John Spence Assistant Informatics Director – Operational Services Sheffield Teaching Hospitals NHS Foundation Trust

Apologies

PRESENTATION FROM 1995 CENTRAL SHEFFIELD UNIVERSITY HOSPITAL NHS TRUST DOCUMENT IMAGING OF MEDICAL RECORDS A ROUTE TO THE FUTURE

BACKGROUND Massive backlog of Medical Records for archiving Increased congestion caused by increased activity Hospital Mergers Casenotes spread across many storage rooms Dissatisfaction with existing service Need for flexibility

STRATEGIC CONTEXT Movement towards a Single Patient Record Integration of Operational Systems Clinician preference for accessible data - with the ability to write Space is our most valuable commodity

INCREASE IN MEDICAL RECORDS Merging hospitals / libraries No destruction policy Increasing number of patients Increasing number of tests Failure of existing microfilm policy

PROBLEMS EXPERIENCED Volume of medical records Health & Safety issues Security of records Efficiency Staff morale

PROBLEM TOO MANY RECORDS WERE BEING HELD IN PAPER FORMAT

PROJECT OBJECTIVES Archive ‘old’ records Clear space Resolve immediate difficulties Create options for the future Create the foundation for the electronic storage of patient medical records

SYSTEM DESIGN - 2 OPTIONS PAS number only (single index) PAS number –patient identification –letters –investigations –nursing –consultant episodes (multi index)

QUANTIFIABLE BENEFITS Space Maintenance Staff Opportunity Costs

OTHER BENEFITS Guaranteed availability - no lost records Better working practices Better quality of print In-house quality assurance Local systems management ‘Instant’ access to view records View without printing Remote access to records Direct access to relevant part of record Facilitates for a central library Facilitates for a single set of patient notes Allows records to be merged Allows secondary folders to be regularly scanned

OTHER BENEFITS (cont) Option to scan more current information Facilitates ‘back-up’ copies Elimination of Health and Safety risks Improved record security Direct links to other systems Fax input and output Elimination of fire and flood risk Basis of an electronic patient record Option to utilise the released space Can be used for other systems –accounts, finance, personnel, pharmacy, purchase orders, etc. Keeps our future options open

LESSONS LEARNT Document preparation is a very labour intensive process Bar-code or OCR could produce significant indexing benefits Potential benefits of real-time access could be significant Scanning is ‘boring’

ADVICE Establish your imaging strategy NOW Bar-code / OCM your documents NOW Evaluation of imaging is NOT incremental Remain focussed on your objectives Be realistic and deliver results Imaging is only a component of an electronic system

FUTURE CHANGES New casenote folder Bar-coded documents Change of colours Ban use of staples Eliminate gummed forms Use black ink

FUTURE DEVELOPMENTS Duplex printing Integration with PAS Integration with other systems Remote access for medical records staff Remote access for clinicians

DOCUMENT IMAGING IS A very efficient record storage system A very efficient record retrieval system A quality view and print facility A secure environment

DOCUMENT IMAGING OF MEDICAL RECORDS IS Cost effective - for high volumes Achievable A ‘safe’ step to the future A means to the end A component of an Electronic Patient Record and a foundation for the future

PRESENTATION FROM 1997 WHERE DO WE GET HELP –Who is really successful »What can we learn from them »Are they willing to share »Can we copy them WHICH IMAGING COMPANY TO USE –Do they really understand it –Can they prove it »In a Health environment –Do they really understand the issues »Do we???

DOCUMENTS OPPORTUNITY TO DO THINGS PROPERLY DOUBLE SIDED SPACING –Punch holes destroying data METHOD OF FILING –Staples / Gum COLOUR OF DOCUMENTS –Contrast TYPE OF DOCUMENTS –Large / Small Continuous / Card / Tissue STANDARDISE FORMS –Patient ID in a standard location

DOCUMENTS THE DOCUMENT IMAGING SYSTEM WILL BE ‘BLAMED’ FOR EVERY SINGLE CHANGE WHICH AFFECTS THE PATIENT RECORD

QUALITY CONTROL What percentage of images do we check? How many files do we check for 100% accuracy and completeness How do we condone / explain / accept less than 100% accuracy

SUPPLIER ISSUES THEY MAY THINK THEY HAVE AN IMAGING SOLUTION BUT MEDICAL RECORDS ARE DIFFERENT –Colours –Document Types –Age of Documents –Quality of Documents –Size of files –And they are “living documents”

ACCESS TO DATA BATCH /ON-LINE –Reprint Data »Whole Record / Partial Print »Who is authorised to print –How do we control access »On-line and batch versions co-existing –How do we stop them writing on reproduced pages –How do we merge ‘old’ and ‘new’ data

,000+ record have been scanned 500 Optical Disks Disk Storage occupies 5-6 linear metres Original paper record would occupy 11,000 linear metres

2006 Main Royal Hallamshire library is 550 square metres Shelving is 13 metres long and 7 shelves high 20 aisles back-to-back 3640 linear metres We’ve scanned equivalent of 3 times the library

Today Scanning – over 25,000 pages per day Double-sided – so 50,000 images per day Need at least 5 staff on prep to support 1 on scanner Staff costs account for over 75% budget So worry less about beating up the supplier on price Concentrate on operational efficiency

2006 – Today We are acquiring a new system – for the third time Our disks are “guaranteed” for 50 years BUT DISK DRIVES AREN’T IMAGING / DATABASE SOFTWARE ISN’T SUPPLIERS AREN’T

2006 – and finally Document Imaging still has a role to play as part of the Electronic Patient Record Electronic Health Record Integrated Care Record Service NHS Care Record Service Whatever it’s called

2008 New system is live We’ve migrated over 75% records Migration should be completed next month What have we done differently –We’ve gone back to basics –We’ve kept it really simple –No bells or whistles –No goodies and fancy features –And we’ve still found it tough getting what we need

2008 So what does a simple system need Scan Index Audit Retrieve View / Print

Supplies Use of an Imaging System

John Spence