IT & WIRELESS COMMUNICATIONS
trust, that a standardised approach isn’t that easy to achieve.
A local community health organisation, for example, has found it hard to move to electronic records because they are struggling to get to grips with the multi-site, multi-speciality aspects of it.
Training, not just technology
The creation of a paperless office is also not as simple as just installing and implementing new technologies. Training is necessary – particularly as different approaches are being taken. “Warrington & Halton has taken clinicians into the IT department to work alongside health informatics staff to make sure what’s delivered works for clinicians,” Robinson said.
Working with Kofax, the trust has standardised the stationery used by clinicians to complete their reports before they are scanned into the system by administration staff. This cuts down on the need to train each clinician. Instead the focus on records management and systems training is focused on the hospital’s admin staff.
Speaking generally, Jay Goodison of Ascribe Consulting adds: “The app paradigm is perhaps changing the traditional view of training, as it predicates that useable technology should be self-explanatory.”
He also thinks that when the systems are correctly implemented, “the business logic should be able to inform the user at the point of entry that an error has been made.”
The problem is that clinical applications are complex, as is the information and subsequently applied logic, leading to a huge operational and cultural change requirement. So any transformation programme must include all paperless programmes as well as for mobile applications.
Process automation
Robinson said: “With Kofax, information can automatically be collated and then go into the hospital’s electronic records management systems, and we try to make this process as standardised as possible – clinicians complete the same forms as they did in a paper system, because the training needed would otherwise take too long.”
His hospital has over 1,500 different kinds of documents, and so with electronic records it is possible to cut down on training time. The cost of training is cut too, but he admits that the training programme at the hospital is still under development.
The key steps in tackling the ‘mountain of
paper’ in the NHS are: conversion of stored records into usable digital content (backscan); prevention of new paper entering medical record storage (capture at source); and providing channel shift capability to enable business interactions to be predominantly digital through use of web, e-mail and mobile channels.
He elaborates: “The great advantage of Kofax is that it knows our documents. Using the pre-print order code located on each item of stationery, Kofax knows what type of document it is and then it just scans and automatically puts that into the patient’s electronic record in the correct place every time. There are no separator sheets or extra keystrokes for staff.
“For our clinicians, this means they can use the same stationery as before to record patients’ information and to view it at a later date in an electronic format. This has greatly reduced the amount of training that is required for clinical staff, enabling them to get on with treating our patients with minimal disruption.”
Once the documents are scanned they appear on a validation list – particularly if it finds that something is missing or incorrect. An automatic process pulls in reference data to validate the information contained within the documents to permit them to be cross-checked. Erroneous records are checked and corrected where necessary, and the audit trail means mistakes can be removed before they can have any impact on patient care.
BYOD
Savings are also being made by allowing clinicians to use their own mobile devices, but this requires the development of a ‘bring your own device’ (BYOD) policy, to prevent people from using their phones and tablets to inappropriately take photographs of patients.
Warrington & Halton has moved on from using PCs to Dell tablet computers that use docking stations around the trust. This makes records management quicker and easier to achieve.
Staff can take their tablet anywhere within the hospital and take them home, though some systems are locked down for security reasons whenever the device is taken home – unless prior permission has been granted by the IT department.
Only certain staff have the tablets, but Robinson said it is a cheaper solution than static computers, while the increased mobility helps with ward rounds or when moving between bays.
The necessary applications are also pre- installed on the devices, saving time and boosting efficiency compared to solely using PCs – particularly as the devices can
synchronise with the doctor’s own PCs. For security reasons, it’s wise to not allow staff to use generic departmental logins, Robinson said. A personal one enables the hospital to identify the user, making it easier to find out who was using the system at any given place and time.
Reducing risks
Accurate records are crucial for preventing patient harm. The technology in place at Robinson’s trust helps ensure this, by allowing the trust to create drop-down boxes within the system to ensure that what is entered by a clinician is exactly what is expected.
Robinson said: “For example, in a blood pressure record you’d expect to have two to three characters and with the smart form technology, you can drive the user to input what you want them to enter, and ensure the records are filed in the right place.”
There is no such control with paper-based records, which can allow the user to enter the wrong data and they can end up filing them in the wrong place.
A British standard has also been created to forestall the rise of litigation. BS 10008 allows trusts to defend themselves in court by proving the integrity of their electronic records.
“This is important because law firms know there is potentially big business in questioning the legitimacy of hospital records,” revealed Robinson. But electronic records can help avoid wrongful medical treatment.
“The only sure way for trusts to protect themselves is by ensuring the trust obtains BS 10008 certification, if you are going to open your own scanning bureau or ensure that any providing scanning services to the trust holds this certification,” he explained.
Many trusts have failed to do this upfront and have “found themselves scanning records and then retaining paper copies for any future legal case”.
For this reason alone, Derek Kilroe, Kofax’s sales director for government in the UK and Ireland, says that many NHS authorities are actively working to reduce paper and to improve their operational efficiency and compliance in healthcare by using intelligent software to convert paper from the vast number of medical record stores into usable and accurate digital content.
Gordon Robinson
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national health executive Sep/Oct 14 | 91
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