Electronic document management (EDM) for medical records - Steria

WHITE PAPER
Ë
Electronic Document Management
(EDM) for Medical Records
UK Healthcare April 2010
It is estimated that currently, the NHS holds around 13.6 billion pieces of paper from
163 million patient records and incurs an estimated maintenance cost of nearly
£324 million per annum. Also, there is recognition that lost or fragmented clinical
records in acute, community, mental health and specialist care settings constitute
clinical risks to service users.

Electronic Document Management (EDM) for Medical Records
Introduction
Trusts recognise that access to documents, including access to
patient health records at the point of care, is critical to ensure:
Ë Provision of high quality and efficient patient care (improved
patient care);
Ë Implementation of improved service delivery models;
Ë Delivery of Trust improvements including redevelopment and
service modernisation plans;
Ë Conformance with the standards of the Clinical Negligence
Scheme for Trusts (CNST) – now NHSLA.
This focus is consistent with the key objective of the NHS IT strategy,
‘Delivering 21st Century Support for the NHS’ where:
Records about a patient and his/her care are held electronically and
are accessible by all who need them, including the patient themselves,
within any care location at any time.
One method of overcoming such issues is the implementation of an
Electronic Document Management (EDM) system which captures
images of paper medical records and presents these securely and
reliably to medical and clinical staff via a PC or hand-held option
such as a tablet device.
The implementation of EDM supports the following key national
business drivers:
Ë Quality improvement and reduction in errors;
Ë Improvement in efficiency;
Ë Development of staff;
Ë Open access to information;
Ë Delivering the NHS plan;
Ë Information for health;
Ë Delivering 21st century IT support for the NHS;
Ë Clinical governance;
Ë Clinical Negligence Scheme for Trusts (CNST, now NHSLA).
Issues driving the need for change
Trusts experience a variety of pressures which drive them towards an
urgent need to digitise their medical records libraries. Issues include:
Storage
Ë Lack of storage space – some Trusts have calculated their shelf
space for storing medical records to be in the 5km to 10km range;
an enormous drain on estate resources;
Ë Duplication and fragmentation of files in several locations and
between clinical staff results in files not being available or “lost”;
Ë Increasing size of the health record folder adds to the storage
pressures.
Financial
Ë High cost of filing and administering patients records;
Ë High costs of retrieving and delivering patients records to clinics;
Ë Cost of culling and destruction of patient records;
Ë Cost of medical negligence claims if proper treatment cannot be
substantiated by the medical record, if it is misplaced.
Security and audit
Ë Security of patients’ records as they are transported across sites;
Ë Difficulty in controlling or auditing access to patients’ records;
Ë Difficulty in locating files required for clinical, legal, insurance and
Data Protection Authority purposes;
Ë Improvement to clinical and information governance;
Ë Health & Safety issues in storage areas, as well as in the handling
of patients records in clinical areas.
Clinical
Ë Reduction of clinical risks;
Ë Better management of patient journey;
Ë Improvement to patient experience;
Ë Knowledge and information management for greater
clinical efficiency.
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Electronic Document Management (EDM) for Medical Records
Proposition for an EDM shared service
The provision of this service is a key progression of the NHS’s shared
business strategy for health since shared services already achieve
significant savings to the NHS, through initiatives such as:
1. NHS Shared Business Services (NHS SBS), a joint venture with the
NHS, whereby finance & accounting, HR and payroll services are
delivered to some 130 Trusts across England;
2. The Department of Health and Directgov websites run on shared
enterprise strength platforms, providing services to the NHS and to
citizens. Managed through “The Club” robust and resilient web
services are delivered by Steria with ongoing development and
service support available to the organisations utilising the shared
platforms, resources and hosting Services;
3. NHS supply chain, as such, a highly efficient way forward is to
develop a shared Electronic Document Management System
(EDMS) service for medical records based on a shared platform.
A supplier should be willing to invest significantly with the
guidance and partnership of Trusts in ensuring the scanning and
EDMS facilities are attuned to NHS requirements in general - and
the clinical needs of staff and patients in particular.
By being at the vanguard of such a service, Trusts would capitalise on
the benefits of:
Ë Ensuring the shared service is fully tailored to their requirements
without compromise. (Some tailoring is essential to ensure ease of
use of such a product in a demanding clinical environment);
Ë Experiencing year on year service cost reductions as additional
Trusts join the service;
Ë Working with a supplier whose ambitions in this medical records
EDM market place ensure that the service will be resourced for
unfailing success;
Ë Having the service delivered from an even more robust platform
than one Trust might be able to justify;
Ë Receiving functionality improvements funded via additional
requirements contracted by subsequent Trusts.
It is important that a detailed product analysis is undertaken utilising
a depth of skills across a range of products and that functionality is
compared alongside Total Cost of Ownership (TCO) of both project
delivery as well as on-going service provision. Several products
purport to provide the required functionality but don’t unless used in
conjunction with other add-on products, while other products provide
all the functionality but at a high cost. Particular care needs to be
exerted in the effects of volumetrics (users and scan pages) as the
volumes involved in any medical records application are very
significant.
Technically, such a solution must be designed around a highly
scalable, cost-effective and market leading product together with
innovative scanning and image management software. The solution
needs to be tailored to enable images to be identified and restructured
into a consistent medical record, in accordance with the
Royal College of Physicians’ current developing guidelines.
A product such as EMC’s Documentum has been implemented in both
acute Trusts and PCTs. As a result, the shared platform is a very low
business risk since the software product has been successfully tested
in environments attractive to over 300 Trusts, which demonstrates
that the business case is solid.
This also means that a Trust must ensure that they focus on
addressing the key business issues around scanning and delivering
electronic medical records, rather than merely procuring a hardware
and software solution.
As such, a highly efficient way forward is to develop a shared Electronic Document
Management System (EDMS) service for medical records based on a shared platform.
A supplier should be willing to invest significantly with the guidance and partnership
of Trusts in ensuring the scanning and EDMS facilities are attuned to NHS
requirements in general - and the clinical needs of staff and patients in particular.
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Electronic Document Management (EDM) for Medical Records
The Governance of the project, manifested in a Joint Development Board, enshrines
the Trust’s control of business function direction and will provide technical and
commercial input based on experience, to build a quality service for
the Trust.
Solution implementation approach
An approach to implementation should be collaborative, in a true
partnership framework. The Governance of the project, manifested in
a Joint Development Board, enshrines the Trust’s control of business
function direction and will provide technical and commercial input
based on experience, to build a quality service for the Trust.
Embracing the Trust’s approach to implementation, the supplier must
build a cost structure for the implementation around that approach
and undertake detailed planning on that basis. A joint Project
Initiation Document (PID) would document and be the benchmark by
which that approach would be managed and monitored.
A few examples of this type of approach to collaboration include:
Ë Convening a joint development board to oversee strategic
direction and approach;
Ë Running a joint selection “beauty parade” on scanning equipment
to ensure specific case notes are processed with a minimum of
manual intervention to reduce on-going scan manpower costs;
Ë Implementing a Proof of Concept in conjunction with the Trust
and the Royal College of Physicians to show how the Trust’s
specific case notes can be auto-restructured to meet emerging
standards;
Ë Participating in a change management programme with the Trust
to ensure this rapid advance to a paperless environment is fully
adopted by staff;
Ë Participating with the Trust in the further exploitation of EDM
through the product’s workflow and integration capabilities.
Solution outline
An EDM solution provides:
Ë An in-hospital scanning “implant” service staffed by supplier
staff working closely with Trust staff. In-house scanning is
important as the difficulties and costs in retrieving case notes
urgently when they are taken off-site for scanning should not be
under-estimated. The use of supplier staff is important as there is
an initial upsurge in activity while the switch-over takes place,
and in the meantime a medical records function must continue
to be delivered;
Ë Options for scanning either active medical records only, or active
plus dormant medical records, should be considered. Active record
scanning may also include “scan-on-demand”, but this approach
- while it may involve a somewhat lower volume scanning function
than full active record scanning - never gets to the end of the high
volume scanning workload;
Ë Scanning software must provide high accuracy scanning together
with facilities for reliable document recognition to help with restructuring
medical records, to minimise the time being spent on
manual effort;
Ë Scanning software configuration is required to provide automated
document recognition for medical records categorisation. This
enables automated re-structuring of misfiled pages in case notes,
or more far-reaching re-structuring to meet the Royal College of
Physicians best practice guidance on medical records structure,
which is currently being developed;
Ë Scanning hardware must be selected and there is a strong case for
trialling such hardware on each Trust’s records as the quality of
case notes is variable. Final determination should be undertaken
as a trial period on actual medical records;
Ë EDM software from a leading, specialist supplier for medical
records is important as such software will fully meet the
requirements set out by Trusts in a cost effective way. This should
be configured by the supplier to provide a look and feel on-screen
browse experience akin to browsing the paper record, in order to
minimise training time and costs for medical staff;
Ë Integration with PAS, RIS, LIMS and a number of additional
systems for the purpose of capturing, at source, ongoing medical
record related information. In this respect, EDM can provide the
results reporting end of order communications;
Ë A managed service option allowing for the servers to be hosted in
an “industrial strength” datacentre, with high capacity, secure
and advanced data storage facilities. This will provide higher levels
of “admissibility-in-evidence” assurance, with second centre
disaster recovery fail-over facilities, together with 24 x 365
operations cover and SLA guarantees. This in itself is a strong
indication that a shared service is optimal as many Trusts cannot
afford or justify such a contingency capability on their own.
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Electronic Document Management (EDM) for Medical Records
Benefits of the solution to the Trust
The solution brings the benefits of:
Ë Electronic Health Records (EHRs) removing the need for up to
1,000 paper-based case notes to be delivered each day across a
hospital’s multiple sites;
Ë Over £2.5 million per annum per Trust in paper handling and other
costs is expected to be saved for an annual investment of around
£1.5 million – with a pay back of under 2 years;
Ë Major quality improvements to the way that the business service is
delivered in a location independent approach;
Ë Multi-user simultaneous access to case notes allowing true shared
care for patients and better medical outcomes;
Ë 100% availability of case notes (at present we estimate around
20% are not available when needed because someone else has
them or they are temporarily lost) therefore better clinical
judgements are enabled;
Ë Reduction in wasted time of both clinical staff and patients when
they arrive for appointments and notes are not available. Also, as
a by-product, safeguarding the Trust’s “green” status under
Monitor’s compliance regime by helping to meet the national 18
week to treatment target;
Ë Assured automation of aspects of clinical pathways are enabled
through the workflow capabilities built into the EDM (e.g. EDM
provides another option for fast discharge summaries to be
produced, authorised and transmitted electronically);
Ë Risk reduction and increased security through the elimination of
fire and flood concerns. A feature of the shear weight of medical
records means that many Trusts store their records in the
basement where they are at risk from water damage either
through storm overflow or plumbing incidents;
Ë Reductions in litigation risk: With the compensation culture of
today, successful claims can seriously drain a Trust’s resources.
Consequently Trusts need to rely on improved security of
documentation and easy but controlled access to their
information;
Ë Possibilities for further automation of pathways through
partnership with a supplier organisation bringing extensive skills
in large scale, secure EDM implementations - and an organisation
with proven experience in partnering with the NHS for the
development and roll-out of cost-effective services.
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Electronic Document Management (EDM) for Medical Records
Steria
Steria, as a major European IT led business services company,
is uniquely capable of fulfilling all EDM requirements for medical
records including the provision of a managed service around both the
IT functions and the scanning services. Steria’s uniqueness stems from:
Ë Our partnership with EMC, utilising the UK’s leading medical
records EDM system called Documentum to ensure the Trust
requirements are fully met;
Ë Our ability to form long term, mutually beneficial partnerships,
proof of which is the finance & accounting services delivered to
around 130 Trusts through our award winning joint venture with
the Department of Health, called NHS Shared Business Services.
NHS SBS was cited in the recent Operational Efficiency Programme
as an example of best practice in the provision of back office
services to the public sector;
Ë Our willingness to be flexible in the partnership, i.e. to take on
business processes (e.g. scanning) as well as deliver technology
platforms; to transfer staff under TUPE, if appropriate; to introduce
innovation to both the technology arrangements as well as the
commercial arrangements;
Ë Our experience in developing and successfully rolling out major
NHS projects such as the “Spine” equivalent project (the HCN
project) we undertook in Northern Ireland and now operate as a
managed service;
Ë Our ability to develop and operate robust, secure, cost-saving,
shared service platforms.
Our preference is to provide the scanning service as an “implant”
within the Trust’s premises as that approach obviates the high risks
associated with transporting medical records around the country.
We have implemented major EDMS functions in extremely large
government departments - such as the 20,000 user records project in
Northern Ireland, and the secure Documentum system for a large city
police force - and have a high skill level of staff experienced in
implementing health systems within both acute and primary care
Trusts. We also deliver large capacity scanning capability to the NHS,
the Identity & Passport Service, the UK's leading pharmacy-led health
and beauty retailer and several other well known high street
organisations.
We have implemented major EDMS functions in extremely large government
departments - such as the 20,000 user records project in Northern Ireland, and the
secure Documentum system for a large city police force - and have a high skill level
of staff experienced in implementing health systems within both acute and primary
care Trusts.
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Electronic Document Management (EDM) for Medical Records
Conclusion
By utilising a market leading EDM product - tailored by Steria’s highly
experienced EDM specialists to meet specific Trust requirements - the
Trust can be assured that technology risk is eliminated and user
acceptance is maximised.
Steria has designed end-to-end processes and technical capabilities
which dovetail into existing medical records practices, replacing the
manual delivery processes with rapid electronic availability of those
records. We are seeking true partners with whom we can undertake
the implementation and deployment work and with whom we
can jointly base our solution for the future to deliver high quality,
cost-effective medical records across numerous Trusts.
By having the option of participating in the foundation of an
innovative shared service alongside an organisation like Steria, which
is experienced in delivering such shared services, the Trust can be sure
they will gain all the advantages of cost reductions brought about
through service sharing. This represents a win-win situation for the
Trust and for Steria - and a true partnership for the future.
7

About Steria
Steria delivers IT enabled business services which help
organisations in the public and private sectors operate
more efficiently and profitably. By combining in depth
understanding of our clients’ businesses
with expertise in IT and business process outsourcing,
we take on our clients’ challenges and develop
innovative solutions to address them. Through our
highly collaborative consulting style, we work with our
clients to transform their business, enabling them to
focus on what they do best. Our 18,300 people, working
across 16 countries, support the systems, services and
processes that make today’s world turn, touching the
lives of millions around the globe each day.
Founded in 1969, Steria has offices in Europe, India,
North Africa and SE Asia and a 2009 revenue of
e1.63 billion. 19.3% of Steria’s capital is owned by its
employees. Headquartered in Paris, Steria is listed on
the Euronext Paris market.
contact
Steria Limited, Three Cherry Trees Lane, Hemel Hempstead,
Hertfordshire, HP2 7AH
Tel. +44 (0)845 601 8877
www.steria.co.uk
For more information contact Keith Irvine on Tel. +44(0) 7966 824912
or email: keith.irvine@steria.co.uk
© Steria st052uk / April 2010