Case Study: Xerox Document Centre 220ST

Birchill Hospital was buried under paper until it came up with a healthy alternative

Birchill Hospital was buried under paper until it came up with a healthy alternative


There is much more to scanning technology than grabbing graphics for web pages and inserting them into documents. Scanning is an essential element of any electronic document processing system and in those organisations where the move away from paper is starting to take place, document scanning is a priority task. In such a situation the requirements placed on a scanning device are quite different to those required for a scanner in a home or small office environment.

This move towards "paperless" processing is nowhere more urgent than in the health sector. Patient records, case notes, x-rays and other imaging results, drug charts, analyses ... there is an almost endless stream of paper documentation that exists for each patient. Add to this the paper records for the employees in the sector and it is clear why the move to electronic storage and dissemination of records is such a high priority. It also explains why the Department of Health is investing over £1 billion in its flagship NHSnet project, which aims, amongst other things, to get hospitals, clinics, GPs, NHS Trusts and others on-line by the year 2002.

The main aims in moving towards the adoption of electronic document processing are to improve efficiency, streamline working practices and, most importantly, to improve on the delivery of patient care. In practice, this means that local NHS trusts and hospitals are faced with the daunting task of taking their existing paper documents and turning them into electronic equivalents which can be disseminated across networks, printed out where required and stored centrally for easy access. All of this has to be achieved without compromising patient confidentiality or impacting adversely on the

day-to-day functioning of the hospital.

The case of Birchill Hospital

Birchill Hospital, part of the Rochdale NHS Trust, is a typical example. Analysis showed that over 50 per cent of its monthly document output comes from the psychiatric department. This paper documentation often has to be sent to a number of disparate wards and offices, in addition to the main recipients, who include the community mental health nurses housed in the Sudden Resource Centre. Some of these wards and offices are many miles away, which meant that case notes - many of which may extend to several hundred pages - would often have to be delivered using couriers or taxis. This is extremely expensive and risks the chances of notes going missing or, in some cases, breaches of patient-record confidentiality rules.

Because of the risk of notes being lost, it is hospital policy that only copies are sent off-site. This meant that voluminous case notes of several hundred pages would have to be photocopied before being sent off. Other high volume copying work includes regular central government and local government circulars, hospital policy documents and departmental memos ( all of which require photocopying and dissemination.

This high volume of paper document generation was extremely costly and placed a strain on the departmental copying services. Quality was often poor and no provision was made for the electronic transmission of documents quickly and securely. The existing analogue photocopiers were old and unreliable and when it was time for the service contract to be renewed, the Hospital decided to look at the most effective way of improving matters.

Assessing requirements

The first step in improving the situation was to undertake a comprehensive document survey to assess its current and future requirements. The hospital's supplies manager approached Xerox to undertake the study, which looked at the complete range of paper based technology installed in the psychiatric department including copiers, desktop printers and fax machines.

Xerox showed that the Department's needs extended beyond a new generation of faster, more reliable copiers. It suggested quite clearly that the best way forward was to invest in an integrated digital technology that utilised the latest multi-function devices linked together in a network. It also provided the hospital with a Total Cost of Ownership study, which enabled the hospital to assess the leasing and day-to-day running costs of adopting such an approach.


Based on the study's findings, the psychiatric department has installed six of Xerox's latest digital Document Centre devices. Five of these are Xerox Document Centre 220STs and one Document Centre 230 LP. Another two digital machines are due to be put into place in the near future. These new devices are placed at five different locations enabling the department to make the fullest use of the digital connectivity that is a feature of the Document Centre range.

The Xerox Document Centres provides the department with integrated multi-functional devices that can scan, copy, print and fax in one system. As the majority of the department's devices are networked, documents can be sent from one system and then viewed and printed at another. There is no longer a need to copy a document on a stand-alone photocopier and then have it sent by courier to its destination. The Document Centre 230, for example, is being used as a departmental workhouse, providing a central production environment for eight secretaries within the department.


The benefits have been enormous. Unlike the multi-function devices produced for the home or small office market, the Xerox Document Centre's scanning function operates at production speeds. For example, the 230ST can scan at up to 30 pages of A4 a minute, providing more than enough speed to cope with the hundreds of pages that a set of case notes may contain. The scanned images may then be transmitted electronically across the network, then printed or faxed.

Mike Conway at the department of psychiatry comments: "Xerox showed us that its latest generation of digital machines provides a whole new approach ...The key benefit is that we have been able to integrate our office equipment into our IT and communications infrastructure within the hospital. This has long-term implications and benefits in the way in which information is copied, distributed and accessed by our staff at our numerous offices. It means that we are no longer reliant on paper and its limitations."

One immediate benefit, and an immediate cost saving, is that large files of paper-based case notes need no longer be shuttled from office to office by taxi or courier. The main beneficiary has been the Sudden Resource Centre, where most of the notes are sent. Not only is there a financial saving, but the risk of compromising client confidentiality is vastly reduced. Security is enhanced because documents are tagged with a unique ID number and only those users who are logged in and have the correct ID for the document can access it.

A more significant cost saving has been in the rationalisation of office equipment. Once all the Xerox Document Centre devices are all in place they will replace 20 desktop laser printers and five photocopiers. The workload of these various items of equipment will easily transfer to the newer digital equipment. Fewer laser printers and photocopiers will also lead to savings in the cost of consumables. There are two factors at work here. The first of these is simply that the Xerox Document Centres are much more cost efficient devices, Xerox estimate that the cost per copy of a laser printer is around seven pence per page, compared to a cost of one pence per page of the Document Centres. The second factor is that paper usage is significantly reduced when people can work directly with electronic copies of documents. They no longer need to print out everything they receive, they can work with the notes on-screen for example.

In terms of working practices, there has also been a change for the better. People no longer need to walk to a photocopier and then stand and wait until it has made all the copies. A document or set of notes can be scanned once and then accessed or printed as many times as required. Furthermore, bottlenecks are reduced because the system can be scanning and faxing at the same time or scanning and copying, for example. Because these devices are fully networked, people can access documents from the desktop. There are also benefits in terms of the quality of the scanned documents. Staff no longer have to rely on poor-quality second or third generation photocopies, they can now access digitally scanned first-generation files on demand.

The work at the department of psychiatry has been so successful that the hospital is now planning on rolling out the new technology and work practices to other departments. "We see this technology as crucial for the Trust for changing the way that it uses documents and to bringing greater efficiencies to other departments. Key future applications include the scanning of patient records, and we see four or five other departments benefiting from the same kind of infrastructure that we have successfully put into place," concludes Mike Conway.

Pan Pantziarka

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