The Royal Free teaching hospital in Hampstead London has digitised its legacy paper case notes.
The Royal Free Hospital is using an information management platform to tackle the problem of large volumes of paper which are stored and transported around the hospital. Legacy patient medical records are now scanned and indexed, and can be accessed at any time.
The hospital has worked with OpenText to solve the problem of digitising the 750,000 legacy case notes which contain patient medical records.
The hospital found it challenging to make important historical medical records readily available when a patient arrived.
Digitising legacy records is also known as electronic document records management (EDRM), and the OpenTech system sits in-line with Royal Free’s Electronic Patient Records (ERP) system Cerner.
The OpenText Content Suite will be integrated with the trust’s Cerner Electronic Patient Records (EPR) system.
“Like all other NHS organisations, we’re looking for opportunities to improve efficiency, while increasing productivity and improving the quality of care,” said Will Smart, director of information management and technology at the Royal Free Hospital.
Smart said that, while it was involved with the National Programme for IT (NPfIT), it managed to progress to a reasonable distance with its Cerner electronic records system, but it was too complex to push any further. Royal Free exited the NPfIT contract on 14 June 2014, and Smart said it had effectively moved its Cerner system from its original host BT, to be directly managed and hosted by Cerner.
“At the moment, we’re able to link the clinician to Cerner and to open the patient record within the OpenText platform,” said Smart. “But we want to integrate more deeply as we go along so it is available as a window within Cerner.”
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The Royal Free Hospital is a large organisation, employing 10,000 staff with a turnover of just under £1bn year. A hospital of this size produces vast amount of financial and HR paperwork, which the OpenText platform could also host.
The scanning process
Royal Free outsources the scanning to MSL, which then transfers the scanned documents to OpenText to be indexed with metadata and put on the platform.
Smart said the main challenge was making the platform as easy to browse as a paper folder.
“Flicking through a folder, you can see from colours and shapes on the page what you’re looking for,” he said. “We had to find a way to make the user interface as easy as possible for clinicians to find what they’re looking for by using thumbnails and a mechanism to allow you to scroll through docs as if you were running finger through the file.
Royal Free is taking a scan-on-demand approach to the project, which it started a couple of months ago, and has already logged tens of millions of images.
When the hospital books in a patient for an appointment, if that patient’s records are still in paper form, it will pull out the case notes from the library, scan and add to the system. The original paper files are then destroyed.
“We spent a lot of time thinking about the best approach, I guess my original vision articulated lorries would get wheeled in, taken to a tin mine in Cornwall never to be seen again, but actually easier for us to manage the case notes locally,” Smart said.
Smart estimates it will take two years to get through all of the legacy records.
Once the documents are digitised, the hospital can use intelligent software to conduct semantic analysis to drive more meaning from the information for research purposes. Smart said OpenText have some capabilities to do this, but also IBM is working a lot in this area.
“It enables you to classify the diagnosis and treatment by people in our clinical coding teams and effectively interpret what’s been documented clinically,” Smart said.
One of the reasons Royal Free partnered with OpenText rather than a medical-specific company was that Smart hopes to extend this system to digitise other forms of unstructured data in the organisation.
Royal Free’s ERP and EDRM platforms suggest the hospital is on track to delivering health secretary Jeremy Hunt’s ambition of a paperless NHS by 2018.
But Smart thinks that "paper-lite" and using less paper will be easier than becoming completely paperless.
“Even with the EPR, we still generate quite a lot of paper,” he said. “We still do history sheets on paper, case notes by the bedside, so that documentation still exists.”
“My sense is the NHS won’t become paperless because paper is too useful.”
Smart said paper will always be part of the delivery process and hospitals need the correct system to integrate it with existing digital records.
“We want to deal with legacy paper and second challenge is to manage the paper within the care process,” he said.
But he does see a future of doctors using tablets by the bedside. “It will happen, of course it will.”
“But I have two iPhones, an iPad, a Surface tablet, a laptop and a notebook – and actually writing things down on bits of paper is still convenient.”
“It might be, as tablets evolve, people will move to more using tablets. But at the minute, paper is still part of the process.”
Smart said the hospital is currently working on how to stream real-time telemetry data - from machines such as blood pressure monitors - to the information management system.
“I think overtime naturally we’ll evolve to use devise in different ways,” he said. “But today we’re trying to address the problems of today and trying to be ambitious but not so ambitious that we’re running ahead of where people actually are.”