Holistic records management service brings host of benefits to hospital including instant access to patient records, substantial cost savings and reduced storage needs.
St James’s Hospital (SJH) is the largest acute teaching hospital in the Republic of Ireland. Located on a 63-acre site just south of the River Liffey in Dublin, it has over 4000 employees and caters for patient visits every year.
The patient record is the cornerstone of the healthcare system. It is the document on which service delivery is based. Without it, medical staff wouldn’t know what treatment has been given, or to whom.
Traditionally, patient records have been kept in paper form but hospitals are gradually moving towards electronic patient records (EPR).
SJH took its first steps towards EPR in 2006 when it digitised x-ray and test results and made them available through the internal computer system.
In 2010, it decided to extend EPR to the tens of thousands of patient records housed in its primary records facility in the hospital.
The main drivers behind the project were twofold. The first was space. With between 40,000 and 60,000 patient records created every year, physically storing that number of files meant constantly having to free up storage space. By converting records to a digital format through scanning, less space would be needed for physical file storage.
Policy was the second driver. The Code of Practice for Healthcare Records Management launched by the HSE in 2007 contained new guidelines on records management and obliged hospitals to review their patient record systems in the interests of quality and patient safety.
In the wake of this new code, a taskforce was set up within SJH to see how patient records management might be improved.
One of its conclusions was that records should be held in digital rather than hard copy form. The principal reason was speed: records viewed on an EPR system can be accessed far more quickly than those held as paper or microfilm – as the initial EPR project at the hospital had demonstrated.
“If a patient presented themselves to the emergency department and they’d had a test done in the hospital prior to that visit, this was instantly viewable. You didn’t have to go to the chart room, or someone’s office to get the paper record of that test; it was available instantaneously on the computer system. It was felt that patient records should go the same way,” explains Brian Fallon, Patient Records Manager at SJH.
In mid-2010, SJH went out to tender for the provision of scanning and other services associated with EPR. The tender was won by Kefron, which, says Fallon, stood out for its overall ability to meet the brief.
“It was felt that Kefron provided the best package.”
Kefron would provide a full end-to-end EPR system. The core task would be to scan 40,000-plus patient records and make them available for viewing by hospital staff. But around this were many important supporting tasks, including:
It was decided to scan the most recent patient records first – those less than two years old. However, within this group, only those belonging to patients who had not attended the hospital in the last 12 months and who did not have an upcoming appointment were to be scanned. By choosing these ‘dormant’ files to begin with, the situation could be avoided where the hospital would need to recall a large number of files after they had been taken offsite, as might have happened with more active files.
At this point, Kefron went onsite and worked in partnership with SJH patient records staff to pack files into boxes/crates.
Files were barcoded for tracking purposes and a log produced of these files. After this, they were transferred to Kefron’s scanning, storage and shredding facility at Park West. There, files were prepared, indexed, scanned, quality controlled and uploaded to as hosted repository on Kefron’s cloud server.
During this period, hospital staff visited Kefron to satisfy themselves that the scanning was done to the necessary quality standard and that a complete and accurate scan of each record was being achieved.
The physical files were then placed in temporary storage until they were destroyed in line with SJH’s retention policy and a certificate of destruction provided to a file level.
The project presented a number of challenges. One was how to make paper records available to the hospital after they had been taken away for scanning but before they had actually been scanned.
A system was put in place that allowed this to happen. If the hospital emailed Kefron before 9.30am the record would be guaranteed to arrive by 12.30pm that afternoon. If the record was not required for that day, it would be fast-tracked onto the hosted repository and made available for viewing on the EPR system. If a record was needed right away, Kefron would find it and courier it back to the hospital.
The ability to respond to file-return requests in such an efficient and timely manner was only possible because the cataloguing system that Kefron had put in place ensured each file item could be instantly traced to a particular box.
A second challenge was indexation. Individual files were indexed into a jointly agreed taxonomy to enable users to retrieve not just individual files but also documents of a certain type. This involved learning a large number of document types in order to ensure accurate retrieval.
Systems integration presented a further challenging aspect. Files are managed and retrieved by Therefore, an EDMS already used by the hospital’s A&E and HR departments. Access to this system and the information repository behind it was made available to in excess of 300 users within SJH via the cloud install, allowing patient records that had been scanned to be accessed by staff from both desktop and patient bedside.
In order to work, though, the EDMS had to be integrated with the hospital’s own EPR system, Cerner Millennium. This was achieved through a partnership of both technology and communication between SJH and Kefron, a successful relationship that continues to this day.
According to Stephen Mackey, Senior Capture Consultant at Kefron, integration was made easier by the choice of Therefore as the EDMS.
“I chose Therefore because of its wide use in similar healthcare settings both in the UK and the Republic of Ireland, its ability to integrate with relative ease through APIs (application program interfaces) and a good support network“ he says.
AVAILABILITY AND ACCESS
Using the EPR and EDMS, medical personnel can access patient records far more quickly than they could a paper version. It takes just a minute or two to find a PC, enter their password and find a patient record using the search feature. By contrast, a paper file can take 15 minutes or more to retrieve from storage.
Quicker access means quicker decision making: “If I’m working for an insurance company and I can’t find a particular policy document, it can wait until tomorrow. Patient records are completely different: we need them now – for the sake of patient safety and patient care” says Fallon.
Once a file has been accessed, moreover, users can quickly search for and find the individual document they are looking for. By contrast, searching for information in a paper file can be very time-consuming as files can run to several hundred pages for some patients
By outsourcing its document management needs to a specialist supplier, SJH did not need to invest in its own scanning, shredding and related technologies. It also saved on the labour costs associated with scanning thousands of documents. The hospital is also saving in terms of ongoing operating costs as it is no longer necessary to physically collect and return the scanned files from the storage areas. While these cost savings have not yet been quantified in aggregate, they are certainly substantial
The EDMS has strong built-in security features to protect patient confidentiality. Authorised personnel are given password-protected access to the system and the level of access can be restricted so that an orthopaedic surgeon, say, sees only his or her patient’s medical records and not those of a surgeon colleague. In addition, unlike paper files, electronic files cannot be lost or mislaid.
PHYSICAL SPACE CREATION
Removing 40,000 files for scanning had freed up many shelves of space in the hospital’s primary storage facility – space that is needed to house new patient files. Had this not been done, the hospital would have had to move these files into a secondary storage area, a time-consuming and labour-intensive operation.
BEST PRACTICE INFORMATION MANAGEMENT
In deciding to digitise its records, the hospital has adopted a best practice position on information management. Holding files as paper or microfilmed records will soon be a thing of the past as the many benefits of holding data in digital form becomes apparent to more and more organisations.
Kefron’s engagement with SJH has been a ground-breaking partnership – not least in terms of scale. Kefron took away more than 40,000 files to be scanned, with each file averaging 120 pages of notes, charts and test results. By mid-2011, Kefron had scanned some 41,000 files corresponding to six million individual pages.
But the project was about more than simply scanning pages; it was about finding the best solution to an organisation’s complex records and information management needs.
“Digital information management is the future for many aspects of healthcare from both cost saving and process efficiency perspectives but also getting the right information to the right people and ensuring its value is fully realised” says Mackey.
According to Fallon, the hospital has an “excellent relationship” with Kefron, which he praises for its flexibility and willingness to engage with difficult issues.
“They listen to the challenges we face and adapt to what we require. It’s not one-size-fits-all with Kefron.”
At Kefron, we provide highly secure, convenient and cost effective services that immediately take the pain out of paper, leaving you free to concentrate on your core business activities.
Services available in the Kefron Group of companies include:
Shred-it – On-site secure destruction of confidential documents and data