GPs find it incredibly useful," said Darvill. "It helps them with their patient safety and quality of care." They get access to the full patient record - except data from the genito-urinary medicine clinic, given its sensitivity - which means they do not have to wait for discharge letters to see what happened to the patient in hospital. The trust is planning to add a GP user interface.
When asked about how the system fits with National Programme for IT systems, Darvill said: "It complements it, rather than fits. This kind of solution isn't on the NPfIT radar, really." He added that the trust is not planning to be an early adopter of any of the programme's systems: "We're not going to guinea pig anything."
Darvill said that the trust has been checking every page of "the key clinical chapters," of scanned records, finding error rates below 1%. This includes handwritten diagrams, typewritten letters and electrocardiograph traces up to 10 feet long. The trust has moved scanned files to store, and is planning to destroy them.
He added that the staff scanning records were initially located within the paper documents library. Although this was convenient, they tended to be diverted to dealing with paper files. As a result, the scanning has since been moved to its own office, allowing a steady production line process. "It's been the catalyst that made it fly," Darvill said, advising others carrying out such a project to separate the scanning from the library from the start.
However, he added that the library will soon be half empty, and the scanning will eventually be moved back as staff will have enough space to avoid distractions.
