At HTN Now last week, we were joined by Vijay Magon of CCube Solutions for a discussion on patient records management, interoperability and system-wide access and sharing. Vijay’s presentation focussed primarily on how electronic document and records management can be shared in order to support citizens in becoming more proactive in their care.
Vijay began by providing some context into CCube Solutions, an independent UK SME with over 25 years of experience delivering business solutions to help trusts and organisations across the country in managing their patient records and progressing their digital transformation strategies.
Over the past couple of years, CCube Solutions has attained a number of accreditations such as Cyber Essential Plus and ISO standards. “A key milestone for our company has been in assuring our customer that the data that is held in our systems complies with established British standards out there,” Vijay shared, “and we have a solid track record of using this technology.”
The problem
Vijay explained that patient information falls into two broad groups. Structured data, such as the information that is held in databases that drives EPR systems, clinical portals and lab systems, is updated and tracked over time to help clinicians and practitioners make decisions about patient care.
Unstructured information, meanwhile, refers to data that does not have a pre-designed data model and is not stored within a structured database. “This is not limited to paper documents, but also the growing volume of electronic files which hold huge volumes of unstructured content on shared folders and drives,” Vijay said. “This data typically lives outside of the EPR and will be saved in a number of silos and databases. Current estimates show as much as 80 percent of the info that exists on a patient is unstructured.”
Vijay went on to highlight the key problems with using paper to store information, a practical issue being the use of premium storage space. This can make retrieval and access very difficult, he noted, as it is time-consuming for the user to locate the desired information. In addition, filing and refiling accrues recurring costs and brings with it greater risk of GDPR breaches or loss of information due to the vulnerable physical nature of the records. There are also limitations to sharing these documents, Vijay added; to do so, they have to be posted securely to the appropriate place, but this brings costs and risks of its own.
“The cost of doing nothing increases over time,” Vijay explained, “and the problem is further compounded by negative media representations of the NHS’s growing backlogs. Ultimately, the rising cost of managing paper and the inefficiencies running a paper-based business process is simply going to grow and get worse over time.”
Patient-centric record
“The obvious answer is the digitisation of patient records,” Vijay said. “But how do we capture any kind of content? Not just paper-based, legacy or everyday information, but the growing volume of electronic patient information. How do we manage it over time so that it can actually be delivered to the right person, at the right time, in the right format?”
Vijay went on to describe the benefits of the electronic documents and record management system (EDRMS), stating that is is able to capture, store and manage any document. It acts as a multi-object document repository, giving the user a clinical view of the whole patient record and supporting EPR and clinical portals. It also facilities established interfaces with multiple IT systems, allowing information to be shared securely and quickly.
“Creating a true single source of patient information means capturing and consolidating unstructured information and linking it to the EPR,” Vijay summarised.
He explained how the EDRMS “accommodates all the different user roles and demands on the patient record, allowing users to export information digitally without the need to email or copy onto removable media due to the file sharing platform.”
It is important to make sure the solution rises to the challenge and doesn’t offer the same user interface, Vijay added, but instead recognises who the user is and the requirements of their role.
“Interoperability is a key deliverable and is growing in demand; the EDRMS ensures that the entire process is audited and remains visible when shared and received. We have built a rich API library which means that the data held in the EDRMS can be shared easily to a compliant third-party system.”
In terms of record preparation, Vijay explained the physical preparation for effective scanning which involves removing any clips or staples, using barcoded separator sheets to organise the different sections and then placing the paper into a scanner. “The rest of the process is then automated through the scanning system,” Vijay explained. “By adding additional technologies such as recognition technology, we can add more value to the scanned record which paves the way for further innovation.”
Integration: APIs and mobile integration
Vijay went on to discuss the role of APIs (application programming interfaces) and mobile integration. “The CCube APIs support bidirectional interfacing with third parties for both front end and back end interfacing,” he said. “Backend interfacing can be set up to receive data feeds from any source to enable us to fetch and use data in EDRMS.”
Front-end interfacing, meanwhile, can be set up to support click-through from any application into EDRMS, while retaining account context. “In addition,” Vijay said, “CCube APIs support open standards for inbound and outbound data exchange, which can be used for bi-directional integration. Our new suite of mobile applications highlights this interoperability and utilised only the public APIs.”
Lloyd George papers
Vijay then briefly touched on CCube’s work within primary care, chiefly discussing the Lloyd George papers. He said: “It is the only legacy information which is largely paper-based within GP practices. A few years ago, we devised a solution working with an NHS trust scanning provider. Lloyd George records are now scanned, transferred and uploaded into the CQ system which – in this case – is within the trust’s own wide area IT infrastructure.”
GP practices can set up their own account, he added, negating the need to install any software within any practice. “They can access the Lloyd George system through a browser and system login and be able to view their records on screen. The system currently serves around 100 GP practices in the North West, and we are looking forward to further developing within the ICS/ICB model.”
Patient engagement
Vijay then turned his attention to patient engagement and its role within digital innovation.
“We have developed and built a number of tools on this,” he explained, “for example a patient app that allows the patient to be more involved and engaged in the delivery of their care. Using the app, patients are able to submit basic information that is needed, for example, for an outpatient clinic.”
Vijay emphasised that CCube are investing a lot into the patient portal and app to ensure patients are more involved in the process, and therefore better equipped to take an active role in their own care.
“In terms of extending functionality, recording outcomes is a key area for us,” he noted. “Using electronic forms to easily capture information will allow users to design and build their own e-forms for collecting new data. This also allows the user to feedback information and data in real time.”
CCube e-paper
Next, Vijay turned his attention to a project which saw CCube Solutions collaborate with Wacom, an international company who manufacture tablets and writing pads, to create CCube e-paper.
“Through this, you can use existing paper forms and low-cost clipboards to write on, and it connects to a USB or Bluetooth interface to capture digital records in real time,” Vijay shared. “This data can then be shared with any IT system which supports open standards.”
It’s a “very low cost solution”, he said, and one that allows trusts to continue using basic paper forms without adding to the scanning volume.
“The data will then go to CCube E-share Hosted Sharing Platform to be shared, which is a cloud-based software and enables users to share information securely.”
Benefits of electronic record management
“Once the systems are designed and deployed, the benefits are achievable and clear,” Vijay said.
He shared examples of some of the customers that CCube has worked with, including North Staffordshire Combined Healthcare Trust, Mid Essex Hospital Services, Cornwall Partnership and Foundation Trust, all the way to trusts who now have fully integrated records such as NHS Orkney, NHS Cambridge University Hospitals and Aintree University Hospitals.
Looking at the statistics, Vijay estimated that they are currently holding about 52 billion pages of documents, comprising 32 million patients and 500 million documents.
“The average daily usage is 16,500 users a day,” he said, emphasising: “This is a system that is used to enhance and improve patient care, these are not merely systems for archiving patient records.”
From a clinical perspective, Vijay added, the benefits have been “huge”. They include easy-to-use software which aids user adoption, streamlined secretarial services and guaranteed appointment times made possible through the app along with better medical experience due to the flow of accurate information. Other benefits include improved patient safety and the avoidance of unnecessary admissions, along with enabling a patient’s medical history to be made instantly available through the digital platform.
From a patient perspective, he noted, they can share information securely outside NHS networks and it also creates opportunities for patient-initiated follow up, improving patient engagement in the delivery of their care.
“Once you’ve invested in digitising data, it opens up new avenues and improvements for technology,” Vijay went on. “The benefits ramp up over time and the current estimated savings are around 15 million over ten years.”
Operational benefit include reducing delays and costs; Vijay noted that these can be considerable, citing that it costs around £1 in postage, stationery and labour to send a letter to a patient in the UK, and approximately 1 million outpatient appointment letters are sent per year per hospital, not including reminders and other correspondence.
“With the app, this is no longer necessary,” Vijay said. “Electronic copy of letters can be sent and we have visibility over who sent this, when it was sent and when the recipient has opened it. Evidently, there is a huge scope for savings across healthcare organisation and we are looking to set up some trials to quantify this further in future.”
Many thanks to Vijay for joining us.
