John Spence
Assistant Informatics Director – Operational Services
Sheffield Teaching Hospitals NHS Foundation Trust
Apologies
PRESENTATION FROM 1995
CENTRAL SHEFFIELD UNIVERSITY HOSPITAL
NHS TRUST
DOCUMENT IMAGING OF MEDICAL RECORDS
A ROUTE TO THE FUTURE
BACKGROUND
• Massive backlog of Medical Records for archiving
• Increased congestion caused by increased activity
• Hospital Mergers
• Casenotes spread across many storage rooms
• Dissatisfaction with existing service
• Need for flexibility
STRATEGIC CONTEXT
• Movement towards a Single Patient Record
• Integration of Operational Systems
• Clinician preference for accessible data - with the
ability to write
• Space is our most valuable commodity
INCREASE IN MEDICAL RECORDS
• Merging hospitals / libraries
• No destruction policy
• Increasing number of patients
• Increasing number of tests
• Failure of existing microfilm policy
PROBLEMS EXPERIENCED
• Volume of medical records
• Health & Safety issues
• Security of records
• Efficiency
• Staff morale
PROBLEM
TOO MANY RECORDS WERE BEING
HELD IN PAPER FORMAT
PROJECT OBJECTIVES
• Archive ‘old’ records
• Clear space
• Resolve immediate difficulties
• Create options for the future
• Create the foundation for the electronic storage of
patient medical records
SYSTEM DESIGN - 2 OPTIONS
• PAS number only
(single index)
• PAS number
– patient identification
– letters
– investigations
– nursing
– consultant episodes
(multi index)
QUANTIFIABLE BENEFITS
• Space
• Maintenance
• Staff
• Opportunity Costs
OTHER BENEFITS
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Guaranteed availability - no lost records
Better working practices
Better quality of print
In-house quality assurance
Local systems management
‘Instant’ access to view records
View without printing
Remote access to records
Direct access to relevant part of record
Facilitates for a central library
Facilitates for a single set of patient notes
Allows records to be merged
Allows secondary folders to be regularly scanned
OTHER BENEFITS (cont)
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Option to scan more current information
Facilitates ‘back-up’ copies
Elimination of Health and Safety risks
Improved record security
Direct links to other systems
Fax input and output
Elimination of fire and flood risk
Basis of an electronic patient record
Option to utilise the released space
Can be used for other systems
– accounts, finance, personnel, pharmacy, purchase
orders, etc.
• Keeps our future options open
LESSONS LEARNT
• Document preparation is a very labour intensive process
• Bar-code or OCR could produce significant indexing
benefits
• Potential benefits of real-time access could be significant
• Scanning is ‘boring’
ADVICE
• Establish your imaging strategy NOW
• Bar-code / OCM your documents NOW
• Evaluation of imaging is NOT incremental
• Remain focussed on your objectives
• Be realistic and deliver results
• Imaging is only a component of an electronic system
FUTURE CHANGES
• New casenote folder
• Bar-coded documents
• Change of colours
• Ban use of staples
• Eliminate gummed forms
• Use black ink
FUTURE DEVELOPMENTS
• Duplex printing
• Integration with PAS
• Integration with other systems
• Remote access for medical records staff
• Remote access for clinicians
DOCUMENT IMAGING IS
• A very efficient record storage system
• A very efficient record retrieval system
• A quality view and print facility
• A secure environment
DOCUMENT IMAGING OF
MEDICAL RECORDS IS
• Cost effective - for high volumes
• Achievable
• A ‘safe’ step to the future
• A means to the end
• A component of an Electronic Patient Record and a
foundation for the future
PRESENTATION FROM 1997
• WHERE DO WE GET HELP
– Who is really successful
» What can we learn from them
» Are they willing to share
» Can we copy them
• WHICH IMAGING COMPANY TO USE
– Do they really understand it
– Can they prove it
» In a Health environment
– Do they really understand the issues
» Do we???
DOCUMENTS
OPPORTUNITY TO DO THINGS PROPERLY
• DOUBLE SIDED SPACING
– Punch holes destroying data
• METHOD OF FILING
– Staples / Gum
• COLOUR OF DOCUMENTS
– Contrast
• TYPE OF DOCUMENTS
– Large / Small Continuous / Card / Tissue
• STANDARDISE FORMS
– Patient ID in a standard location
DOCUMENTS
THE DOCUMENT IMAGING SYSTEM WILL BE
‘BLAMED’ FOR EVERY SINGLE CHANGE WHICH
AFFECTS THE PATIENT RECORD
QUALITY CONTROL
• What percentage of images do we check?
• How many files do we check for 100% accuracy and
completeness
• How do we condone / explain / accept less than 100%
accuracy
SUPPLIER ISSUES
• THEY MAY THINK THEY HAVE AN IMAGING SOLUTION BUT
MEDICAL RECORDS ARE DIFFERENT
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Colours
Document Types
Age of Documents
Quality of Documents
Size of files
– And they are “living documents”
ACCESS TO DATA
• BATCH /ON-LINE
– Reprint Data
» Whole Record / Partial Print
» Who is authorised to print
– How do we control access
» On-line and batch versions co-existing
– How do we stop them writing on reproduced pages
– How do we merge ‘old’ and ‘new’ data
2006
• 800,000+ record have been scanned
• 500 Optical Disks
• Disk Storage occupies 5-6 linear metres
• Original paper record would occupy 11,000 linear metres
2006
• Main Royal Hallamshire library is 550 square metres
• Shelving is
• 13 metres long and 7 shelves high
• 20 aisles back-to-back
• 3640 linear metres
• We’ve scanned equivalent of 3 times the library
2006 - Today
• Scanning – over 25,000 pages per day
• Double-sided – so 50,000 images per day
• Need at least 5 staff on prep to support 1 on scanner
• Staff costs account for over 75% budget
• So worry less about beating up the supplier on price
• Concentrate on operational efficiency
2006 – Today
• We are acquiring a new system – for the third time
• Our disks are “guaranteed” for 50 years
BUT
DISK DRIVES AREN’T
IMAGING / DATABASE SOFTWARE ISN’T
SUPPLIERS AREN’T
2006 – and finally
• Document Imaging still has a role to play as part of the
Electronic Patient Record
Electronic Health Record
Integrated Care Record Service
NHS Care Record Service
Whatever it’s called
2008
• New system is live
• We’ve migrated over 75% records
• Migration should be completed next month
• What have we done differently
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We’ve gone back to basics
We’ve kept it really simple
No bells or whistles
No goodies and fancy features
– And we’ve still found it tough getting what we need
2008
• So what does a simple system need
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Scan
Index
Audit
Retrieve
View / Print
Supplies Use of an Imaging System
John Spence
0114 2713462
John.Spence@sth.nhs.uk