HTN was joined for a recent panel discussion by Restore Information Management, who shared their experiences with digitising patient records for Leeds and York Partnership NHS Foundation Trust (LYPFT). Panellists included Carl Starbuck, Head of Information Governance and Data Protection Officer for LYPFT and Restore Information Management’s Stefan Chetty, director of digital services; Ted Reynolds, head of healthcare for digital services; Claire Colraine, national account manager; and Andrew Robertshaw, implementation manager.
The discussion explored how LYPFT transformed from a years-old dependency on paper records to a fully digital system that works seamlessly alongside their Electronic Patient Record System (EPR).
Offering some context around Restore Information Management and what the organisation does, Stefan shared a slide detailing some of the ways the team supports the NHS in improving patient outcomes, by providing “all and any part of the document lifecycle” from physical records management, storage, retrieval and delivery, through to “digitisation, appropriate data capture and classification, imaging and data hosting, and the secure destruction of the physical record”.
As well as the physical management of documentation, “a key part of the service is giving our customers access to experts who have led these kinds of digitisation projects before”, Stefan said, “so our experience can be used to inform your specific set of circumstances”.
When it comes to the team’s work with LYPFT, Stefan said, “it’s important to remember that this case study isn’t just about scanning paper records; a significant part of the success of the project was in the detailed, due diligence, and thorough understanding of the trust’s physical records and their future priorities.”
In mental health trusts, information is often held in a variety of formats and across multiple locations, Stefan shared, “so a practical solution for bringing those formats together was critical”.
Digitising mental health records: approaches and challenges
Taking over to present the case study in more depth, Ted said, “digitising patient records isn’t easy; there are many elements to consider, and in many cases there’s no clear starting point”. When it comes to mental health settings, there are also key differences between acute and mental health services around records, he went on, including a longer-term focus, an increased complexity with information “often spread across multiple disconnected systems”, access challenges when it comes to identifying or locating specific data, and the need for rapid information access to facilitate the effective treatment of patients experiencing mental health crisis.
The length of time records need to be retained is also “significantly longer” for a number of different records, according to Ted, “posing the question: what in fact should be digitised, and what do these differences mean in practice?”. As well as challenges with accessibility of records due to their “cumbersome” nature and their existence across multiple locations, Ted also talked about issues around data security and GDPR, responding to SAR’s, and the resource intensity and space requirements linked with handling “a large volume of records over long periods”. Removing paper from the system “opens up the possibility of repurposing space and refocusing staff on patient-centric tasks”, he continued.
Leeds and York Partnership NHS Foundation Trust: the approach
Giving a bit of background to the case study, Ted talked about LYPFT’s numerous care services, operating out of ~40 operational sites, and more than 3,000 staff. “The trust is a leading provider of specialist mental health and learning disability services,” Ted said, “and these services include community mental health, crisis resolution, inpatient care, and specialised support for conditions such as dementia.”
Ted went on to explain the trust’s motivations for pursuing digitisation, highlighting that “although there will be cost savings generated by this programme, it was not a cost-saving exercise”. Instead, he outlined motivations including “patient care, compliance, operational efficiency, and supporting digital transformation”. For LYPFT, “digitising paper records would improve patient safety by making records available at the point of care,” he said, “and it would also provide a continuity of care for patients as they moved between settings”. The opportunity to streamline workflows and improve patient flow was also a major factor, he summarised.
The programme also offered support for the trust’s wider digital transformation strategy, with digitised records to be entered into an EDRMS, which in turn would support a new EPR, Ted explained. “Finally, digitising would allow the trust to future-proof itself, placing it in a position where it could adapt to new data and technical standards as and when required.”
Requiring the collating and scanning of over 35,000 patients in the initial phase, Ted referred to the “gargantuan effort” surrounding the digitisation process, “not only in terms of logistics, but also in accessing, capturing, and managing patient data from multiple sources”.
From Restore Information Management’s perspective, Ted highlighted defining elements of the programme which needed to be met: “it was clear the need was for a hybrid system that captured the active caseload digitally and preserved the paper record for inactive patients; achieving this depended on getting a deep understanding of the trust’s paper-based model and developing a transition strategy with the trust and its partners.”
Project phases
Moving on to talk about the different phases of the project, Ted told us how the trust conducted a Requirements Analysis in conjunction with Apira (a healthcare consultancy provider with pedigree in EDRMS implementations); as well as an exercise to map internal processes, logistics, and available resources; and a wider change management process, which was essential in ensuring “everybody knew how and why existing processes were being adapted, as well as in assessing training needs”.
“The decision was made to use a trust site in Leeds as a hub,” Ted shared, “and to split the processing of records between the hub, where Restore Information Management staff would perform some processing, and the their scanning facility in Manchester”. He went on to outline benefits of this approach, including the trust not having to deploy staff to pick and process records across ~40 sites, and that records scanned were “pre-checked”.
To arrive at a “consolidated list of patients in the active caseload” took the project through several different stages, Ted said, “with the objective of using disparate data to create a cohort of patient’s records to be scanned”. This meant comparing lists and inventories to “ensure the trust only scanned what needed to be scanned”, he continued, “meeting the compliance and operational efficiency criteria”.
Restore Information Management also needed to produce a solution capable of processing the digital images, according to Ted, “adding the metadata to them and then delivering them to MediViewer (LYPFT’s chosen EDRMS solution)”. This involved creating an audit trail which spanned several business services, multiple locations, and different organisations; consolidating the data ahead of the arrival of physical records to ensure the audit trail was continuous; logging and processing “thousands of individual files”; and finally, “delivering the images to the trust within the SLA to be reconciled”.
Summing up the project’s phases, Ted explained how the project “took around 14 months to deliver”, and provided the trust with a single platform “from which they could request records to be retrieved from storage, scanned and delivered digitally”. Processes for ordering online and requesting urgent scans for records were developed both for the trust and internal use, “ensuring there was a common approach to fulfilling these requirements”, he added, “whilst new methods of working had to be introduced without an impact on service delivery”.
Benefits realisation
Sharing some insight from the final analysis, Ted highlighted how benefits realised by the trust were “in line with their original requirements”, including the availability of accurate and up-to-date patient information across the active caseload, “high compliance from an Information Governance perspective”, and “a firm foundation for the trust to progress its plans for a full EHR”.
For “those who like statistics”, Ted also offered an overview of the programme’s activity, with 24,600,000 images scanned to date, 27,404 case notes digitised, and “a significant impact on the files pulled per month”, which decreased from 326 per month pre-pandemic to 80 post-project. “That’s a significant saving not only in cost, but also in terms of impact on the environment”, he concluded.
Carl Starbuck, Head of Information Governance and Data Protection Officer for LYPFT, then joined the session to share his perspective on the programme, and to answer some questions from our live audience. Responding to a question about how the trust assured data quality, he informed us of how LYPFT began by quality assuring a “very high number” of records, but that as confidence grew in the process, “that tapered off”. The trust also had quality assurance internally, he went on, “so not only were Restore doing some of that, but we were randomly sampling a set percentage at our end too, and the incidence of error has been negligible”.
Had the trust decided not to contract with an external party, Carl said, “we would have had to stand up that functionality within our trust”. That would have meant the procurement of the machinery, the recruitment of “the right people”, and “a lengthy period of time to achieve the accreditations that then allow you to destroy the paper once it’s scanned”. That would have placed an “elongated timeframe” on the project, he went on, “and that means you’re still holding the paper, which is taking up space and costing you money”.
On why the programme succeeded, Claire referred to the “tenacity” of LYPFT. “They had a drive and a desire to make it work,” she said, “and they knew it was going to be difficult, they looked at it from a long term point of view, they appointed the partners they needed, and we all worked together on a project basis for many months.” Carl also attributed the success to “quality partners”, as well as the will within the organisation to do it, and “clinical backing right to the top”.
From an implementation perspective, Andrew shared some insight around successes and challenges, saying that “first and foremost it’s working with the trust to understand exactly what it is that they need and how we can work together, being honest and open about any challenges that may come up”.
We’d like to thank our panellists for sharing their insights and experience with us around this project at LYPFT.
