The transformation of paper-based patient record-keeping practices into a fully digitised data asset management strategy has been a long process for many healthcare institutions. The historical legacy of paper records is often cultural as much as it is practical, and it has proved stubbornly hard to shift. As a result, the benefits of digitisation -especially seamless remote access for clinicians and the removal of costs associated with physical storage - have been slow to materialise.
But pioneering healthcare providers such as University Hospital Southampton have led by example, and now provide a blueprint for an integrated approach to digitisation to which other institutions can aspire.
University Hospital Southampton NHS Foundation Trust is a major teaching and research centre, with ambitious plans to digitise by integrating open systems. Following the Wachter Report in 2016, it was named as one of England’s global digital exemplars – with a significant difference: unlike most of the others, it has based its strategy on an integrated electronic document management (EDM) system – Hyland Healthcare’s OnBase enterprise information platform – rather than an electronic patient record suite from a single supplier.
The system went live at the Princess Anne Hospital in 2017, ahead of a subsequent roll-out to the Royal South Hants Hospital and Southampton General Hospital. While the initial focus was on cost-savings - the closure of a health records centre shared by the three organisations - the long-term strategy was to support a move from paper-heavy to paper-light working, and enable the facilities to share information with each other more easily.
Ditching paper
Adrian Byrne, chief information officer at University Hospital Southampton, says: “We wanted to start moving people away from writing notes on paper to entering information into digital systems. This fitted with our strategy of migrating from being paper-heavy, to paper-light, to paperless.”
Byrne adds: “In addition, the trust does not want to be dependent on just one supplier and its development path - it wants to be able to switch or add innovative products, economically.”
Some aspects of the implementation project and its ongoing evolution reveal the scale of the task faced by any healthcare provider embarking on a digitisation strategy. The trust instituted a scanning programme that will ultimately see around 15% of its historical records digitised - or 60% of those in regular use to provide care to patients who have repeated contact with the trust.
Byrne says the trust’s IT systems already contain a lot of data about patients, but some key pieces of information are still held in paper-based historical records. “There are two things, in particular, that you find yourself pulling records for,” he says. “ECGs and drawings, particularly things that people drew a long-time ago, such as an image of a congenital heart defect.”
Medical staff can now access this information via OnBase, which holds content in a single, secure location, and enables it to be viewed on secure devices. Byrne says a lot of work went into the rollout model because once a patient group or department goes live with the system, its clinicians are creating information that will not be available to others until their part of the trust also goes live.
Shared access
While the trust’s immediate priority has been to close the Health Records Centre, the deployment of OnBase also supports further elements of its digital strategy. For example, it is becoming easier to support clinicians who need to run remote clinics, and for the acute, mental health and community trusts to share information with each other.
Byrne says: “As we move away from paper notes, we have to become more agile when it comes to mobile working. At the moment, if somebody needs to run a mobile clinic in Dorset, they can take the notes; but what happens when there are no notes? We need to make sure people can work in that situation. It’s also part of our regional information sharing strategy, because we can put documents into the EDM system (OnBase) and interface to them.”
Byrne is a keen advocate of institutions proactively influencing system development – in this case, focusing on the needs of other trusts looking to digitise without going down the single-supplier EPR route. He sits on the company’s advisory board and says: “I want to highlight the issues we see as a UK customer. For example, if you talk to US customers, it’s clear they are focused on the big EPR suppliers, and only interested in using EDM as an archive. They don’t use it much as a forms creation system; whereas this is one of the things that we are keen to develop.”
Byrne adds: “Forms creation will be a large component of our paperless operation. It will mean information will be much more readily available to our clinicians. It will enable us to do some significant business change. We may also end up using it for HR and financial tasks, and take out more paper that way.”