The first Trust in the UK to stop using paper medical records, St Helens & Knowsley Teaching Hospitals NHS Trust, has upgraded to the latest version of CCube Solutions’ electronic document management software (EDMS) as it continues its journey of shifting from paper light to paper free processes.
Utilising a completely re-architected version of CCube Solutions’ software, version 4 will introduce support for mobile and tablet devices, introduce additional workflow, OCR and eForms capabilities, and enable closer integration with the Trust’s other IT systems including a brand-new PAS.1
In 2010, St Helens & Knowsley Teaching Hospitals NHS Trust pioneered the use of a scan-on-demand2 approach to digitising medical records and serving them electronically to clinical staff in what was then a landmark and award-winning initiative well ahead of its time.3
Using a customised version of CCube Solutions’ EDMS software and a bespoke portal – created for the first time in the NHS further to close collaboration with clinicians and other key stakeholders – the Trust migrated away from a labour intensive and unsustainable paper process which involved moving 7,000 records each week between its two hospital sites – St Helens and Whiston. Around 130,000 medical records were digitised – some 41 million pages – which has saved the Trust £1.4 million annually further to an initial £1.2 million investment.
The digital system implemented mirrored the old paper medical file and displays information such as patient name, appointment time, last doctor’s letter, and has a range of links – so-called chapters – so that clinicians can quickly and easily delve into a patient’s medical history. Over 500 doctors and 130 medical secretaries were trained with the implementation gradually rolled out over 22 months.
Karl McIntyre, St Helens & Knowsley Health Informatics Services’ Assistant Director for Innovation, says, “We set the agenda for other NHS organisations to follow. Many Trusts have visited St Helens & Knowsley to see how we solved our paper problems. We’ve practically become the digital blueprint for modern medical records delivery.”
New version of CCube Solutions’ EDMS allows the Trust to build on its success
Now completely deployed and live, the introduction of version 4 of CCube Solutions’ EDMS will allow the Trust to capitalise on the work and success made to date to digitally transform.
The rollout is an enabler to do as follows:
- Offer mobile access to the EDMS. Based on Microsoft’s scalalable ASP.Net MVC framework, version 4 is ‘web friendly’ and will enable the Trust to provide access to the EDMS for authorised staff using devices such as smartphones and tablets given the software now has a HTML-based front end. Whilst mobile access has yet to happen, the underlying IT infrastructure is in place to do this when the organisation decides to ‘turn on’ this capability;
- Enhance the workflow in the administrative function to speed up the process of letters being drafted by medical secretaries, consultants then approving and signing them and the correspondence finally being sent to GPs or patients themselves;
- Continue to remove and absorb paper which comes into the Trust such as mail and referral forms and make this available at the point of care via the EDMS. The use of eForms – a module in the CCube Solutions suite – is being piloted;
- Review how technologies like OCR and forms recognition technologies can help make the searching and finding of information even faster than it is today;
- Provide remote access to EDMS for clinicians working in St Helens & Knowsley’s broader health economy. For example, the Trust runs satellite clinics across 20 different sites stretching as far as North Wales. Role-based access is being provided to clinicians when they are off the main St Helens and Whiston hospitals sites.
- Link EDMS with other key IT systems like the Trust’s electronic observation system and the new Medway patient administration system from System C.
McIntyre says, ”We’ll be integrating EDMS with the Medway solution so that when you’re in the PAS, you’ll be able to click on a button and launch EDMS to view the scanned paper record of a patient. Currently clinicians have to flick between the two systems.”
St Helens & Knowsley Health Informatics Service has also shifted the CCube EDMS onto a VMware virtualised server environment running Windows Server 2012. All patient data – around 15 TB worth – is stored onsite securely on EMC Isilon and VNX storage arrays and managed by the Trust itself.
Typically, the Trust has around 400 concurrent users of EDMS. During the upgrade project, the whole CCube EDMS platform was performance tested to ensure scalability.
McIntyre says, “During the migration phase some bottleneck issues arose when usage increased. Minor infrastructure changes were made and code altered and we stresstested EDMS with up to 750 staff and the performance was linear. This gives us the absolute confidence that we can scale and take on three times the number of users if our workload increases.”
Vijay Magon, CCube Solutions’ managing director, says, “Clinical and administrative processes in hospitals change all the time. You cannot successfully introduce EDMS if you expect an organisation to have to bend to the way the software operates. It has to support the way clinicians want to work and be configurable and flexible. That’s what we have achieved at St Helens & Knowsley along with all our other NHS trust customers and is why we get such wide scale clinical acceptance and buy-in.”
- Patient Administration System
- Scan-on-demand is an approach where only the records of people coming into outpatient clinics are scanned. The EDMS is then used to deliver them. It avoids Trusts having to digitise their whole records libraries which is time consuming and costly given some patients never re-attend. Their files are destroyed in line with set and approved records policies.
- The Trust won numerous accolades in 2010 including: The UK IT Industry Awards, Document Management Awards, Health Business Awards and the Techworld Awards.