By Vijay Magon, CEO, CCube Solutions
NHSX has announced it wants to assemble a world-class team of technical experts to help solve some of the biggest technology challenges in health and care. The objective is to help clinicians and policymakers improve patient experience through the power of technology.
More recently Matt Hancock has announced as part of the TaxPayers’ Alliance report that technology will allow NHS staff more time to do the vital jobs they love and that technology can help address shortages and free professionals from repetitive tasks.
The TPA’s report considers how existing and developing technology can enable the health and social care system to increase productivity, reduce costs, and result in world class health and social care.
The NHS must now encourage a culture shift to ensure technology is properly being used to boost efficiency, remove repetitive tasks for professionals and remove the hours of wasted time through manual process.
Using technology to improve healthcare delivery and patient care has been a hot topic over the last few years. Technology is not just making its presence felt in operating theatres and hospital wards – NHS Trusts and CCGs are quickly becoming aware that being able to access, store and share patient records is as crucial to improving patient care as the latest breakthroughs in medical science.
The need for an efficient and effective information management system manifests itself across all levels of modern healthcare provision. It encompasses everything from consultants and surgeons accessing x-rays and scans from workstations across a hospital complex, ending the need for cumbersome transfer of paper records from site to another, with the incumbent risk of them being misplaced or lost or misused; to administration staff using systems that help automate selected processes, saving time and money. Add a dose of security and audit, and suddenly, the prospect of a system that mandates governance and eliminates un-scrutinised misuse, becomes quite real. This has been achieved in some NHS Trusts who took the bold step to deliver change some years ago and are now leading the way forward.
The implementation of an electronic system turns around the culture of information. Much like the NHS’ founding principle, the modern information management system provides a ‘cradle to grave’ auditable trail of legacy documents such as patient records and correspondence. Implementing an electronic information management solution delivers the proverbial ‘double whammy’ of improving accessibility, whilst ensuring that healthcare providers like NHS Trusts and CCGs are fully compliant with their legal obligation in storing and sharing healthcare records.
Document management or “electronic filing” started with turning paper into electronic files, which can save, space, be moved around and shared. Lessons learnt from early adoption of such systems are now being realised through more sophisticated Electronic Document & Records Management (EDRM) Systems which include electronic content. Add a dose of systems integration, workflow, electronic forms, content extraction, compliance, and interoperability between systems, and suddenly organisations are beginning to realise tangible benefits from this technology. With appropriate safeguards in place, EDRM has a proven track record of long-term cost savings combined with increased efficiency with no loss of security (in fact, enhanced security).
With the consumerisation of IT, introduction of mobility, cloud solutions/services, big data and analytics, Internet of Things (IOT) and social media, there is growing pressure on Trusts to convert paper-intensive workflows to digital, demanding increased urgency on patient-carer engagements, improving delivery of healthcare and reducing costs associated with inefficient workflows. There has been a rise in the use of capture technology supporting the integration of paper content within digital workflows. This includes the integration of structured, semi-structured, and unstructured content, as well as growing adoption of technologies to extract information out of data.
We’ll look at how newer technologies can help to extract meaningful information out of the huge volume of content held in EDRM to deliver the NHSX objectives.
Unstructured Information
Extracting textual information held on paper records is not new – limitations due to hand-written text remain although recognition accuracy is getting better. Simply searching through extracted text offers limited returns. Organisations want to be able to rapidly analyse both unstructured and structured data. Ingesting large volumes of documents into a knowledge management system so they can be searched is not a practical option in organisations that want real-time or near-real-time insights into their operations. Moreover, the large-scale corporate knowledge management systems that were popular a decade or more ago are not usually flexible enough to accommodate new types of information or to support new analytics tools.
There are more advanced search techniques based on machines understanding the text to help “find” information rather than simply “search” for information. The key difference between the two is that the outcome from a “search” will present the user a list of related items to select from; the outcome from a “find” will not only present what the user is looking for but offer suggestions for more because systems understand the textual content and, more important, understand what the user is looking for. We all use search engines almost on a daily basis – I can search for “cardiology” and spend my time finding what I actually need! In other words, searching is one step in making sense of unstructured data – the real value is linking apparently disparate pieces of information to generate actionable information.
Text analytic solutions leverage new text analytics technology to deliver the capability to read free-form text in health records to discover both content and context, analysing the results and transforming those findings into usable information which can then be used for more-efficient patient treatment and to support researchers. Machine Learning and Artificial Intelligence breakthroughs are helping to unlock vital information buried in unstructured data and potentially transform it into actionable information.
Using technology to discover and extract usable information from unstructured data is helping to realise tangible benefits for businesses across all sectors. The gains in competitive advantage are beyond question; potential life-saving opportunities are a real blessing!
Interoperability
Once existing paper and electronic repositories are captured and managed, it is important to ensure that systems no longer feed storage sub-folders, ie. new patient information can be captured at source, managed, and delivered without resorting to paper. Integration between multiple IT systems and devices that generate patient information must be mandatory to ensure that patient information is accessible and usable regardless of where it is held. This includes medical devices that record vital signs – a key area of concern as currently, most medical devices work autonomously, ie. data from medical devices is (manually) transcribed and re-keyed into IT systems for reuse, or simply printed and saved on paper, adding to the scanning volumes.
Compliance
The combination of external threats (hackers, malicious damage, fire, theft, flooding, etc.) and legal obligations (Data Protection Act, Freedom of Information Act, and Civil Procedures rules on Electronic Discovery) surrounding the issue of storing and safeguarding crucial information applies to all businesses across all sectors. Data merely stored on computer hard drives or paper-based filing systems are particularly vulnerable to loss or destruction. Failure to manage electronic documents as formal corporate records will mean that organisations will not be compliant with government legislation. Compliance demands at the very least a high-level inventory of a company’s information assets and investment and careful application of available technology.
Sharing of patient information across NHS organisations
EDRM is widely used for sharing patient information within a Trust, including geographically distributed sites. Sharing patient information across different NHS organisations is a key topic of interest, for example – patients can move around anywhere in the UK (and abroad) and may need treatment wherever they are. This has led to a number of initiatives and technology drivers to ensure that:
- Patient information is readily accessible and not held within any proprietary system;
- All required information for medical decisions is both correct and available to healthcare professionals, using established standards like SNOMED and ICD-10
- Patient information can be readily exchanged between systems using standards like HL7-FHIR
Opportunity through innovation
Despite funding constraints, the intent to change is certainly there from NHS Trusts and Health Boards. Newer technologies are creating new opportunities for innovation and help achieve more from the investments already made. The key message is that careful application of established EDRM technologies is delivering measurable improvements and benefits. These must be applied to address strategic requirements, rather than using EDRM as a short-term measure to solve paper problems. The technology is not rocket-science, but has evolved gradually as customer demands, interoperability, and web accessibility have evolved.
