County Durham & Darlington NHS Foundation Trust shifts to digital medical records

Joining an increasing number of NHS Trusts who have now addressed the challenging job of digitising their vast medical records libraries to save money, improve efficiency and enhance patient care, Kodak Alaris announces that County Durham & Darlington NHS Foundation Trust has completed a project to deploy a new electronic medical records (EMR) system throughout the organisation to provide clinical staff access to notes via desktop PCs and mobile devices.

In line with Government policy to improve NHS performance through technology and communications, the Trust has scanned around 252,000 patient folders each containing on average 229 pages, thereby creating over 115,416,000 images given the requirement to scan both sides.

The huge job of doing this was outsourced to TNT Business Solutions who has deployed high performance ibml ImageTrac® scanners and SoftTrac® Capture Suite supplied by Kodak Alaris to process the massive volume of paper. This solution captures documents at a rate of over 16,000 pages per hour.

Over the ten year project lifecycle, the Trust expects to save £4.5 million by shifting from paper to digital records with the total investment in an electronic solution over this period predicted to be £33 million.

The Trust handles around 650,000 outpatients attendances per annum, along with 70,000 emergency and 70,000 planned admissions. To date, it has operated three record libraries located at Durham and Shotley Bridge Hospitals and a warehouse in Darlington.

As the Trust has modernised services over time, notes and patients move around its local system all the time. This means someone may go to Durham for an outpatients appointment and then Bishop Auckland for surgery. The impact from a records delivery perspective is significant. Managing six community hospitals along with two acute hospitals 21 miles apart has meant delivering notes was a real logistical challenge.

Sarah Perkins, County Durham & Darlington NHS Foundation Trust’s associate director of operations and performance, says, “Whilst our 100 records staff have delivered a very good service in terms of notes availability there was always a constant level of stress about moving them about to get paperwork to the right place at the right time and then filed away correctly such that at any one time 25% of our library was out and in use. When I came into post, I felt there must be a better way which is why we’ve procured an electronic system.”

Self evidently this removes the perennial headache of preparing, sending and collecting physical notes, but the real benefit is that digitising records enables multi-user and multi-site access to the same notes which is key given multi-disciplinary medical care is often provided to patients.

Outsourcing to specialists has reduced project risk
The project roll out has been aggressive. The Trust started a pilot in August 2013 in the dermatology and plastic surgery units after consultation with 116 departments. In addition to its IT department, a team of 14 other Trust staff were involved including change management specialists, trainers along with an overall project manager and health records expert.

Phase two involved rolling out the system to the rest of the hospital with the whole process completed by December 2013. The Trust contracted with TNT Business Solutions as its scanning partner as it did not have the skills in-house to manage the complicated process of document scanning with all the staff and technology implications and risks that this entails.

The new EMR system comprises various components including Civica WinDIP records management software, with the actual notes digitised using ibml’s high performance ImageTrac production scanners and SoftTrac Capture software. Kofax software has been used to classify document images from the ImageTrac system. In addition, a data warehouse storage system was created to store all the images funded by the Trust’s IT department.

Alex Morris, TNT Business Solutions’ General Manager Operations, says, “We took over the Darlington library facility which was converted into a scanning bureau. Every patient has been given a unique barcode so we know where every single record is. Now records are digitised, it will make it far easier for everyone working in the Trust and, of course, patients themselves will be better served by immediate notes availability.”

A core group of 80 staff were allocated to the project by TNT Business Solutions to provide a round the clock service – with the team peaking at 200 people onsite to deliver 1 million scanned images each day. A range of safeguards have been put in place to ensure documents are legible and indexed properly, with TNT awarded BS10008 accreditation in a recent audit.

Scan-on-demand has meant fast notes availability
Typically notes are destroyed if an adult has not been to hospital for eight years or more. To avoid scanning notes unnecessarily, the Trust has adopted a scan-on-demand approach rather than digitising everything. This means that people coming in for outpatients appointments have their paper notes scanned in advance of clinic and made available electronically via WinDIP. Individuals arriving at the Trust’s emergency department receive their complete digitised notes within three hours. Other records which have passed the eight year mark, will be destroyed.

Given the Trust estimated that it had 900,000 folders in its three libraries, the benefit of this scan on demand approach has been that around 55% of files have not had to be scanned thereby saving time and money – with the team just scanning around 400,000.

Ashley Keil, ibml’s sales director says, “County Durham & Darlington has now closed its three libraries and our ImageTrac scanner and software technology are being used for all day forward scanning. In other words, patients who come into hospital and see a clinician have the handwritten updates collected daily which are then scanned into the system within 48 hours.”

To date, 4,000 staff have been trained to use the new EMR system which they either access directly using an icon on their desktops or via an iSOFT-based system which integrates with it. The EMR solution displays information in a time line format and via tabs so that staff can quickly see and access associated records.
Neil Murphy, Kodak Alaris’ UK sales manager says, “Scanning medical paperwork is basically an industrial process which most hospitals just aren’t able to deliver given their focus is to care for sick people. Country Durham and Darlington recognised that you need the right blend of skills and equipment to run a successful scanning bureau so it partnered with one of the best in the business to deliver this aspect of the project for them.”