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Sarah Perkins Associate Director of Operations & Performance, Project lead for the introduction of Electronic Clinical Document Management. The project involved the re- provision of the paper based medical records into a scanned( digital ) format for County Durham & Darlington NHS Foundation Trust. The Trust provides health care to a population 550,000 across County Durham and Darlington on multiple sites and employs 8000 staff. The Trust had approx. 900,000 paper files containing on average 230 pages of clinical information, the files were used in all medical settings, i.e. out-patient appointments, planned surgery and emergency admissions. The project involved reorganising the current files, deciding how they would be scanned, installing software to view the records, training staff to use the software and agreeing the new processes in a paper light environment
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www.cddft.nhs.uk
Changing from paper based health records to a digital version - ECDM
Sarah PerkinsAssociate Director of Operations and Performance
www.cddft.nhs.uk
What will the presentation include
What is Electronic Clinical Document Management (ECDM)
What were the options considered for an ECDM solution
What are the benefits
Clinician engagement – how do we involve 8,000 staff
How will ECDM change working practices
Project Management arrangements
What have I learnt
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What is ECDM?
Electronic version of current paper health record – approx 900,000 in existence
Paper record is scanned when required, and destroyed (within agreed timescale)
Electronic record made available using a software application
Contents of the record is indexed to aid presentation and retrieval
Opportunities to introduce electronic forms and closer interaction with other electronic systems
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The Previous Situation 1
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The Previous Situation 3
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The Previous Situation 2
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Clinical Benefits of ECDM
Notes can be accessed 24x7 securely from any Trust location leading to timely diagnostics and treatment
Notes available across Acute and Community teams supporting integrated pathways (and potentially other providers in the future)
Notes available instantaneously:Removes the current paper-trail of requesting, finding and transporting notesNo cancelled clinics due to notes not being available
Multiple people can access a set of notes simultaneously
Provides flexibility in where we provide care from
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Clinical Benefits of ECDM
Opportunity to use electronic forms to aid clinical recording
Removal of the clinical risk caused by loose filing
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Further BenefitsReduced costs for:
Medical Records staff
Storing paper records
Transporting records
Stationary (paper folders etc)
Staff efficiency savings in terms of time locating records (e.g. Medical Secretaries)
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How were clinicians engaged
At the start of the procurement process
3 clinicians on ‘evaluation team’:Helped develop Trust requirementsAssessed supplier demonstrationsVisited other Trusts as supplier ‘reference sites’Advised on contract contents and provided clinical assurance
Trust events (January 30th and 31st 2012)Over 600 attendees326 people provided feedback151 stated a preferred supplier98 people volunteered to be involved going forward
On going road shows
Clinical reference group – all decisions about devices/layout of software made by clinicans
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How it change the way clinicians work?
No trolley with piles of paper notes
Notes are scanned ahead of clinics
Clinician access record electronically
Notes are written onto history sheet, which is subsequently scanned and incorporated into main electronic record
Supplier has to make record available to contractual response times (e.g. 3 hours for emergency), initially returning the paper record if required.
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What was the impacts on our staff?
Health Records staff had the option of transferring to the supplier, or being re-deployed within the Trust in some cases
Transferring staff will had full TUPE rights
Staff had to undergo a significant transformation by working with electronic health records as opposed to paper – mandatory for all consultants
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Management risks that were identified
Forming a suitably skilled team in time for the project
Trusts acceptance of ECDM and the willingness/ability to change
The Trusts ability to manage any other significant transformations taking place during the ECDM project timescale
The model and scale proposed has not been successfully implemented in another Trust
The project remaining consistent to the planned objectives and scope, in order to realise the benefits envisaged.
Maintaining the clinical engagement for the project
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Project Management
Project planned to be 13 month implementation
Stage 1 January 2013
TNT started to work with current Medical Records service 4 months from contract signature
Stage 2 August 201 3is services going livePilot department go-live Trust-wide over 4 month period including pilot
Project teamStaff to plan and support the changes to working processes in order to maximise the benefitsHuman resource and communications staff to support the transformationIM&T staff for integration to Trust systems and device roll-out
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What have I learnt
Private companies were not as ‘expert’ as they thought they were
Project management was crucial
Communication skills, how to connect with 8,000 staff
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Any Questions?
