Electronic Document Management

Transcription

1 Electronic Document Management The London branch of ASSIST held a one day seminar on the subject of Electronic Document Management (EDM) on the last Friday of January. ASSIST is grateful to Tribal Consulting for initiating and leading this event, as part of our formal partnership arrangement. We are also grateful to Tower Software and Blueware, who sponsored the event. The seminar provided ASSIST members with an opportunity to explore and share the issues around EDM, and talk directly to suppliers. The feedback from the day was universally positive and this seminar was re-run on Thursday, 13 th March, in Stafford. There were presentations from two NHS informatics professionals in Portsmouth, two directors from Tribal Consulting and an independent health care consultant. There was also plenty of time to examine the products of Tower Software and Blueware, and talk to their EDM specialists direct. Dr Bill Flatman, Director of ICT, Island & Portsmouth Health ICT Service, described the drivers that are stimulating the need for EDM in Portsmouth Hospitals. In setting the scene, the hospitals provide health care to a population of 550,000, there is a cost improvement programme that aims to deliver 69m by 2015/16 and the PFI build that brings all the hospital on one site will be completed in He also set about dispelling some myths that helped participants understand the constraints within which he is working. More and more clinical information is collected and available electronically but the traditional paper health record will not wither away in the short term. This would result in the danger of running dual systems without either of them being the master record. Although it varies between specialties some old data is very important. Bill s judgement is that electronic systems for collecting clinical data effectively and efficiently in all clinical situations are insufficiently developed and this means that temporary paper is required for the medium term. Added to this The core Care Record Service (CRS) product (in the South), Cerner Millennium, does not address the historical paper record issue. EDM is an additional bundle. The CRS programme is currently suspended in Portsmouth, Isle of Wight & SE Hampshire. There are problems with paper records. From a clinical perspective this includes: Misfiling of documents Documents never filed Records lost Multiple records Specialty notes Time taken to find relevant information. This results in clinicians having to make clinical decisions based on incomplete information. In terms of managing the paper there are issues with: Filing and retrieving of paper records Policies for Retention & Disposal Health & Safety Space

2 Transport Multiple stores Cost. Whilst in terms of security there is no auditing of who has viewed record; records left in insecure areas; it is difficult to control access and records physically lost. There expected clinical benefits of EDM are: Information available when required Available simultaneously in multiple places Electronic records are more complete Research Future better structured to aid care pathways and decision support. There are arguments why now is the time to implement EDM systems but it is important that EDM is not considered in isolation but as part of an overall strategy. The Portsmouth EDM business case was agreed simultaneously with a single sign-on and context switching business case. There are also risks associated with EDM that have to be managed. Wendy Clark, of Tribal, stated that there were a consistent range of questions being asked by health service organisations about EDM. Her perception is that the drivers for this are: Clinical and information governance Patient experience and safety The physical environment Modernisation of services Rising costs Knowledge and information management NPfIT implementation timetable and confidence The questions that organisations are asking include: What are the options - Health records / other documents / archive or workflow? Compatibility with NPfIT? What are the potential solutions? Price tag and VFM? Will clinicians use the system? What are the key implementation questions? Phasing Scope Change management Information governance She concluded by stating that there is: Definite change in the level of interest in EDM and options for health records management National thought leadership and direction are lagging behind the service Lots of organisations are thinking the same things and asking the same questions Need for greater understanding of the supplier market place Need to share ideas and experience. Paul Duller, of Tribal, examined EDM in other industries and covered:

3 Long term trends and historical changes Major challenges and issues A description of what success looks like. He described how organisations are becoming more information-centric. This can be seen in the office software products that are available today compared with a decade ago. He described how in one major company staff spent 60% of their time looking for information in 1998 whilst dedicating a mere 18% to useful work. This move towards being centred on information can be seen in the increase in EDM systems, the widespread use of scanning technologies, an increase in electronic documents has been by a factor of 25, there has been a reduction in filing clerks of 95% yet the amount of hard copy has increased by a factor of 3. This increase in hardcopy documents can be described as a nightmare, as workers can t find what they need and they waste six weeks per year trying to find mislabelled, misfiled or misplaced documents. Further 10% of staff report that incorrect documents have been re-used whilst 67% have unwittingly relied on the wrong information. The major challenges facing organisations are to improve efficiency (in terms of cost reduction and finding the correct information); distributed working (globally for multi-national companies but also for round the clock expert advice in the NHS, closer working relationships with partners and home working) and increasing regulation. Paul outlined the key elements of any EDM programme and listed the signs of success. He summarised by saying that the following are required: Senior management support Effective partnerships Making documents and records management routine Enforcement where necessary Robert McIndoe, Independent Healthcare Consultant, provided an overview of EDM and the marketplace for products and services. He started by showing the results of a business case for EDM with the net present value of five options over ten years. It became clear, when Philip Scott spoke later, that the falling costs of technology and services have altered the financial balance, so a business case which may not have succeeded a few years ago may now be worth re-examining. He continued by describing how EDM has been implemented in UCL and set out many technical details. He stated that the progress to mid-january is: 630,000 documents scanned Growing at 2000 per day All GP referral letters now scanned in Clinic letters to be rolled out trust wide by end of 2008 Discharge summaries to be rolled out trust wide by end of The key benefits of this are: Reduced clinical risk Clinicians can always access documents on-line Documents are shared to improve communication between clinicians No more missing notes

4 Reduced cost Reduced cost of clinic preparation and notes pulling Reduced cost of duplicate investigation ordering Improved clinical efficiency Faster production of clinic letters and discharge summaries Improved accessibility of information Clinical work lists Increased mobility information available via the network at point of care Improved access control and security Electronic access can be controlled more securely than access to paper files Better communication with patients and colleagues Improved discharge documentation for patients and GPs Better communication with GPs about patient progress Easier management of access to information requested He also described how EDM has been achieved in a wider context in the States of Jersey for health and social services. This project started in April 2004 and went live in January It involved 2,500 users and over three million records. Paper records have been removed and the benefits are: Improved access Secure Archive Reduced Space He described the issues that need to be addressed and how to prepare for an implementation and listed the major project activities, which include: Complete business classification scheme Create records management unit Define records management policies Educate staff Dispose records that are past their retention period ECM systems readiness Roll out technology Migrate electronic records to the new structure Organise physical records to the new structure management Review remaining physical records Records management compliance monitoring Automate business processes Increase collaborative working. Philip Scott, Head of IT Projects & Development, Portsmouth Hospitals NHS Trust, set the scene for EDM in Portsmouth Hospitals but swiftly moved to the practicalities of implementation, including procurement and deployment, strategy, governance and the lessons learned. He addressed the issue of whether to scan historical records and, if so, which. A decision needs to be taken about whether to go live across the whole organisation in one go or whether to phase in the introduction of electronic documents. There is a risk in withdrawing paper documents once electronic documents are available and he explored ways to reduce this risk. It quickly became apparent that there is not a single correct answer. Philip had a set of answers that are applicable to Portsmouth Hospitals. The logical steps to reach the implementation plan are both

5 fascinating and informative. The value is in the debate as it helps tease out the issues that have to be addressed. There is a need to take everyone in the organisation along the journey to EDM. There are the enthusiasts who welcome it and will put themselves out to have it implemented. However most people will use what system is available but they do not want to be inconvenienced on the journey from paper to electronic documents and there are those who are sceptical about the whole enterprise and believe that it will never work and will probably try to retain the paper documents for as long as possible. John Leach