Kainos

The Ipswich Hospital NHS Trust - Electronic Document & Records Management Project

pdf-small-icon.gif Ipswich Hospital Case Study 

Less than four months since go live and all new case notes are now created electronically, 70%+ of discharge summaries are delivered to GP surgeries within 24 hours and over 8,000 case notes, each 160+ pages have been carefully scanned and captured by medical records staff. The story so far…

Ipswich Hospital NHS Trust was one of the first hospitals to select Kainos as its technology partner to deliver a high profile and ambitious Electronic Document and Records Management (EDRM) project. The project, which went live in November 2009, is part of a longer-term migration to an electronic patient records strategy at the Trust, one of the largest general hospitals in East Anglia which provides healthcare services to nearly half a million people.

Now a short four months later and the Trust is experiencing a real mind-shift towards electronic records, as it makes significant inroads into reducing its reliance on paper records, with all new case notes now created electronically, paper case note scanning firmly underway and clinicians and Trust staff positively embracing a future of electronic documents.

The Ipswich Challenge

The Trust was struggling to manage more than half a million case notes housed both on and off site; its premises span 45 acres. The sheer storage demands of this quantity of paper-based case notes and the level of security and management involved, was substantial. The retrieval and management of notes, so that they were with the right clinician in the right department at the right time, was time-consuming and difficult.

To tackle the problem and kick-start a move to a more efficient, electronic records strategy, the Trust took the decision to invest in a specialist EDRM solution, involving the establishment of a high-end scanning operation on its own premises. The facility, jointly set up by EDRM system integrator Kainos in partnership with the Trust, is managed by Trust staff and enables the scanning of case notes required for clinic appointments, as well as the case notes for all new patients.

With the support and advice of Kainos, the Trust has implemented an electronic document and records management system (EDRMS) based on the Autonomy Records Management tool and integrated with the hospital’s Patient Administration System (PAS) and Clinical Management Systems (CMS), with a customised portal for access.

Existing physical records, newly received paper referrals and so on are scanned locally to populate the electronic case note. The scanning solution includes intelligent indexing to ensure the human interpretation of where forms should be filed is reduced, and provide a consistent filing approach. The electronic case note is displayed with tabbed dividers, just as the current physical records folder to speed adoption by clinical and clerical staff.

Once a patient has been admitted to the hospital, an electronic discharge form is available to staff to complete during the patients stay. An auditable form, with predictive text for rapid completion, is available for update by clinicians and pharmacists during the patient’s stay. When the patient has been discharged, the form is immediately and securely sent to the patient’s GP and a copy saved to the patient’s file. In addition to meeting the compliance requirements, the automation and speed of the discharge process will meet contractual targets, ensuring income. There are also considerable predicted savings in staff, stationery and storage/logistics costs.

Because the EDRMS is standards-based, migration to a designated electronic patient record specification at a later date will be less painful than with a proprietary solution. Ultimately, the real benefit for the Trust and the patients it serves is better healthcare outcomes at lower risk and cost.

The Facts Four Months down the line

Sara Clark and Neil Turnbull at Ipswich Hospital NHS Trust’ IM&T department look back at what has been achieved so far, which hurdles are yet to be overcome and what lessons have already been learned.

“It’s all about people,” Neil tells us. Ipswich elected to manage its case note scanning in-house rather than use an external bureau and this has paid dividends and in no small way has contributed to the success of the project in its early stages.

Creating an in-house scanning service means the Trust retains ownership of the scanning process and by using existing, experienced medical records library staff to manage the scanning process has resulted in greater quality, accuracy and usability of the scanned patient casenotes. “We could not have achieved this quality and accuracy off site – the experience of the medical records staff has proved invaluable and everybody feels involved and supportive of the project. We are acutely aware that incorrectly scanned case notes can introduce clinical risk, for example changing a course of treatment, so experience and knowledge when preparing case notes is paramount.”

All new case notes are now created electronically and a further 8,000 case notes with no recent or pending activity have also been scanned and this project is continuing apace. Not one set of ‘green’ case notes has been created on paper since November last year.

Power to the people

Access to these electronic case notes has already been extended to Trust staff working on remote NHS network sites too delivering on the promise of simultaneous case note access. Clinical colleagues are now also embracing the new system since go-live in November, according to Neil. “If we underestimated one thing, it was the level of change that was being delivered and the resistance it might meet. We have managed many large scale change management projects yet we still found it a challenge to get people to support the lack of paper-based case notes initially. However the tide is turning and we now have a great team of very supportive clinicians who are very keen to do more and whose positive participation and buy-in is making this a real success.” 

This very visible success can also be seen in the creation of electronic discharge summaries, 70% of which are now delivered electronically to the GP surgery within the targeted 24 hours. “Both the GPs and our Trust doctors are very positive about the success of the electronic discharge process. We responded to very aggressive targets and it is going very well indeed.”

Ipswich is now enjoying a lot of interest from other Trusts keen to learn from their experiences particularly in addressing scanning and change management issues. “We have made great inroads into what is a long term project for the Trust but already the benefits are significant. Benefits in reduced time, improved accuracy, better service levels and improved healthcare are very visible. Having instant access to accurate case notes saves hours/days/months filing or indeed risking misfiling.”

“Misfiled or lost case notes cost dearly, for example to meet the coding deadline we have 5 days from month end to code. On average 20 sets of notes cannot be found in time – at an average of £1500 per episode. That presents a potential loss of income of £30,000 minimum each month;  60 sets of notes took over 5 days to find in August alone;  one set of notes in February was so poorly filed it took 5.5 hours to code (this should have taken ½ hour). “This is the tip of the iceberg is terms of what we are now eliminating with our new system.”