CaseStudy

From Document Manager Magazine Vol 20 No 02 - March/April

An NHS Trust's 'invest to save' approach has achieved huge ROI from lower operational costs and better use of estate in a project that aims to digitise over 40 million pages…

Aintree University Hospital NHS Foundation Trust has implemented an electronic medical records (EMR) system throughout the whole organisation using CCube Solutions' electronic document management system with outsourced scanning services provided by Capita Total Document Solutions powered by Kodak production scanners and Kodak Capture Pro Network Edition imaging software.

The EMR system enables the Trust to increase access to patient information, guarantee case note availability at the point of patient care, improve efficiency, and reduce the costs, security risks and space associated with paper handling and storage.

The Trust has invested £1.5 million in software, scanning hardware, and scanning bureau services and expects to save £750,000 annually based on reducing labour, transport and storage costs. In addition, it has released 30% of a brand new £40 million Elective Care Centre recently built on the hospital site which is now being used for clinical activities rather than paper storage. This is a £12 million estate benefit to the Trust as a whole floor has become available for patient care.

Providing acute healthcare to a population of 330,000 in North Merseyside and surrounding areas, Aintree University Hospital NHS Foundation Trust operates from two sites - Walton Hospital and University Hospital Aintree - and is the teaching centre for the University of Liverpool. Predominately serving three Primary Care Trusts in South Sefton, North Liverpool and Kirkby, specialist support such as respiratory disease, ophthalmology and cancer services are also provided to a wider population of 1.5 million in the Midlands and North Wales.

With 850 beds, the Trust caters for 86,000 emergency admissions every year, along with 330,000 outpatient visits and 77,000 inpatient day cases.

While isolated standalone scanner solutions were installed three years ago in the patients' appointment centre and A & E, legal and pathology departments, it was felt that a Trust-wide solution was required to improve the way patient related case notes are handled across the organisation. The decision also involved clinicians who felt that the quality of case notes needed significant improvement as finding information often took too long, and delays were experienced in case notes actually arriving for patient consultations.

Ward Priestman, Aintree University Hospital's director of informatics, says, "The Trust has an aggressive IT strategy and wants to invest in and use technology to drive service improvements. The EDM solution is a major step towards digitising the patient record."

The solution from CCube Solutions comprises EDMS and eForms software along with a bespoke built front-end portal which clinicians use to navigate around patients' case notes from their desktop PCs, laptops or trolley-based computers. CCube Solutions was chosen as it offered the most cost effective EDMS solution, and was responsive and willing to tailor the software to meet the Trust's needs. Archie Menzies, CCube Solutions' NHS sales director, says, "Our approach is very much applying our EDMS technology to solve business issues. By linking to line of business systems, we ensure that the accessing, sharing, and storing of information in all systems is sensibly integrated which means that EDMS doesn't just become an archive for documents, but directly contributes to improving sharing and collaboration among staff and enhancing organisational efficiency."

Staff access the EDMS via the Trust's Patient Management System (PMS) once a user logs in which is in effect the front end to a full electronic patient record.

Various other IT solutions are also integrated covering pathology and radiology results, pharmacy, prescribing and theatre systems. All information pertaining to a patient can therefore be accessed by one route - the PMS - which gives one view of a patient and their medical history and means the Trust avoids having information silos. Ward Priestman commented, "Clinicians have been actively involved in helping define the look and feel of the system which CCube Solutions has incorporated in the user interface design work." Given the poor state of the original casenotes, CCube Solutions worked closely with Trust clinicians to implement an "intelligent document searching" facility which employs Optical Character Recognition (OCR) to generate searchable text and identify designated forms in use. The solution generates a new, "virtual view" of the traditional case note which enables clinicians to quickly find documents of interest without having to search through many electronic pages.

The Trust outsourced the huge task of scanning patient files to Capita TDS, a Capita Group company. A scan-ondemand service is being delivered from Capita's secure facility which uses a weekly list of clinical appointments to identify specific patient records which are then processed and digitised for patients coming in for consultations. It is expected that around 282,000 patient files will be scanned which equates to some 45 million pages. As outpatient case notes are used - on average 2½ times a year - once a person's file is scanned, the work is completed and the notes are subsequently available digitally. Capita TDS has standardised on Kodak's high performance production scanners to meet the workload demands with its scanner fleet comprising i700 series, i4000 series and the latest i5000 series scanners. In addition, Capita TDS uses Kodak Capture Pro Network Edition imaging software to ensure fast, reliable capture. This highly productive process not only makes for the highest quality image first time, every time but also maintains consistent and compliant output while maximising operator productivity. The images and associated data are then sent via a secure FTP connection directly back to Aintree.

Colin Labrum, Kodak's UK software sales manager, says, "Digitising health records is not only an 'invest to save' initiative, but it gets crucial patient information to the point of care automatically so people have a better clinical experience.

Reliable, well-designed and easy-to-use technology solutions are fundamental in making this all work and ensuring user acceptance. The Capita TDS, CCube and Kodak solution does just this and means the Trust can remove the laborious process of transporting paper files about and trying to manage an unmanageable logistics operation."

The EDRM solution implemented at Aintree has proved successful and is helping the Trust deliver its EPR strategy.

A key component of this strategy is to further reduce dependency on paper. The current EDRM configuration takes care of the legacy paperwork; but what about the on-going use of paper? EDRM can readily capture, store, manage, and deliver electronic information, without the need to print and scan. The Trust is looking to minimise, and in some cases eliminate, the production of paper.

CCube Solutions is working closely with the Trust on solutions that combine Electronic Forms with the rapid consumerisation of mobile devices, to support rapid data entry by time-pressed practitioners using low cost and familiar devices. A number of prototypes are on trial - these offer seamless, real-time integration between disparate systems while the data is being captured and the automatic integration of completed forms within the patient's case note - all without paper and without re-keying data.

More info: www.ccubesolutions.co.uk

CaseStudy