Case study: Scrapping snail mail for a digital trail

David Marsden, EDT service delivery manager at NHS Greater Glasgow and Clyde discusses how the removal of paper is making a real difference to the flow of crucial information

Waiting as long as a week for letters, results and other crucial documents to reach a GP was the norm not so long ago. It was the way that things were done.

It would take at least three to four days, often longer, for hospital staff to generate letters, print them, physically place the documents in envelopes, and for those documents to then arrive at a GP surgery. This is despite the importance of the information contained in supporting the delivery of effective care for patients.

NHS Greater Glasgow and Clyde (NHS GGC) has been an early adopter of a system that has been changing this through a project that enables much-faster communication between hospitals and GPs. This approach has seen improvements in the sharing and flow of information between the health board and GPs, which supports the move towards the national ambition of delivering integrated care.

NHS Scotland first signed up to the national deployment of the electronic document transfer (EDT) system in 2011, so that all hospitals across the country could send crucial correspondence digitally to GPs. NHS GGC saw the opportunities for better care immediately. As an early adopter, the health board started a rollout of EDT with the support of implementation partner, Microtech, to the 260 practices across its area as early as February 2012.

Now some 2.5 million documents a year are being sent electronically by NHS GGC alone - a figure that is expected to increase substantially as more documents are introduced into the system. This already accounts for a significant element of the 12 million documents expected to be transferred using EDT across Scotland in 2015, documents that would otherwise need to be sent via internal delivery or by post.

Instead of being printed and posted, correspondence is created digitally and is collected electronically twice each day to fit with working practices. Documents are then placed into the health board’s Docman Hub, which sends the document directly to the GP on the same day it is collected.

The document arrives as an image file with accompanying metadata, such as the patient’s forename, surname, unique Community Health Index (CHI) number, as well as the date of the document and clinical event, and originating information such as the organisation name, department, and specialty. This allows correspondence to be filed automatically and accurately into Docman GP, a software system already used at every surgery in the area to allow GPs to review electronic letters.

Previously, filing the documents would have involved a labour-intensive process at the GP surgery, with practice staff having to open the document, unfold it, identify it and separate it into a multipage document before manually scanning it into Docman GP. Staff would also have had to go through a series of manual protocols to extract information for the metadata.

An individual could easily spend three to four hours a day doing this. That time is now dramatically reduced – with details being checked as correct in a couple of seconds for each document. The process to open and sort letters manually disappears, as does the risk of important documents being sent to the wrong surgery or incorrectly filed under the wrong patient.

Microtech had also previously rolled out the Docman GP software to all the surgeries in the Greater Glasgow and Clyde area. This gave NHS GGC an advantage when it came to implementation, as EDT merges seamlessly with Docman GP. It is also a much-more-secure way of transferring information, reducing the risk of documents being mislaid, and providing a full audit trail that helps ensure patient confidentiality is maintained.

Benefiting the patient has always been the key driver behind the EDT project. It has been incredibly well received by GPs, who now have the information they need to carry out necessary interventions and deliver results and feedback to patients much faster.

This is already shown by a significant reduction in the amount of queries from GPs to hospitals to find out details on the care or treatment a patient has received. If a patient leaves the hospital and visits the GP surgery the next day, the GP will have the information from the hospital available as they sit with the patient.

Additional information streams can now also be delivered. Some documents that are now being delivered electronically would never have been received by the GP previously. Ambulance reports, for example, show information on patients that have been attended to in an ambulance, but who have not been taken to hospital. This information-sharing service was not previously available, but now that it is, the GP can access important background information on what happened to the patient.

Another direct result of improved information flow and access is efficiency gains. Eliminating manual processes associated with postal correspondence, such as staff no longer needing to file envelopes and sort mail, has resulted in more-efficient use of employees’ time in both hospitals and surgeries. In addition, less money is spent on paper-based consumables.

Health boards are now better able to follow patients as they move across Scotland. NHS GGC has sharing arrangements in place with five other health boards including Highland, Ayrshire & Arran, Lanarkshire, Forth Valley, and Golden Jubilee National Hospital boards. The ultimate aim is to connect all health boards across the country. This will mean that hospitals can deliver information electronically to GP surgeries outside of their area, which is particularly important when patients are treated across different health boards. At present, NHS GGC sends between 4,000 and 5,000 documents electronically in this way each month, and this is only set to increase as more sharing agreements are signed, reducing the reliance on paper processes even further.

In the meantime, a digital mailroom has been created to cover those health boards that for the time being remain outside of sharing agreements. This allows documents to be printed in instances where electronic transfer is not possible and also caters for patients from other parts of the UK.

The volume of documents being transferred electronically is set to increase as the programme moves forward.

A pilot is currently being carried out for microbiology. Once complete, EDT is expected to cover a whole range of new documents from labs that could treble the number of records transferred using EDT.

Patients, hospitals and GP surgeries in NHS GGC and similarly connected health boards are benefiting enormously from the more-efficient flow of information. This will only improve as the project goes on, and the vision of technology-enabled integrated care becomes a reality across the country.