THE CLINICAL CASE NOTES ARE FULL AND THE MEDICAL RECORDS LIBRARY IS RUNNING OUT OF SPACE Michael Brown Deputy Director – Performance & Informatics The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust

Overview of the current state Medical Records library totalling 120,000 patient case notes. –held both on site and off site –35,000 case notes into an electronic format Access to health records is achieved through; –The physical acquisition of patient folder –A request for reconstitution of scanned documents into a folder –Direct access to scanned documents via computer software

The Problem “The problem is that the clinical case notes are full and the medical records library is running out of space.”

The Objective “To move the clinical case note to an electronic format that is available on a desktop at the patient bedside / clinic room within 9 months”

Root Cause Analysis Trust has a split Medical Records library totalling 120,000 patient case notes and is running out of space. Last year the Trust scanned approximately 35,000 case notes into an electronic format. Access to health records is achieved through; - The physical acquisition of patient folder; - A request for reconstitution of scanned documents into a folder; - Direct access to scanned documents via computer software.

The Selected Strategy Considered options (e.g. increased storage) The long term vision to introduce Electronic Document Management (EDM) across the whole Trust with a clinical case note available with secure access at a user’s fingertips. Strategy Scan all historic notes Pilot in clinical areas Consider corporate areas that may benefit (e.g. complaints) Roll-out electronic documentation across other clinical areas and consider wireless access on tablets and smartphones.

The Implementation Plan Key Actions 1.Design a working model - 3 months from project initiation; 2.Test in specific clinical area - 1 Month (PDSA); 3.Review lessons learnt from pilot / test - 1 month; 4.Take corrective action if necessary and develop a roll-out plan - 4 months. The HEALTH RECORDS MANAGEMENT COMMITTEE will be accountable to delivering the transition from paper to electronic record. Resistance will be managed through this established group and through the Consultant Chair (Clinical Lead)

Implementation Plan – Timeline

Evaluation Plan Measure access to the Medical Record through the main library and electronically What were the access issues, if any? Identify any potential issues and put in plans to resolve them ProcessOutcome Requests for RecordsReduction in cost of stationary Electronic access pointsReduce staffing in Medical Records Increase in the number of electronic records Reduction in the size of the Medical Records library

Lessons Learnt Leadership needs to be strong and prepared to test something that may fail Don’t be afraid the challenge the current system – cultural challenge Your working group needs to share your vision and a common goal The organization benefits from; Use of technology Improved efficiency Reduced costs