Electronic document management – a paperless cure for the NHS?

Will the NHS meet the 2018 deadline to go paperless? Or is it more likely that the NHS will just have less paper than it did in 2013?

Last year health secretary Jeremy Hunt gave the NHS the challenge of becoming paperless by 2018. Can the health service meet that deadline? Or will the NHS just end up with less paper than it did in 2013?

Mark Austin, CIO of Bedford Hospital, is in no doubt about whether the NHS can hit the paperless target.

“No,” he told Computer Weekly last year. “I think going paperless by 2018 is a good aspiration, but totally paperless is just too big an ask.”

Meanwhile Professor Mike Pearson at Aintree University Hospital said that a paperless NHS is achievable only “with enough will and drive,” and that it is unlikely to happen.

“There will be odd examples of it achieved well, but the NHS doesn’t have the organisation to achieve that at the moment,” he said.

Pearson added that it all comes down to politics, and local versus central decisions. “Politics and the inability to coordinate will prevent us meeting that target. 

“I think if we got it working it would save money. I think our challenge is the human factors of satisfying so many masters. They vary, and every doctor is looking for something slightly different in the system they use.”

Pearson also pointed out that software is written by developers who have never worked in a clinical setting. 

“If you’re doing a ward round and you go to the room of a patient with a nasty infection with a tablet PC, do you take it in with you or leave it outside?” he asked. “And if leave it outside, will it be there when you get back? The practical issues have to be resolved.”

But pockets of paperless achievement are starting to appear. South Tyneside NHS Trust, for example, has moved board meetings to the cloud using Huddle for iPad, reducing its paper consumption by 100 reams a month. 

And the NHS Shared Business Services (NHS SBS) initiative hopes to eradicate paper invoicing by implementing an e-invoicing system that will be free for suppliers to use.

Electronic document management

Meanwhile, the Pennine Acute Hospitals NHS trust is planning to digitise 100 million paper-based patient records, in what could be one of the largest electronic record implementations in the UK.

The Pennine trust’s move is not the sole example. In fact, the UK is the biggest electronic patient record (EHR) market in Europe, with $2.1bn expected to be spent on the technology by the end of 2015 following 4.1% annual growth.

The same research from Accenture revealed that $22.3bn will be spent on EHR globally by the end of 2015, with 5.5% growth every year. The US market will be worth $9.3bn, with yearly growth of 7.1%.

But the difficulty associated with measuring returns could slow adoption, according to Kaveh Safavi, global managing director of Accenture Health.

“Although the market is growing, the ability of healthcare leaders to achieve sustained outcomes and proven returns on their investments poses a significant challenge to the adoption of electronic health records,” he said. 

Grove House Practice

At Grove House Practice in Runcorn, GP David Wilson has headed up a project to digitise records.

Grove House scanned all its legacy patient records, saving a vast amount of space and time. Receptionists no longer have to search through thousands of folders.

“We’ve not used paper records in consultation since 2000,” Wilson said. “We have 11,000 patients, and the racking space was astronomical, taking up 20 square metres. So we revamped the office space once we went live 18 months ago.”

Although the documents weren’t used very often, they still needed to be accessed for insurance reports or by solicitors, and medical records never get destroyed. “They just grow and grow and grow,” said Wilson.

Grove House worked with the local hospital trust, CCube Solutions and Kodak scanners to digitise its legacy papers.

“My receptionists – they love it,” said Wilson. “For the first time they think they’re working in an office rather than in between racks dropping dust. If the records were coming back tomorrow, they’d kill me.”

My receptionists love it. If the records were coming back tomorrow, they’d kill me

David Wilson, Grove House GP

Aintree University Hospital

Pearson has also led a transformation project to reduce the amount of paper within Aintree Hospital.

Like Grove House, Aintree used Kodak Alaris scanners and CCube Solutions as well as Capita Total Document Solutions to digitise its archives.

“The biggest benefit is the lack of need to file this vast amount of paper,” he said.

Now if a patient comes into a clinic, they are given a temporary folder for the day’s record, and those few pages are then sent straight off to Capita the next morning and will be on the system by the afternoon.

Pearson said it was much more efficient to outsource the scanning because Kodak’s scanners are working flat out and having that technology on-site wouldn’t produce the same results.

He said the hospital has an ongoing contract with the suppliers and will see payback within the first 12 to 18 months. “First of all you don’t need a building to house the archives. We would need a staff of 60 to serve the library of a million records – nearly all those jobs have gone and the staff have been displaced.”

Pearson said this has saved Aintree over a million a year in running costs.

Document management versus true digital delivery

But neither Aintree nor Grove House are truly paperless, and the question is, will they ever be? 

Could Aintree, for example, skip the scanning process and enter data straight onto the system during a consultation?

“People still write on paper in clinical consultation and the ward, and then archive that electronically afterwards,” said Pearson.

He said the difficulty in creating a true electronic record dates back 40 years. “No one has really succeeded.”

He explained that for a true electronic patient record, doctors need to change the way they think during consultations. 

“A doctor’s mind is constantly making shortcuts,” he explained. “A patient walks into the cardiac clinic: the doctor can make the presumption that their nervous system is OK because they walked in normally, so they can move on to assessing the cardiac – but the computer wants the doctor to ask questions about their nervous system.”

He compared electronic records to modern banking. “You used to keep your bank records in a file at home with each month stored away, but now most banks offer that online. That’s much easier than going to your file and having to sift through 26 pages to go back a year. And if you want to search online for something you can do a Ctrl-F search.

“We are looking and actively considering all options, and would like to report every blood pressure on every ward electronically.”

The basic electronic patient record is hard to get ROI for

Justin Whatling, Chair, BCS Health

Just a paper storage solution 

But Dr Justin Whatling, chair of BCS Health, said that digitising documents is not the same thing as creating a true electronic patient record system.

“You’re just solving a paper storage issue. Hospitals need to implement electronic patient records,” he said.

Electronic patient records integrate devices and connect test results with prescription services. That said, Whatling claims he hasn’t found one organisation that is completely paperless, whether it’s writing on a specimen tube for a blood test, a piece of equipment like an arterial blood gas machine that cannot communicate electronically, or a care provider sending in a paper referral because they are not paperless themselves.

“These organisation didn’t go out with the intention of being paperless,” he said. “But with the intention of automating the care environment to improve care and reduce costs.”

Whatling also noted that organisations that have digitised their document management but not implemented a full-scale electronic patient record will find it difficult to achieve a sufficient return on investment (ROI).

“The basic electronic patient record is hard to get ROI for. [You have to be] using the entire systems and using the clinical data for multiple purposes. You don’t really get ROI from back-office systems.”

But Whatling understands that digitising care is a “big change programme” and one that comes with lots of hurdles.

“These are big change programmes, which will change the way healthcare is being delivered, and technology is one of the few tools which can be used to deliver it more efficiently,” he said.

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