Almost half a million medical records are now available at the click of a button thanks to the completion of a digital database at Basildon and Thurrock University Hospitals NHS Foundation Trust.
The trust this week scanned the final batch of records from its paper medical records library onto a 34 terabyte (or 34 million megabyte) database.
In the space of four years, the Trust has transferred all of its patients’ medical records from a warehouse the size of a small aircraft hangar into a computer that is not much bigger than the size of a fridge freezer.
Designed by the clinicians who use it, the system allows doctors, nurses and other healthcare professionals, round the clock electronic access to their patients’ medical records. Important clinical documents can be located quickly, via ‘smart indexing’ to automatically recognise documents. Doctors can immediately view the records including medical histories, test results and appointment times of the patient they are treating.
The system improves safety for patients by ensuring medical records are always available to all the hospital's health professionals involved in their care and treatment.
Betty Jackson, was the first person to place a medical record on the shelves at Basildon General Hospital in 1973. To mark the occasion, she was invited back to remove the last paper-based file from the Trust’s library shelves to be scanned into the digital database (see attached interview).
A team of 35 have been scanning patients’ medical records into the EMR system, designed in conjunction with the system supplier Fortrus Ltd and using scanning equipment from Kodak and IBML Ltd. Some 446,000 sets of medical records are now available electronically for medical staff to use.
The system will dramatically improve the way clinical information is captured, managed, accessed and updated. It means clinicians can access information about patients quickly and instantly from multiple locations, including health care facilities outside of the hospital.
Clinicians at the Trust helped configure the system, led by a Clinical Advisory Group of 12 of the most senior doctors and surgeons, and chaired by Mr Ian Linehan, a consultant colorectal surgeon (now retired).
Pushpakaran Munuswamy, a consultant gastroenterologist, is chief clinical information officer at the Trust. He said: “Clinicians are entirely dependent on medical records, but paper records can only ever be in one place at one time. Patients may attend a number of clinics and each time the records are out of circulation for five or six days. Our EMR system helps to fix that problem.
“This system makes it easier to access information and means more than one person can access it at the same time. This is a huge change to the way we are all used to working, but we can all see the benefits.”
Phil Burke, EMR project manager, said: “We really are pioneers with this system and it is creating a lot of interest from other Trusts. The success here has rested on the way the Trust’s internal team has implemented it. A number of hospitals have started to scan their medical records but we are among the first in the NHS to completely digitise them.
“It is not an IT project; it has been designed and driven by the clinicians who use it. Putting a system like this in place is a major challenge and we needed universal acceptance of the project from medical staff."
Paper medical records for patients at Basildon and Thurrock had originally been stored in five different locations before being moved in 2002 to a central warehouse, three miles from Basildon Hospital. Scanning of these files began in July 2010 and the warehouse closed in June this year. The project cost £7 million to implement but it is estimated that it will save £1 million a year in reduced operating costs and £1.6 million a year in improved efficiencies across the Trust.
The EMR system provides stricter security than the old paper-based system. It is just for hospital staff, and patient confidentiality rules mean that not everyone can see everything. Safeguards are built into the system to avoid any abuse. For example, there is a permanent record of who has viewed every page. It is straightforward to use, with colours and icons allowing doctors a quick overview of a patient’s medical history and prompt access to relevant information.
Phil Burke added: “We are very proud of the way of the EMR programme has proceeded. This is a ground-breaking initiative, which will benefit patient care and safety and support innovative clinical processes. It is one of the most sophisticated solutions of its type in the United Kingdom."
Mark Magrath, Commercial Director, said: “You only have to walk around the hospital to see what a difference this project has made. Previously many of the medical secretaries’ offices were stacked floor to ceiling with medical records, and there were cages of medical records being pushed along the corridors. How things used to be; files at Sovereign Park, the Trust’s off-site medical records storage facility which has now closed
“Purging the use of paper as the primary means of communicating clinical information presents a challenge to any organisation. The shift to electronic information management solutions is as much about a change in culture and organisational behaviour as it is about technologies”.
For the time being, doctors and nurses will continue to generate new information on paper and these will be sent to a state-of-the-art scanning bureau to be added to the electronic records.
Electronic medical record factfile:
• There were 446,610 medical records in the medical records library, containing around 68 million pages
• Each patient record has on average 152 sheets and 304 images
• 3,000 trust and community staff have been trained and have access to EMR. On average we have 165 concurrent users accessing the system
• As at October 2014, 85% of BTUH outpatient activity was seen via EMR, this equates to 26,000 attendances per month (this will be 100% on completion of all scanning)
• The trust has appointed remote clinical coders to work from home. This was not possible prior to the EMR implementation and BTUH were unable to recruit the appropriate qualified clinical coders
• If EMR had not been implemented, BTUH would today need a warehouse twice the size of Sovereign Park
• If you lined up all the A4 sheets of paper scanned to date this would cover from London to Sydney (50m sheets scanned to date)