In our latest interview we spoke with Neil Darvill, Director of Informatics at North Bristol NHS Trust (NBT), to find out more about how the trust is becoming paper free:
Where did you first start when you looked to digitise?
We had around 1.2 million medical folders stored off-site, with in excess of 1000 being delivered to Southmead Hospital and other premises daily. In the long term, clearly this was an unsustainable way of working so we set corporate and clinical objectives to find a digital solution and ensure our staff were case note-free at the point of care.
Our digitisation project started a few years ago with the creation of a demanding product specification. Our focus was on usability and what the solution would look like for staff. We decided to work with CCube Solutions, and chose their Electronic Document Management System (EDMS) to digitise medical folders and case notes.
The project was an integral part of NBT’s phased Electronic Patient Record (EPR) strategy, as we sought a platform to ensure that our 6,000 clinicians and healthcare professionals had instant access to patient medical records as and when needed. We were also working to NHS national strategy which set organisations the target of being paper-free at the point of care by 2020.
How did the project go?
The project has gone well (it’s actually the second deployment of this particular software that I’ve been involved in).
Before rolling out the solution we worked with staff and clinicians, mocking up a case note online and going through a process to ensure everyone was happy before it was approved. As mentioned, the usability of the product – in particular to support consultations – was a key clinical requirement and instrumental in both ensuring adoption across the trust and saving as much time as possible.
Rollout itself involved strong face-to-face engagement. This was achieved through dedicated training and having IT ‘floorwalkers’ in those areas of the trust as they went live with the software, as well as backing all of this up with a variety of staff support channels.
Almost 2 years on from the first rollout, EDMS is virtually ‘business as usual’; we are 90% digital and the last exit of paper is anticipated by March 2020 meaning that NBT is on track to achieve the NHS paper-free target. The project segues neatly with the recent launch of a long-term digital strategy for NBT and our local partners which seeks to further integrate digital solutions to improve the patient experience and enable more collaborative working.
Staff have generally embraced EDMS, and where there’s been reluctance or uncertainty we have continued the engagement process, e.g. creating short ‘explainer’ videos where NBT clinicians share tips and workarounds for the benefit of their trust colleagues.
How is this system being used?
The system means that records are readily available and can be read by the appropriate person when they need to. Previously we had an archaic arrangement where files would have to be requested and moved around. In particular, if a patient had appointments close together the paperwork would be completely unattainable.
Being digital gives us instant access to records, whether seeing a patient during a consultation or when staff are on the telephone and can search records to have the required information with just a sub-second click.
What was the business case for the project?
We had a high volume of paper being stored and moved around, which was costly and inefficient. Our business case for the EDMS project is predicated on a scan-on-demand model where only the patient notes for people booked to attend clinic will be processed – not everything in the library. This saves a huge amount of money given that other records will be destroyed in line with the trust’s retention policies and procedures.
Of a total of 1.2 million folders, NBT estimates that it has 400,000 active patients who will need their records scanning. As each folder contains on average 150 sheets, this means approximately 60 million pages are likely to be digital.
Consequently, there has been both a significant time saving for our organisation and also a financial saving of a million pounds annually.
We must also remember the patient case for going paper-free. In particular there’s an important patient-safety aspect to their records now being online and instantly accessible simultaneously to a large community of healthcare professionals. As with all other aspects of our digital transformation, better patient experience is the imperative for change.
What advice would you give to other Trusts looking to digitise?
Firstly, be clear on what you want to achieve and don’t feel you necessarily need to scan everything. In our experience, only 35% of the library needs to be digitised. A key focus for NBT was high quality software so I’d also recommend investing in the right software.
Finally, this is a digital solution with a strong human dependency so make sure that filing – the right chapters and sections – is done correctly. Poor filing behaviours were exposed in some areas during our project so that a cultural change was needed as much as a digital one. The involvement of clinicians here is vital, and is the backbone to our digital transformation at NBT. Having the agility to respond to – and act on – their needs and feedback is key to successfully transitioning from one way of working to another.
