HTN was joined for a recent interview by Andrew Robertshaw, implementation manager at Restore Information Management, who talked us though the implementation of their auto-ordering solution and its benefits for healthcare organisations.
“My role involves looking for efficient and cost-effective solutions to help our customers resolve challenges around records management,” Andrew said, “and I work with large hospitals who might have millions of files stored with us, meaning we’re sending thousands of files per day back to the hospital to support direct patient care”.
That’s where the auto-ordering solution comes into play, he continued, “because it takes the need away for hospitals to have to manually request records from us”. Instead, when a patient has an appointment booked or is admitted to a ward, “the system automatically sends Restore Information Management a message to tell us which patient is coming in, when, and to what service”.
The process is seamless, meaning “the person booking that clinic or admitting a patient to a ward doesn’t even need to know that anything is happening in the background”, Andrew shared, “because a live message is generated out of their PAS system and sent in real-time”. Once this message is received, the system creates an order for the delivery of those notes back to the hospital in time for the appointment.
Restore Information Management can set a number of options at clinic- or ward-level, including whether delivery of notes is required, whether or not these need to be scanned, and what volumes of notes are needed. “We can also vary the delivery of the notes,” Andrew said, “because some clinics might want them the day of the appointment, whereas others may want them a week before”.
Boosting time and space efficiencies with auto-ordering
When it comes to the benefits of auto-ordering, “the first person to consider is the patient”, Andrew says. “Through this system, we make sure we deliver the right record, at the right time, to the right place for patient appointments. Not only that, but if someone is placing an order manually, they may only consider their area or their clinic, and not consider an appointment happening beforehand. Our system can, however, handle all that – it’s about making sure that the record is there when the patient’s being seen, so they’re seen on time, and the appointment isn’t cancelled due to that information not being available.”
Another major benefit is the space saved within the hospital, Andrew went on, as “space within a hospital is at a premium, and we’re all struggling with that”. Having large areas dedicated to millions of records “isn’t always a good use” of the space that is available, he said, “so we can take those records in and manage them on the hospital’s behalf”. This frees up space to be redeveloped or repurposed to support patient care, Andrew told us, “sometimes that might be for outpatient wards, or even services for patients like a coffee lounge”.
For those working within medical records teams preparing notes or pulling notes, the main advantage is the time saving, he continued, because the system “bridges the gap of on-site and off-site for the customers, taking that need to sit and manually place orders away, and allowing that time to be used toward other things supporting patient care”.
Not only is the ordering process made easier and more efficient, but there are also benefits to be seen in the method of records delivery. Andrew shared that records are ordered by clinic code and appointment date, so that when “maybe a thousand sets of notes are being delivered in the morning, they’re delivered in a really structured way”.
Records can be delivered pre-sorted as requested by the clinic or service, Andrew said, “so by patient number, patient name, or even appointment time, with the idea being that the first patient being seen that day is the first record in the box – again supporting that the right notes are being delivered to the right place, at the right time”.
Traditionally, this part of the process is much less organised, Andrew considered, “because what usually happens is that all one thousand sets of notes would get delivered and not sorted, so it’d be difficult having to trawl through those and organise them manually”. Again, taking that time-consuming element of the process away saves more time to put back into patient critical activities, and ultimately “back into caring for patients”, he concluded.
In terms of quantifiable benefits, Andrew shared that Restore Information Management “typically sees about a 90 to 95 percent reduction in the need for manual requesting of notes, although requests for other purposes such as research or audit do still need to be made manually”.
Use cases around auto-ordering within the NHS
Andrew talked about how Restore Information Management’s customers currently using the auto-ordering process have utilised the time saved, including “looking at other aspects of health records and their digital journey”. Hospitals are “always looking at how they can reduce the amount of paper in their organisation”, he said, “and this works really well for that, because it supports their change in process needed to stop using paper”.
There are a number of different ways that hospitals can do that, according to Andrew. “One of those is to reduce the use of paper records, so newly created records are created digitally or scanned straight away, and once a patient has been seen or a clinic has been live for a while, they’re pretty confident there’s no longer the need for a historical record, because there’s enough information stored electronically, so the system is flexible in that it allows us to turn off the need for notes to reduce the number of notes coming out.”
Talking specifically about a Central London trust that Restore Information Management has been working with, Andrew noted the challenges of their location and the lack of options to extend. “They were looking for a record management supplier to take all of their records away,” he said, “which meant they could move their staff canteen into the basement where the records were, and then repurpose the original staff canteen for patient care.” Read more on this here.
Restore Information Management also prepares the trust’s records ready to be used for patient care, Andrew told us, “so it doesn’t end with the delivery – the records are ready for the patient to be seen, and don’t need to go through another team of people who have to do more work on them. As part of that, we link into their PAS system using remote access, and track the records on their behalf .”
For another customer, University Hospitals Coventry & Warwickshire, Restore Information Management takes a slightly different approach, and has a small team of people working in a hub within the hospital, taking on the work surrounding final-mile delivery out to clinics, and overseeing the collection of records at the end of the day.
“There are several advantages to that approach,” said Andrew, “including ensuring that those records are back under our control and ready to be delivered out to another appointment if needed”. The hub can also do what Andrew terms “record chasing”, meaning that if notes aren’t at the facility, the team makes calls to locate and collect them, “so they’re then back with us ready for the next appointment”.
Additional and indirect benefits
The way that the process works lends itself to increased standardisation and centrally controlled processes, Andrew said, “whereas if you have maybe 20 people working in a medical records department all requesting notes manually, it’s very difficult to control when they request notes, how they request notes, and who they request notes for”. Where the system helps overcome this, he went on, “is that it takes away from that individual person having to make those decisions – that’s all controlled centrally by a management team at the hospital”.
That “massively standardises the delivery of records”, Andrew told us, “ultimately reducing costs to the organisation, and also making sure that the right patient is seen with the right notes, at the right time, which comes back to that patient care piece”.
The clinic prep of records “can also really help get them ready for scanning”, Andrew said, “because as part of the coding process we have a really tight control on what is acceptable for a medical record, including condition, structure, and size. In a busy medical records department, time constraints might prevent that kind of control or oversight, but we can make sure the notes don’t get too thick, and then if they want to go down the scanning route it’s already organised with only the most relevant paperwork for scanning.”
When it comes to implementation, Andrew highlights the efficiency of the process, talking about recent development work focusing on making the process quick to roll-out. “This is our own software we’ve developed,” he said, “so whereas before we had to create a new system for every hospital, now, with our expertise of working with lots of different hospitals, we’ve come up with a standard message format that will actually work for all hospitals, and then a shared system on top of that, so adding a new customer into this now is really quite quick and easy”.
To learn more about Restore Information Management and their services around document management and storage, please click here.
