At HTN Now, we were joined by Vijay Magon from CCube Solutions for a discussion on forming a patient-centric health and care record and creating a true single source of information.
To set the scene, Vijay provided some background information on CCube Solutions, explaining they have been running for 25 years, working mainly in the public sector and delivering patient record solutions in the NHS. They are also a proud member of the King’s Fund Digital Health SME programme and the All-Party Parliamentary Health Group.
What is the problem?
Vijay began by establishing the patient information landscape, stating that data falls into two broad and distinctive categories: structured and unstructured. Structured refers to data held in a database such as EPR systems, clinical portals and lab systems and provides a “unified view of patient information.” These system are “necessary for any digitally enabled clinical transformation, and they are systems that need to access patient information. But they also create new information which gets added to the volume of clinical records within a trust.”
On the other side, you have unstructured data which “largely refers to unstructured content held in documents, whether its paper or electronic files or a combination of both. These live outside of the EPR in a number of siloed systems and repositories.”
The problem, Vijay specified, lies primarily in unstructured data, which historically takes up physical storages space in clinical spaces. Vijay highlighted the risks associated with storing physical documents, primarily the risk of security and GDPR breaches due to the physical accessibility of the information. There are also limitations on sharing the data and recurring costs for filing and refining physical documents.
What are the solutions?
Vijay noted “growing adoption of technologies such as electronic forms – the idea being that if you capture the information electronically, and adapt and save the information electronically throughout its life cycle, you therefore negate the paper problem.”
He said that electronic document and records management systems (EDRMS) have traditionally provided a platform for capturing any kind of content; a multi-document repository that can store and maintain that content over a long period of time, ensuring that content is accessible and delivered to the right user at the right time.
Vijay then went on to provide a solution overview. He noted that capturing data is a key element of EDRMS – not just legacy information but day-forward information too It links to an array of applications and devices to capture more data, including desktop and handheld devices.
Management and delivery are the other crucial elements of successful EDRMS delivery, Vijay explained. “We need to recognise that there are many different kinds of users within a hospital, for example, that require access to the patient record. They also need access to different parts of that patient record. Any system that delivers the digital patient record to those users must understand the user’s role, and deliver pertinent and relevant information.”
Vijay spoke about patient engagement and how in the last few years, CCube Solutions has explored and implemented new ways to involve patients in the design process – placing their needs at the centre of digital solutions. He emphasised the importance of making the patient a part of “the care team and putting them in a position to help in the delivery of patient care, improve their engagement.”
How do we create a paperless record?
Vijay went on to share the ways in which physical documents are transferred to electronic records. He explained that the documents are physically prepared with paperclips and any other items removed to ensure effective scanning. They are then organised using barcoded separator-sheets recognised by the scanner, which ensures the information is ordered correctly upon digital upload.
In terms of filing and indexing paper records into an EDRMS, Vijay commented that there is no “one size fits all” solution. The initial scanning follows paper record structure and day-forward records can be restructured to support new ways of working, organisational and service changes where necessary.
Vijay then talked about APIs and mobile integration, explaining that CCube APIs support bi-directional interfacing with third parties for both font-end and back-end interfacing. “Back-end interfacing can be setup to receive data feeds from any source to enable us to fetch and use data in EDRMS,” he said. Additionally, front-end interfacing can be set up to support click-through from any application into EDRMS while retaining account context.
Lloyd George Platform
Moving on to primary care, Vijay drew the discussion towards the Lloyd George (LG) Platform. Vijay said: “About 10 years ago, we launched a service working closely with a trust in the North West who collect and scan Lloyd George wallets from GP practices and upload them on the system, which is itself installed in the NHS IT infrastructure. The LG platform is a hosted service with secure VPN access, it is fully audited and practices can manage their own users in their account. As it is digital, sharing information is extremely simple and involves the click of a button.”
eForms, Tablets and CCube ePaper
On the subject of e-forms, Vijay emphasised some of the key features gained from recording outcomes via CCube’s form filling process. These include:
- Intelligent Form Filling with real time calculations
- Ability to link with any number of back-end data sources
- Design any form without programming
- Non-IT skills for designing forms
- Accessible via any web browser
- Device agnostic
- Non-propriety data
- Access to public web services/information sources, including SNOMED
The digital platform is also able to recognise patterns and trends in the data uploaded and in the user’s activity, which provides a deeper level of insight compared with traditional forms of information storage and form filling.
Vijay then talked about CCube ePaper, which uses existing paper forms and low cost clipboards to capture information digitally. It takes the traditional action of writing notes on a clipboard but elevates it to reduce the reliance on paper, whilst capturing a digital record of that information in real time. This information can then be shared and viewed easily and safely via bluetooth or USB interface.
Summary
Reflecting on the wider digital healthcare journey, Vijay surmised that the we must first solve the legacy problem, embrace the whole patient record, streamline processes and ensure consistent record keeping at the point of care. Once we have achieved each of these goals, we will be able to improve patient outcomes, healthcare data capture and delivery as well as cultivating a digitally positive healthcare culture.
Thanks again to Vijay for joining us.
