Adoption model helps NHS trusts meet deadline for paperless records

NHS trusts struggling to introduce paper-free record and referral systems before the Government’s 2018 deadline are being offered support with the publication of a best practice guide that gives step-by-step instructions to deploying digital solutions.

The Electronic Medical Records Adoption Model for Europe (EMRAM) provides a blueprint for transforming healthcare through the introduction of innovative IT solutions and has been based on an earlier version designed for the US and Canada.

It takes trusts through seven critical stages, at the end of which they will no longer be using paper charts to deliver and manage patient care, instead utilising a mix of discrete data, document images and medical images within their electronic medical record environment. In addition, clinical data warehouses will be able to analyse patterns of clinical data to improve quality of care, and patient safety and clinical information will be readily shared via standardised electronic transactions.

Achieving this level of integration and such a high level of data security represents a milestone in healthcare

This is in line with the Government’s plans to revolutionise NHS systems and comes just weeks after England’s Health Secretary, Jeremy Hunt, ruled that the NHS will be completely paperless by the end of 2018.

While some forward-thinking trusts have already made inroads into this, others are at the very beginning of the journey and are worried they will not be able to meet the deadline.

The EMRAM has been developed by HIMSS Analytics Europe and has already seen its first success, with Germany’s University Medical Center Hamburg-Eppendorf (UKE) achieving the top rating recognising a totally paperless medical record environment.

In just three years it has implemented a hospital-wide IT system based on Soarian Clinicals and Soarian Health Archive from Siemens that allows the entire continuum of care to be managed through an electronic patient record.

“The University Hospital of Hamburg Eppendorf provides a blueprint for transforming healthcare through IT,” said Uwe Buddrus, chief executive of HIMSS Analytics Europe.

“Paper is now superfluous and the benefits are apparent on several levels. Thanks to IT systems, patient healthcare can now be delivered more quickly and to a higher standard.”

Technology that delivers the right information, about the right patient, to the right clinician, at the right time is crucial to transform healthcare services

Dr Peter Gocke, head of IT at UWE, added: "The electronic patient record enables us to handle all patient documentation free of the restrictions of a paper-based environment and independently of location.

“Achieving this level of integration and such a high level of data security represents a milestone in healthcare. At the same time the best possible framework is in place for a future in which telemedicine will play a much greater role.”

Through the EMRAM, NHS trusts will be able to identify their level of EMR capability, ranging from limited ancillary department systems at Stage 1, through to a paper-free EMR environment at Stage 7. Having such a measure in place makes it possible for hospitals to assess how close they are to being paper-free in the run up to 2018.

Stages 1-5 require self audit and a focus on the implementation of suitable software. Stages 6 and 7 have an emphasis on how the software is being used to improve processes and achievement of Stage 7 is subject to an on-site visit carried out by HIMSS to assess these processes.

To complete Stage 7, hospitals must meet a number of specific requirements, such as not using any paper charts and ensuring that 90% of all clinician orders are made digitally. In addition, all critical documents must be imported or scanned into the system and available for viewing within 24 hours, while all non-critical documents must be scanned within 72 hours.

The adoption model has been welcomed by UK solutions suppliers, who are keen for the NHS to have structure for the rollout of technology.

Speaking to BBH this week, Steve Rudland, healthcare industry manager at Hyland Software, said: “Technology that delivers the right information, about the right patient, to the right clinician, at the right time is crucial to transform healthcare services.

If the NHS wishes to offer services globally, it needs to accept some global measures. The EMRAM is a global measure that aligns not only with the NHS domestic mandate to be paper-free, but also with its global ambitions

“Most organisations will progress through various hybrid states as they move towards a paper-free electronic patient record (EPR). However, up until this year, the only model for measuring the degree to which a facility was paper-free was the US-oriented HIMSS Electronic Medical Record Adoption Model (EMRAM). Although a number of European sites have embraced the model, it hasn’t been widely adopted because it wasn’t relevant to the European experience.

“Adoption of the HIMSS EMRAM for Europe plays a beneficial role in NHS globalisation plans. If the NHS wishes to offer services globally, it needs to accept some global measures. The EMRAM is a global measure that aligns not only with the NHS domestic mandate to be paper-free, but also with its global ambitions.”

It’s easy to shrug and say that a hospital will never be paper-free, but it’s clearly a key priority for the Government and it’s not only possible with ECM, it’s being achieved around the world and measured via HIMSS

Commenting on the challenge still facing NHS trusts, Rudland added: “Even with the most sophisticated EPR systems, at least 25% of the information relating to a patient still lives outside of the EPR – on paper, in messaging systems or on other fileservers. To achieve Stage 7 and reap the benefits of moving to EPR, healthcare organisations should consider the implementation of an enterprise content management (ECM) solution. This provides a repository for all unstructured information, integrated with the EPR. This would deliver clinicians with a complete view of all patient information, without them having to leave the EPR.

“Once a hospital has all of its information under control, its ability to improve clinical and business processes dramatically increases. Referrals, admissions, multi-disciplinary team processes, coding, billing and subject access requests all benefit from the automation and monitoring that an electronic document workflow brings.

“It’s easy to shrug and say that a hospital will never be paper-free, but it’s clearly a key priority for the Government and it’s not only possible with ECM, it’s being achieved around the world and measured via HIMSS. With a relevant EMRAM in place, NHS and other European hospitals have the perfect opportunity to drive industry standards, improve quality of care and patient satisfaction, while streamlining workflows and increasing efficiency.” <’p>