University Hospitals PlymouthNHS Trust (UHPNT) operates predominantly out of Derriford Hospital in Plymouth (UK), the largest hospital in the South West Peninsula and the region’s major trauma centre. The Trust provides comprehensive secondary and tertiary healthcare, has a secondary care catchment population of 450,000, and a wider peninsula population of almost 2,000,000 people who can access the Trust’s specialist services.
UHPNT is committed to creating a single, secure digital health record for every patient, accessible from any location, at any time. The key to achieving this was to set up an in-house scanning bureau. Rob Harder, Head of IT Infrastructure and Support Services said that there were two significant drivers to begin replacing paper with digitised records. “It’s key that we achieve this objective in line with the Government’s plans for transforming the NHS by achieving a paper-free health and care system. In addition, the volume of paper case notes was about to exceed our warehouse capacity.”
Health Records Manager Vanessa Bennett, said that enabling clinicians to have instant access to records and for the notes to be available in more than one place at any one time, was a key criteria. “Over the years, activity in the hospital has increased significantly. Patients are often treated across multiple departments. We needed to address the problem of paper notes only being in one place at any one time.”
She continued: “Furthermore, our storage facility is off-site, and if a patient was admitted as an emergency, retrieving their paper notes out of hours could be an issue. Electronic information is much more agile and can be accessed at any time day or night.”
“We recognised that digital transformation is not as easy as simply pushing paper through a scanner, it’s considerably more complicated than that, which is why we chose to partner with Alaris to support us on our journey,” Rob added.
We recognized that digital transformation is not as easy as simply pushing paper through a scanner Rob Harder Head of IT Infrastructure and Support Services
Alaris worked closely with the Trust team to confirm and identify the capabilities of the hardware and software to support the Trust’s scanning strategy. “The Professional Services team helped fine tune the solution to make the scanning process as efficient as possible,” Rob explained.
“That’s been a huge benefit. When you are trying to get a scanning bureau up and running you need to ensure that all of the different elements are working together as effectively as possible,” he added.
Once the documents are prepped, scanned, indexed and quality checked, the files are put into a watch folder. “We then use OpenMigrate to push the data into our document management system, Documentum and then they are viewed through Fortrus Unity. Alaris helped us streamline the scanning process making sure we captured the appropriate metadata and, because we use barcodes to streamline some of our processes, they ensured the software was configured to identify those barcodes. All of that really helped with the project in terms of making processes more efficient and effective.” Rob explained.
As part of the digital transformation project, the Trust developed its own scanning application. “This is linked to our use of barcodes in association with our Scan4Safety programme,” Rob said, adding: “The App helps us track paper records through the scanning process. Case notes are pulled from the warehouse, boxed and stored on shelves, each box has a barcode so we know which notes are in which box. With the App, we link the notes in the box to the shelf in the racking, and then we can track them as they are processed through the scanning process, from preparation, scanning, quality check and output, to being placed back on the shelf ready for archive.”
The Trust has been delighted with the quality of the scanners. Rachel said: “Since becoming fully operational we have scanned a total of almost 24,000 case note volumes - just over half of which were for deceased patients - and 20,000 were day forward files.
“We typically process circa 1,300 case notes and 2,000 day forward files each month. Our peak throughput was 3,800 volumes and 2,650 files in January 2018, and the scanners have proven to be robust and reliable throughout,” she added.
The ongoing service and support have also proven to be a value-add. “The engineers are very helpful, they have shown us what to do to eliminate minor issues such as lines on images, how to change settings to make some images clearer, and troubleshoot, plus they will conduct a regular health check to ensure the solution is continuously optimised,” Rachel said, adding: “The best piece of advice we were given was around the importance of keeping the equipment clean. We do a daily clean and weekly deep cleanse - it can be time consuming but saves time in the long-term.”
With this paperless project, the Trust is looking to reduce costs, increase productivity and further improve patient care by providing clinicians with faster access to records. Feedback from the medical staff has been extremely positive. “They really like the ability to access the patient notes when they see the patient instead of having to think ahead and request the notes out of the Records Library,” Vanessa said.
She added: “Another benefit is that once digitised, the patient record can be seen by any other speciality, so whilst the project has to date been centred on Paediatrics and Hepatology, if a patient in either of those specialities is referred to another department, we will digitise those notes as well.”
“Generally speaking clinicians like the ability to access digital patient records but there are issues around the availability of computers in certain locations, so for example, in outpatients departments where patients are seen in small treatment rooms, it can be a challenge to access a PC when space is restricted,” Rob said.
Speaking of the ‘loose filing’ issue that affects every Trust, Vanessa continued: “Because records move around a hospital so quickly, there are inevitably items that don’t always get filed into the notes. These get sent back to the Records Library for filing. We were faced with a colossal backlog of loose filing going back many years - it was a mammoth task and if we had to physically file all the paper documents, we would never have got through it.” Scanning has improved this process.
In addition to the number of volumes cited above, the Trust has also scanned almost 400,000 loose filing sheets. “We have been able to clear the loose filing backlog and most importantly make that information accessible to clinicians. They can now simply logon to e-notes and access missing information - if we receive any loose filing for Paediatrics/Hepatology or ENT, we simply scan it as it comes in now,” she explained.
Rob said that the Trust is currently reviewing the need for back scanning. The reason behind the review is that the back scan is relatively unstructured. “Feedback from clinicians is that for patients with large volumes of notes it’s quite difficult to search through the back scanned documents to find the relevant piece of information they need.”
He continued: “Our intention is to roll out digitised health records to all specialities within the hospital over a three year period. Whether this will be day forward or day forward and back scanning in tandem, will be dependent on the outcome of the review.
“There is a requirement to review the storage capacity within the warehouse and our objective is to reduce the cost associated with physical storage. Once the organisation is clear on its direction of travel, we will be able to achieve these goals, whilst still adhering to NHS Records Management Code of Practice, and being able to pull data in a reasonable time frame,” Rob concluded.
The decision to digitise the records in-house was made in September 2016 and the Trust set up an in-house bureau equipped with Alaris production scanners and Alaris Capture Pro Software. The solutions were provided by Alaris reseller CDW, backed by Alaris’ expert service and support.
Throughout the deployment, Alaris Professional Services supported the Scanning Bureau Team in making the capture workflow as productive as possible. Services included setting up the equipment for maximum efficiency, training staff to use the scanners and software correctly to ensure perfect image quality, as well as providing support in setting up jobs, updating firmware, conducting regular maintenance and changing consumables.
Mindful of the requirement to adhere to the BS 10008 standard, which assures the authenticity, integrity, confidentiality and availability of electronic information, the Trust also worked alongside Elisabeth Belisle, a long-term Alaris partner who set up one of the UK’s first BS 10008-accredited specialist scanning bureaus. Elisabeth provided expert support, collaborated on creating new procedures and delivered hands-on training, thus helping the Trust to work towards achieving accreditation, something it expects to attain by autumn 2019. Once accreditation is achieved, the Trust will be able to start to destroy the paper records.
The team started scanning deceased notes in October 2016. Scanning Bureau Manager Rachael Sargeant, said: “Prior to going live with the project, whilst we were still undergoing training, we decided to digitise deceased notes. We are continuing to scan these records when there is additional capacity in the bureau. This gives us the flexibility to free up space in our warehouse to continue to store paper records until such point as we achieve paperless status.”
When the project went live in March 2017, the bureau scanned live patients’ notes, firstly within the Paediatrics speciality and then, moving on to digitise Hepatology patients’ records. “Our operational requirement for the bureau is to scan live patient notes,” Rob explained. “We started this initiative with these two specialities and we have been back scanning and day forward scanning in tandem.”