We recently sat down with Stefan Chetty, public sector director of Restore Records Management, for a chat on how the digitisation and wider management of patient records can support patient outcomes as well as freeing up space, time and money.
Restore Records Management: the offering
Stefan explained that Restore Records Management supports all elements of document lifecycle for customers. “People tend to think that it’s just a case of storing documents, but in reality we do so much more,” he said. “We create documents, we undertake ongoing data capture, we track documents through management process through barcoding of files and boxes. This ultimately takes us through to digitisation or secure destruction based on the customer’s preferences.”
Restore Records Management also offers consultancy through its account management teams, Stefan added. “In the NHS we use our experience and expertise from other customers to help trusts achieve the benefits that our services can bring.”
Their work with the NHS “can often be more complex than it is with other organisations, mostly because of how patient records are used within the NHS and how critical they are to patient care,” he said.
“Typically an NHS trust will store some records off-site; but they tend to store the most active files onsite still, often right in the middle of the hospital taking up prime space. Our aim would be to outsource that full function.”
Often, Stefan said, physical records management within an NHS trust is seen as part of the problem rather than part of the solution when it comes to going digital. Another key challenge can be the differences in the way that trusts operate and the fact that they are at varying stages when it comes to their digital journeys. “Some trusts out there are virtually fully digital, but others are quite a way off being able to implement a digital patient records solution,” he acknowledged. “They may have signed contracts with EPR providers, but getting that legacy information into the right systems may not have been fully worked out yet.”
Where Restore Record Management’s solution “works best” according to Stefan is within the trusts who are “not quite ready to go digital, but they are looking to do some work in the short to medium term that puts them in a better place to transition to digital. That’s where we find that our solutions can best deliver benefit now as well as benefit in the future.”
The journey of the record towards digitisation
Outsourcing inactive records is the first step, Stefan said. “You immediately get a space saving benefit there which is very valuable to a hospital,” he pointed out. Then outsourcing moves onto the live records.
He noted that there can be a perception that it is not possible to outsource live physical records off-site, but “the service actually tends to work better if it is off-site because we can ensure standardisation of processes and tracking measures are in place to make sure that their service level agreements are achieved. We are accountable for those.”
As part of the outsourcing for live records and the planning for that, processes are agreed for the whole project. “For example, how will clinic preparation be done? What does loose filing look like? What do they do with temporary notes? The processes for these can be fairly inconsistent within trusts so we standardise them all and document them, making sure they are signed off by the trust.”
Over time, the records themselves become standardised “so that when they come to be digitised, there is less paper to scan and the contents of the files are all in order. They might include standardised barcoded forms over time as part of the clinic prep process to support the future digitisation process. Ultimately, this work makes it more affordable at the point of digitisation if the customer chooses to take that route.”
Benefits for the NHS
“There are numerous benefits to generally outsourcing records, but this process often allows trusts to realise benefits that they might not have thought possible,” said Stefan.
A key consideration here, he continued, is the need to work on physical record management. “Typically, if you don’t get your physical solution right, you won’t get your digital solution right – many digital solutions rely on legacy information being fed into them, including in paper format. So your paper needs to be in good order for that digitisation to reap the benefits.”
Stefan went on to share some of the main benefits that an NHS organisation can expect to see when outsourcing its medical records function.
“There’s the benefit of giving back storage space, of course – creating space that can be used for clinical areas, beds, operating theatres or so on. That comes with a cost saving too, through the potential to release property that is no longer needed.”
Outsourcing comes with a cost saving in itself, he added, as the processes that are put in place as part of this are not as costly as doing it in-house, and the transactional nature means that as the volume of records changes over time, costs tends to come down as fixed costs are removed.
Regarding the workforce, outsourcing “can help the NHS to tackle recruitment and productivity,” said Stefan, “as we are taking those challenges out of the trust’s hands.”
He continued: “Outsourcing offers enhanced control over records; access is highly regulated with authorised users only, so there is no opportunity for someone to go into a medical records library and take out a file. That can happen in a hospital. The file can then go missing if it is not tracked properly, and then the notes are unavailable for future appointments.”
Stefan noted that a “common benefit” brought about by Restore Records Management’s solution is a reduction in the number of emergency record deliveries. He described how Restore Records Management can put processes in place to tackle this, such as linking a record ordering system into the trust’s patient administration system. “With one trust we have worked with, they originally had around 400 emergency deliveries a month,” Stefan shared. “Now that they are working with us, they have between 12 and 15 per month. Alongside making the process more efficient, there is a big cost saving here, as staff are not required to manually order files and as such they can be redeployed elsewhere.”
Availability of notes within the NHS can be a major challenge, Stefan acknowledged. “It’s common for a trust to have thousands of sets of notes around the hospital. We have found that often, without a management solution in place, of the notes needed in clinic on a given day, 20 to 30 percent of them are located around the hospital somewhere.” A medical records team onsite or offsite can pick every record that is available to them in storage; but they can only pick what is actually there. “An outsourced solution puts processes in place to release the notes as soon as they have been used, and the tracking processes mean that they are available as soon as possible for the next appointment.”
Other benefits of outsourcing include a reduction in the time taken to transport notes between hospitals, with digital delivery even quicker; and there are peripheral benefits around reducing loose filing and temporary notes. “With an outsourced solution, you are tracking and barcoding every file, so you know where every single note is,” Stefan pointed out. “By managing this you can change behaviours over time – we provide metrics on the reduction of temporary notes to support this.”
These are the direct benefits of an outsourcing solution, Stefan added, but “what often gets missed is the benefit of the future around digital. Because it is a physical service, it gets badged as a physical service, but actually doing all this work now enables change management to happen over time so you don’t have a big bang when you go digital. For those trusts which are quite a way off digitising, they can outsource their medical records department now. That will see staff redeployed accordingly, releasing time and cost in the short term, and crucially it will give them space back straight away. You don’t have to only see the benefit at the very end of the digitisation journey, you can smooth the transition by starting this process now.”
He also commented on benefits around sustainability, saying: “I think there is a bit of a myth that if you outsource your records management, you’re adding more vehicle emissions through transporting them to our sites. In reality, our transport would be far more consolidated than the NHS’s system of moving between hospitals, which tends to be quite ad-hoc. Our ordering systems will set up driver times and delivery times in such a way that is optimised for that particular hospital. Obviously, if you digitise, you remove that transport need entirely.”
In the end, Stefan said: “This work all comes down to supporting patient outcomes as it means the patient is seen with the right information at hand.”
Coordination of records management across an ICS
Restore Records Management is working with a number of integrated care systems, Stefan shared. “Hospitals have joined us over the years with different agreements and different processes depending on what they want and need. Standardising that is a challenge in itself.”
He reflected that they are seeing coordination across ICSs; but generally “at a very high level. Over the past six months, we’ve seen a growing intention to standardise contracts. It’s less about the nuts and bolts of a solution, which are the things that I think would probably bring the bigger benefit.”
If the ICSs focused on a more granular level on solutions for records management, Stefan predicted that they would see “millions of pounds of savings, per year, to make this kind of change.”
Automation and digital delivery
“There are different technologies that are in play through electronic patient records (EPRs) and electronic document and record management system (EDRMS), and our solution feeds into them. But as I’ve mentioned, a challenge with EDRMS is often how to get legacy information into the solution. The obvious answer to this is to develop more integrated EDRMS and EPR systems on a consolidated basis across ICSs, and this is being looked into in some areas.”
There are technology solutions being put in place “which could bring benefit now,” Stefan noted, “and which cater towards tackling the physical challenge of the legacy information in the first place. Automating ordering, for instance – that’s not a common solution, but it brings about benefits straight away. All NHS trusts, unless they have got an automated system in place, will have a cost of ordering files from their internal teams or from an outsourced provider. Automation removes that. It also mitigates against the potential for human error when it comes to ordering files.”
Automated tech can order files ahead of appointments; it can tell the outsourced team how to prepare files based on the specifications on a particular clinic; it can even tell the team to present the files to the clinician in the order in which they will be required that day.
There is also digital delivery, Stefan pointed out. “Being able to release a record digitally whenever the trust requests it delivers a significant cost saving over time, and we’ve helped numerous trusts through that process. But they need to be ready for that point in their digitisation journey.”
If you could solve one challenge in this space, what would it be?
“When I go into hospital, or my team visit a site, space is the thing that trusts are the most concerned about,” said Stefan. “There is a lot of space taken up in prime locations by medical records. We’ve done some research on data released by the NHS on how much space is taken up by the medical records function and the average is 1,600 square metres. A private bed in a private room is about 16 square metres. So even on very conservative numbers, by outsourcing that function you could add 100 beds into each hospital in the NHS.”
Ultimately, he said, “That leads to reduced wait times and it could allow patients to stay for longer in hospital if it helps their recovery – because discharge times and expectations are very quick these days. You always hear about patients waiting in ambulances and corridors for care and it’s really hard; but we’ve got a way to create some more space right here.”
Many thanks to Stefan for sharing his insights.
