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Video: Digitising Lloyd George records at HTN Digital Primary Care

As we continue to recap the HTN Digital Primary Care event from early August, we next revisit our session with Vijay Magon, Managing Director of CCube Solutions.

In his live discussion, Vijay chiefly focused on the case – and options available – for managing Lloyd George records. In this write-up, we’ll catch up on the presentation and share the main talking points – but you’ll also be able to view the full video of the session, at the bottom of this page.

First providing the background story for CCube, an independent UK SME that’s been in the industry for over two decades and receives 98 per cent of its business through the NHS, Vijay pointed out that the company is a member of both the All-Party Parliamentary Health Group and the King’s Fund Digital SME Programme. He also added: “We’ve been working in the public sector for some 20 years now – essentially dedicated to delivering patient records management [and] patient information management solutions in the NHS. Most of our work is in secondary care – delivering solutions for capturing, managing and providing patient information at the point of need.”

However, in primary care, the company does specialise in dealing with the Lloyd George records, he said, before outlining the “some 30 trusts and health boards up and down the country – all the way from the Orkney Islands down to Cornwall” that the SME works with.

“We capture patient information from pretty much anywhere around a trust, manage it in an underlying solution, which is electronic document and records management, and deliver it at the point of need to those who need it, where they need it, when they need it,” he said.

CCube is, collectively, managing around 450 million documents for roughly 35 million patients – some 52 billion pages in total. “On any day,” Vijay added, “some 15,000 to 16,500 users actually log on and use this information. This is not an archiving system.”

“A key message is,” he continued, “that access and use of digital records is not new, we’ve been doing this for a number of years”.

Around 9 years ago, CCube turned its attention to the Lloyd George records in particular. At this stage, Vijay used a slide showing hundreds of folders on shelves, stuffed full of paper documents, to illustrate his point. “We started looking at how we could apply the lessons we learnt in secondary care to dealing with the Lloyd George problem that most – if not all – GP practices face,” he explained.

After briefly highlighting the well-known problems, such as use of premium storage space, the time and costs of retrieval and access, and the risks around physical records, Vijay said: “The key here, really, is ‘can technology which has been very successful in secondary care be applied to solve the Lloyd George problem?’ The short answer is yes.”

After summarising the legal background to this on a slide, he said: “It actually comes down to compliance and lifecycle management of information. That’s actually crucial in the context of the established standards and GDPR that kicked in about three years ago, in particular.”

“Why digitise Lloyd George records?” Vijay asked, “these records are needed to provide proof of identity, to serve medical legal, and also when a patient moves from practice A to practice B.”

Vijay also illustrated, through a slide, the benefits of digitising the records – such as removing the last of surgery legacy papers, freeing up surgery space, improving efficiency and productivity, enhancing security security and access control, cost savings, removing risk of physical damage, and ensuring full auditing and GDPR compliance.

On potential solutions, he added: “The actual solution for dealing with Lloyd George can be divided into two very distinct areas. The first one, as you can imagine, is digitisation – so collection, preparation, scanning and so on. And the second part, which is really key for us as a software provider, is that once the records are digitised – how do you store them? How do you manage them? And how do you deliver them where they need it?”

“Lloyd George records present their own significant and specific problems because the Lloyd George wallet…contains a lot of sheets of paper that are folded, almost in half, and stuffed in. [It] causes particular challenges to the scanning service providers but it’s been done and there are experts out there we work with. It’s key to ensure the entire process – from collection of the records, all the way to destruction of the record – complies with established processes and standards.”

After explaining the process of scanning Lloyd George records, Vijay went on to discuss options for repositories, such as Direct File Access, GP Clinical Systems and Dedicated Records Management. On the latter, he said, “this is the application of the lessons learnt in secondary care, brought into primary care.”

“We actually investigated all three options – keeping in mind  that we have delivered option three as a solution in secondary care,” he explained, highlighting that each is looked at through a lens of 11 requirements: storage and management; access and navigation; metadata; life-cycle management; data security; access controls; sharing; patient moves; audit; compliance; and electronic discovery.

“The third one, document and records management, ticks pretty much all the boxes because this is exactly what has been delivered in secondary care and it works really well there.”

Vijay then gave an overview of how the Lloyd George Platform solution works, from GP practice to collection service, scanning and secure file transfer, through to being hosted on the platform and having the information made available to the practices that signed up.

“There’s no need to set up any software locally within a practice – each practice has their own account on the Lloyd George Platform. They can actually manage their own account as well, in terms of setting up additional users…and [can] have access to the system simply by clicking an icon on the desktop,” he stated, before explaining file upload security and providing an example of usage by the St Helens and Knowsley NHS Foundation Trust, which manages over 1.5 million records for 105 practices using the CCube eLG system.

On interfacing the record with existing GP IT systems, Vijay used EMIS as an example, to show how the platform’s screens can appear within the web portal or in a new window, before also covering eShare and how this can support the sharing of images, files and multi-media.

“The entire process, from uploading to access and viewing and downloading by the receiver, is strictly managedbehind the scenes – in compliance with the standards,” he said, before sharing a screenshot of the cloud-based, fully audited CCube Sharing Portal.

Concluding with more benefits of the company’s Lloyd George service, and of trusts making savings by using the solution, Vijay added: “They key objective here is to repurpose space that is currently being used – premium space – that is being used to simply store Lloyd George records within practices, and give that space back to the practice.”

For the full session and Q&A, watch the video below: