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Using technology to improve healthcare delivery and patient care has been a hot topic over the last few years. Technology is not just making its presence felt in operating theatres and hospital wards - NHS Trusts and PCTs are quickly becoming aware that being able to access, store and share patient records is as crucial to improving patient care as the latest breakthroughs in medical science.

The need for an efficient and effective information management system manifests itself across all levels of modern healthcare provision. It encompasses everything from consultants and surgeons accessing x-rays and scans from workstations across a hospital complex, ending the need for cumbersome transfer of paper records from site to another, with the incumbent risk of them being misplaced or lost or misused; to administration staff using systems that help automate selected processes, saving time and money. Add a dose of security and audit, and suddenly, the prospect of a system that mandates governance and eliminates unscrutinised misuse, becomes quite real.

Document management started with turning paper into electronic files, which can save space, be moved around and shared. Lessons learnt from early adoption of such systems are now being realised through more sophisticated EDRM Systems which include electronic content. Add a dose of systems integration, workflow, electronic forms, and compliance, and suddenly organisations are beginning to realise tangible benefits from this technology. With appropriate safeguards in place, EDRM has a proven track record of long-term cost savings combined with increased efficiency with no loss of security - in fact, enhanced security. This comes however with the caveat that the information is used as a resource in a defined and responsible manner, with an implicit code of good practice and security protocols to act as checks and balances against misuse or malpractice.

Modern EDRM offers much more than just an electronic filing system - EDRM can deliver an effective, enterprise-wide approach to patient information management, integration, delivery, and workflow, for both clinical and non-clinical applications.

The document is the vehicle for content which must be searchable and integrated with core hospital systems and practices. Its management has to encompass the document life-cycle which includes day-to-day patient record management (including security), as well as retention and destruction in compliance with established guidelines. Furthermore, EDRM systems must provide functionality to generate ongoing patient documents electronically, and manage these within the electronic patient record, and capture electronically generated patient information across disparate systems. Simply digitising paper records, then, is not enough - the solution must include generation, management, and integration of ongoing (electronic) records, in order to minimise or eliminate the paper chase.

EDRM is the underlying technology which provides a compound document repository that can be shared among many departments, provide access to the Integrated Patient Record, and support generation and management of patient information without relying on paper. The key requirements are:

1. Capture and manage legacy (paper) patient records The majority of document management solutions in use provide facilities for capturing, managing, and delivering electronic patient records. Organisations looking to digitise legacy records have to meet a variety of business objectives which may include:

• cost related to maintaining existing record libraries;
• pressure on storage space, especially if moving to a new site;
• operational costs - finding and delivering records, especially across a number of geographically distributed sites;
• strategic objectives related to operational performance and efficiency gains;
• customer service improvements

Advances in recognition technologies are beginning to unlock the vast amount of information locked in scanned records and make this information available to practitioners. Using technology to add value to scanned records is enabling practitioners to access and view legacy case files in a manner consistent with how they access and view on-going and new information, regardless of how the legacy records are digitised.

It is important to align digitisation of legacy records with specific processes within a Trust, rather than simply digitising records to alleviate problems related to storing and using paper. For example, the "scan-on-demand" approach applied to the Outpatient process has enabled some Trusts to realise very tangible benefits including year-on-year cost savings while delivering "paperless healthcare" - a good example of process mapping and application of the right IT solution.

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