November 20, 2013 – CCube Solutions today announces that Milton Keynes Hospital NHS Foundation Trust continues to realise savings as a result of investing over £2 million to digitise the Trust’s entire patient records library. Since the electronic document and records management (EDRM) project went live in all outpatient clinics three years ago, it has delivered a cumulative £1 million saving against previous levels of spend, and continues to deliver recurrent cost savings as outlined in its original business case.
Trudi Mynard, Milton Keynes Hospital’s head of patients’ services says, “The EDRM project is all about improving the quality and accessibility of patient notes to assist clinicians. It also releases space, saves money and puts in place technology to support the hospital in the future. This is especially important as the NHS is challenged by the health secretary to become paperless.”
The cost savings will be realised as the Trust has reduced the headcount of its medical records staff by over 35%. In addition, it has made other administrative processes more efficient and repurposed the use of its library building.
Working in partnership with Hugh Symons Information Management (HSIM) who provided bureau scanning services, the Trust has digitised 287,000 patient records each containing on average 200 pages. This totals some 57.4 million images. The project started in August 2010.
The digital records management project helps the Trust meet its key organisational objectives to increase patient safety, improve the patient experience and enhance clinical effectiveness.
Occupying one 60 hectare site to the south of the city, Milton Keynes Hospital is a medium sized district general hospital that serves Milton Keynes and surrounding areas providing a range of general medical and surgical services including accident and emergency (A&E). Employing around 3,000 staff, the hospital has approximately 400 inpatient beds and treats 200,000 outpatient episodes per annum, 20,000 elective patients, as well as handling 70,000 A & E visits.
CCube Solutions was chosen as Milton Keynes Hospital’s EDRM software supplier given its response to a thorough tender process; feedback from clinicians after they attended a demonstration, and medical records staff visits to other hospitals to see its system in practical use elsewhere.
Further to input from clinicians, CCube Solutions created an electronic version of the medical record to mirror the format of the paper notes. All clinical correspondence is stored in the EDRM system along with colour photographs, ECGs[1] CTGs[2] and reports. The system is intuitive and easy to use which has enhanced clinical acceptance of it.
The digital record features a series of tabs similar to the paper file, along with a variety of sub sections to help navigation. For example, within individual tabs, the subsections enable clinicians to find important information like consent forms and operation sheets quickly and easily – documentation they regularly need to review.
Dr Ijaz Mehdi, Associate Medical Director and member of the EDRM project board, said, “This has made a big difference to us because we can access and review the notes any time enabling us to improve patient care. For example, we may have a patient arrive at A&E or the Medical Assessment Unit with chest pain. Before EDRM, the previous ECG would not be quickly available for us so we could not compare and confirm if the changes were new or old. Now we can immediately see the difference, correctly diagnose the condition thus enabling us to provide appropriate treatment that could be life saving.”
The EDRM solution is accessed throughout the hospital in clinics, wards, offices, operating theatres, on wheeled trolleys and tablets. All authorised staff have access to it once training has been given.
Dr. Mehdi adds, “As another example, I was recently in discussion with some radiologists. They commented that previously they did not always have the optimum information available which made it difficult to interpret the radiological findings accurately. Now, they just open EDRM and get all the relevant information. This helps them which in turn helps the clinicians and surgeons to treat the patients appropriate. I feel very satisfied that over the years EDRM has successfully solved many of the concerns that were previously raised by my clinical colleagues.”
In addition to the financial savings, the EDM solution has delivered a variety of important operational and clinical benefits for the hospital as summarised below:
Notes are now accessible 24 hours a day, 365 days of the year by multidisciplinary clinical teams who often provide care to one patient but are located in different buildings;
Secretarial support has been streamlined and made more efficient. Historically, the location of paper notes would have to be laboriously tracked in the Trust’s Patient Administration System (PAS) so staff knew who had the files. Given the notes are now digital, this is no longer necessary in most cases.
Producing clinical letters for GPs and patients can now be facilitated within the EDRM system which automatically populates demographic information into standard letter templates i.e name and address, date of birth and NHS number. These letters are then saved into patients’ electronic files without the need for printing and scanning.
Image quality of the paperwork is guaranteed in contrast to paper which degrades over time with useful features available within the computerised system such as a zoom function which allows clinicians to highlight particular areas;
Deployment was successful and very close to budget with the main cost over run due to VAT increasing from 17.5% to 20%;
Information governance has been improved as an audit trail tracks who has viewed the electronic record. With paper where this was difficult to do;
Space devoted to medical records file storage has now been repurposed to create a Back Care Department [an internal training facility] as well as enabling the records team to be in one area rather than various places within a building. This has improved joined up working.
Trudi Mynard adds, “We’ve also established two new large offices in the old records library to house staff moved from another area of the hospital to allow our new emergency care unit – called the AECU[3] - to open. In just one month of operation, 96.5% of patients were seen within four hours – up from 77% - which far exceeds national targets. It is something the hospital is rightly proud about.”
While HSIM was responsible for the massive task of scanning the records library, the new EDRM system means that Milton Keynes Hospital will be paper light not completely paperless. Once a clinic appointment has taken place, clinicians still complete a paper history sheet which is scanned and the digital record then updated.
Milton Keynes Hospital is managing this day-to-day scanning process itself rather than outsourcing. Based on recommendations from its IT partners, the hospital has standardised on Kodak for its whole scanner fleet and a variety of production scanner models have been installed including the Kodak i730, i750 and the latest Kodak i4600 scanner which is rated at 120 pages per minute and designed to cope with volumes of up to 50,000 pages per day.
The EDRM solution runs on a mirrored dual server environment to ensure resilience and availability, and guarantee business continuity in the event of a hardware failure.
In terms of future developments, Milton Keynes Hospital is working with CCube Solutions to develop a ‘generic importer’ which will enable patient information from various hospital systems to be integrated into the EDRM without requiring manual input. For example, the first system being looked at is pathology. Results will automatically appear in the EDRM database once published without clinicians having to swap systems. This will also eliminate the need to print and scan results. The hospital will then look at incorporating other IT systems over time.
Vijay Magon, CCube Solutions’ managing director, says, “Moving away from paper is not easy. It’s a huge transformation process which radically changes the way NHS organisations work. It’s challenging. We’ve worked closely with Milton Keynes Hospital to overcome issues as they have arisen to ensure the system delivers exactly what records and clinical staff want so they can move away from well understood but archaic paper-based systems which just don’t work in today’s hospital environments.”
[1]Electrocardiogram
[2]Cardiotocography
[3]Ambulatory Emergency Care Unit
