100% Digital Records: Just What the Doctor Ordered
– Linda Watts, GDE Programme Manager and Head of Health Records, Imperial College Healthcare NHS Trust
When Imperial College Healthcare NHS Trust appointed Linda Watts as the Head of Health Records, her remit was clear: to digitise the trust’s four on-site patient record libraries and its off-site archive, together holding around 2.8 billion pages.
Linda wasn’t expecting any additional budget to achieve this objective. “In fact,” she says, “I still needed to reduce the health records budget year on year, in line with our overall cost improvement programme.”
Linda did have two things on her side. The first was that, having worked with Xerox at another trust, she knew she could leverage their expertise as she developed her plans.
The second was that the trust had already been capturing patient records digitally at the point of care for about 12-18 months. It had decided to move to electronic note-taking soon after implementing its EHR system a few years earlier — a decision that proved very valuable.
Step 1: Free up budget
With the recent history of many active patients already digital, Linda discovered through an audit that in around 30% of cases, the paper files delivered to clinics were always returned unused (because for some specialties, once a patient’s history was older than a year or 18 months, it was generally no longer relevant to the care given).
Using this data, Linda got clinical buy-in for her team to stop delivering legacy records to those no longer using them. This meant she could reclaim budget originally earmarked for additional recruitment, and in fact release almost a third of her existing team: some 40 people. Linda lent them to other departments with vacancies, where they proved themselves and were soon permanently hired. This retained valuable members of staff, avoided redundancy costs, and returned their salaries to the records management budget.
Meanwhile, Linda had also addressed inefficiencies in the trust’s offsite records archive service. With advice from Xerox to back her up, she moved the trust’s archive from box-based to open-rack storage, delivering additional savings.
Step 2: Appoint the right digitisation partner
With budget freed, the trust went to tender for a scanning partner under the Crown Commercial Service framework RM3781.
“Xerox was head and shoulders above the other respondents, both for the quality of its offer and in being the lowest-cost option,” says Linda. In its end-to-end service, Xerox is:
Scanning offsite archived records to maintain a standard run-rate
- Digitising all onsite records, site by site and specialty by specialty, with on-demand scanning of files for upcoming appointments
- Securely destroying scanned records after two months, to allow for quality assurance
- Managing the relationship with the offsite storage provider
- Managing the tender process for a secure, integrated cloud-based document management system, to be delivered as part of the Xerox service. Together, Xerox and Imperial chose MediViewer from IMMJ Systems.
The value of the Xerox service was proven during the pilot project, in which Western Eye Hospital’s library of some 30,000 records was digitised.
“We evaluated the pilot continually through its duration,” says Linda, “but honestly, it was pretty straightforward.
When you work with Xerox you have confidence that the inevitable hiccups will quickly be cured. They know what they’re doing, and they really stand out for responsiveness and flexibility.”
The library at St Mary’s Hospital followed, freeing up 547m² of floor space for clinical use. Once Hammersmith Hospital is digitised, a further 489m² will be freed, and at Charing Cross Hospital there will be space for a whole new 23-bed ward.
When Linda started this digitisation project, the health records budget was around £3.8m. Just over two years later it’s down to £2.6m, and on track to be just £0.5m following a five-year strategy.
“Most importantly,” she says, “our clinical staff have really taken to working completely digitally. And we’re also using the scanned records to give patients better access to their own records through the Care Information Exchange portal.”
About the Trust
With five hospitals on four sites in London, Imperial College Healthcare NHS Trust is one of the largest NHS trusts in England. It has close to 12,000 staff and completes more than a million patient appointments every year.
The trust is one of 16 acute Global Digital Exemplars (GDEs) in England. These are internationally recognised NHS organisations that can act as a reference for the use of digital technologies in healthcare, and help other trusts to follow in their digital footsteps.