For a recent HTN Now webinar, we were joined by James Williams, diagnostic imaging and ECM specialist at Dedalus, to discuss how an Enterprise Content Management (ECM) strategy can support healthcare organisations in their journeys toward digital transformation.
We looked at the benefits of a centralised ECM platform in enabling the automation of workflows, improving information search and retrieval, and ensuring secure, compliant data management with full auditability. James then offered a demonstration, walking our live audience through functionality and exploring key features of Dedalus’s HYDMedia solution.
Talking briefly about his own experience in healthcare, James shared some details of his clinical background as a radiographer, and a medic in the Royal Navy. “Throughout my different roles, I’ve come across different EPRs, systems, workflows, and ways of working,” he said. “Similarly, in my current position, no customer is ever the same as another; everyone is at different stages of the journey.”
ECM ultimately refers to electronic documentation, whereby information may have been taken from physical documentation and been scanned, or else brought in electronically such as from ECG machines where the output is direct electronic content, James noted. “ECM can capture that information, store it securely, make it searchable and accessible,” he continued. “But it’s more than that – it needs to be connected to an operational workflow, and connected to the patient. What we then need to do is preserve any compliance on that, so we know where it was taken, who it was taken by, who has viewed it, and so on.”
ECM is not a replacement for an EPR, James went on, but it enhances the EPR by allowing the electronic content sitting in a lake underneath it to be brought up into the record as required. It can help healthcare organisations in four main ways: eliminating paper-based processes, bringing fragmented systems or legacy systems together, improving access to patient information, and supporting compliance and audit.
ECM benefits and outcomes
Paper continues to be used in various places and processes in many departments, according to James, even those that have introduced electronic communication. “The impact of that use of paper is that it delays access to information, making information difficult to find, causing an admin burden with filing, retrieval, transport, and storage, and leading to slower clinical decision-making or disconnected care,” he said. “There’s also the physical cost, with estimates from The King’s Fund that £240 million per year is being spent on storage across the NHS, which works out at around £1.22 million per trust.”
Pulling up some customer insights, James highlighted that Lennox & Addington in Canada has seen a 50 percent reduction in physical storage space, a 50 percent decrease in paper processing time, and a saving of 22.5 clerical staff days annually. Similarly, Saint-Lo & Coutances in France was able to destroy 33 tonnes of redundant paper records during archive rationalisation. “When fully digitised, you get instant access to documents and files, you can share information easily with other sites or departments, and everything is there in one place,” he added.
When considering the upfront cost, which can be sizeable, James said: “There are trade-offs – North Bristol Trust said they save around £1.1 million a year by being fully digital, but again there’s a business case to align how you get to that, spending money to save money. It has been said that typical scanning costs £10 to £15 per patient, so when going fully digital that’s a huge spend straight away. Another option is to go hybrid, or paper light, taking it department by department, or looking at who is coming in for pre-planned operations in the next year and scanning on demand.”
It’s important not to simply create an image from a paper document and then leave it in storage, James shared. ECMs capture that information and digitise it, scanning and using optical content recognition, looking for keywords and adding metadata to the document so it can be retrieved. “That means you add in the patient ID, name, document type, date, and other key bits of information, so when you want to search for it, you can find it easily,” he went on. “The ECM sits as a separate layer, and can bring multiple departments or multiple streams of information together in one place to be viewed in the EPR.”
The ECM can act as the bridge between different systems, creating a “golden source of truth”, James explained. Accessing clinical content becomes much faster and easier, with figures showing that it takes an average of four seconds to access information required. “That’s a time saving of hours, usually, just from having ECM,” he noted. “Other time savings we’ve observed include a reduction from 25 minutes to three minutes in the time taken to fill in the documents for a newborn baby. The outcomes are less searching, more informed decisions, and faster access to patient history.” For non-clinical staff, the change means less admin, fewer requests for records, and faster investigations. For patients, it’s better continuity of care, fewer delays, and improved outcomes.
James moved on to talk us through some key points for compliance and audit, including role-based permissions to allow certain individuals access to documentation, auditability and traceability to record who opened or made changes to documents and when, and lifecycle management. “Let’s take the Ockenden review – one of the outcomes of that was that people failed to investigate, but why? Did their system not allow them to investigate properly? Nobody looks into that when everything is going fine, but as soon as there’s a patient complaint or a coroner’s inquiry, people want to know what happened and in what order,” he said. “With everything digitised properly, there’s no question over that, so it can both help you, and cover staff, as well.”
Dedalus’s HYDMedia ECM
For the second part of the webinar, James offered a demonstration of Dedalus’s HYDMedia ECM platform, with over 30 years of deployment history in hospitals and healthcare organisations, and 640 references worldwide. “We can integrate with almost every EPR, we are IHE compliant, and we follow standards-based working so we can work with anyone,” he updated.
James proceeded to walk through Dedalus ORBIS EPR with HYDMedia integration, finding a specific patient, opening the patient’s record, viewing medical history, and performing a search using filters for a test result or a clinical letter. “I can look through the document details to see when it was created and edited, and by whom,” he said. “You can also use HYDMedia as a standalone product, and we can find a patient again using the search filters, and then click on them to see all the cases and episodes of patient care, with a view also of where it was done, in inpatient, outpatient, if it was an emergency, and so on.”
James showed that it is possible to look at where a patient was brought in, what care they received on a ward, and observation charts from their time there. “You can follow that, and see how a patient was when they went to cardio, what the nursing records said from cardiac care, and pull up all the observation charts that have ever been recorded for them,” he demonstrated. “For clinicians, having it within the EPR really brings that information to the surface, without the need to remember multiple logins or visit multiple systems. We often have fragmented systems for a reason – we need LIMS for pathology, PACS for radiology, and you want scanning from those to come into your ECM to be surfaced in another system.”
We would like to thank James and Dedalus for taking the time to share these insights with us.
