IT Success in NHS through partnership

Optical Image Technology UK


Most NHS sites hold patient related data in a variety of ways using differing media, eg. paper, microform, and digital. Although some areas have introduced bespoke databases allowing storage and audit, the majority rely on more traditional means.

It is currently very difficult, if not impossible, to identify exactly what information may be held on a given patient. Some departments compile their own copy of patient's records with the prime objective of having information to hand when required.

This practice has resulted in falling standards for timely filing of patient related documentation in the patient's acute medical record; increasing risk and disadvantaging patients and clinicians. Using Information Technology (IT) in this area alone would deliver real benefits to secretarial staff and improve data quality.

Advances in IT have paved the way to providing a central Electronic Document Management (EDM), delivering measurable benefits, in real time. EDM systems facilitate the electronic transfer and storage of documents ensuring high levels of security and audit. EDM is, however, a much greater asset than simply an electronic filing system.

OITUK continue to work closely with NHS users to develop and provide integrated solutions, using EDM as the underlying technology.

Solutions for the NHS

The Health Sector has traditionally handled large paper volumes and complex record sets, managed internally at departmental level, via a range of technologies including imaging, document management and workflow. Nowadays, a whole range of pressures are driving organisations to provide web-based facilities that enable external bodies to interact with the core information systems.

At its simplest level, members of the public, and multiple health care departments, must now link together to extend health services and streamline operations. This paradigm shift must operate within the laws of the existing Freedom of Information Act, the Data Protection Act, and for many organisations, The National Archives (TNA - formerly Public Records Office) - regulations.

OITUK believe that NHS Trusts must adopt a more holistic approach for content management. The core component of all such systems is document management. Unfortunately, document management per se is still regarded as a luxury and, in many cases, utilised as glorified electronic filing of patient records, with little or no return from investments in such systems.

Organisations must demand a more integrated approach - the digital patient record cannot sit in a document management system that remains un-connected with other patient administration and clinical care systems. The document is the vehicle for content which must be searchable and integrated with the core hospital systems and practices.

Its management has to encompass the document life-cycle which includes day-to-day patient record management (including security), as well as retention and destruction in compliance with TNA guidelines - the integrated, holistic approach.

The underlying EDMS technology provides a compound document repository that can be shared amongst many departments, to unify the document repository and provide access to the Integrated Patient Record:

Case Study: Addenbrooke's NHS Trust

Cambridge-based Addenbrooke's NHS Trust has achieved what for most UK Trusts is considered the 'holy grail' of information management: critical information is available to clinicians at the point of care in real time, as it is created. The Electronic Medical Records solution developed with OITUK offers huge data quality benefits, significant savings in secretarial time and specialist stationery, as well as a Trust-wide standard for all documentation.

A common problem across the health sector has always been that one patient's medical records might be required by a number of different people at any given time. In the case of a diabetic, for instance, records and notes might need to be available to the eye unit, the heart unit, and even a chiropodist. Managing such requirements from a paper-based system represents a logistical nightmare.

Dianne Nixon, who was Project Manager for Electronic Medical Records (EMR) at the time of the project, recognised the need to identify first of all what types of information were being created both electronically and in print, and what was then happening to those documents. Essentially, she discovered, most letters were being generated electronically (in MS Word), printed out, and then moved around the various departments physically.

Once a patient had had no further contact with the Trust for four years, each document would be scanned for archive purposes, and then shredded.

When the Trust's project team looked around for possible solutions, they were surprised to find very little that really fitted their requirements. Lots of document management vendors offered systems to scan medical records, and specialist clinical IT systems were already in place in various departments, but nothing seemed to address the routine document production and management needs of the Trust: in the first instance, writing to patients, GPs and clinicians and keeping track of those communications.

What ultimately made the OITUK solution successful was the company's willingness to involve the Trust itself in developing the system, as Dianne Nixon commented: "Vendors should never try to build something themselves and then impose it on the NHS - it won't work!"

There is a need, given the enormous complexity of the NHS, its Trusts, and the scope of work they do, for any supplier to work hard to 'get inside' how things are done, and be willing to let the Trust staff themselves specify much of the system.

Since implementation of the C-Cube eMR system there is considerable evidence of the success of this approach: nearly 2,500 registered users of the system now access over 1,500 templates specific to their departments via the Trust intranet. Around two million documents are now available within the system for review and reference.

Many of the users are secretaries and clinicians rather than technical staff, and so it was essential that the system be intuitive and non-intrusive to their normal working practices. The OITUK solution requires no knowledge of indexing on the users' part: all relevant index data is gleaned from within the system, transparently to the user - the system is integrated with a number of hospital systems, automating the patient data feeds into eMR and into the letters generated, providing a single access point for the integrated patient records.

A unified logon means that users do not have to 'enter' the system; all documents are available from within their standard application interface, whether that be Word or a clinical application.

The user enters a patient's 'hospital number' used to uniquely identify each individual, selects a letter type from the template, which will then automatically pre- populate many of the fields using data extracted in real time from a variety of different Trust systems. All letters are automatically saved to the system database, again with no special steps required by the user. The system includes such document management essentials as version control and full audit trail.

But the OITUK system now streamlines much more than just letter writing: telephone conversations are easily summarised and saved in the system for easy retrieval and reference. Similarly, discharge summaries, complete with all take home drug information are completed at point of discharge and fully integrated with eMR. This has huge benefits for patients and GPs alike, and the information is immediately available throughout the Trust should a re-admission occur.

The OITUK solution is already capable of exploiting other new technologies as their use expands within the Trust: previously if a call came in to say that a kidney had become available for transplant, the relevant team would have had to print out vast reports to see the entire patient data needed to make a decision.

Now, staff use portable electronic communications devices to view all the appropriate data in a user-friendly format instantly, enabling them to make what could be a life-or-death decision more quickly, and with greater confidence.

Future developments include use of more database technology within patient letters, use of web portals and electronic forms to support two-way interaction between systems and the professional staff, and document workflow to further automate back-end processes.

C-Cube Solutions

The key to all C-Cube solutions is integration with business systems to ensure that information is delivered on time and to the right place. OITUK has provided EDM & Workflow solutions into many NHS, Local Authority, and Private Sector sites over the last 12 years and is now in a leading position in the Records Management Industry. The full scope of the C-Cube integrated document and records management suite includes:

  • Electronic Document & Records Management
  • Standardised Letter Generation & Management
  • Web Based Electronic Forms processing
  • Storage management and archiving
  • Workflow
  • Content Search & Knowledge Management System
  • Web Portal-based solutions, with collaboration facilities
  • XML and HL7 based application integration

The products support standard application interface technologies to ensure that solutions can be readily expanded to use emerging technologies, incorporate future requirements, and allow integration with existing desktop and business systems. These software components from OITUK form a market mature, integrated suite with associated software longevity, an ongoing future development vision and high quality levels of support.

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