Noble’s Hospital meets target to remove paper records by the end of 2018

As part of a Government-wide Digital Strategy which aims to use technology to further improve the Isle of Man’s public services, Noble’s Hospital set a goal to remove paper records by the end of 2018.

The Digital Future project involved digitising the 20-ward, 314-bed hospital’s entire medical records archive - some 90,000 records - as well as conducting ongoing day-forward scanning as new clinical notes are created to increase efficiency and deliver enhanced care for all patients.

Digitisation has afforded frontline medical and nursing staff with significantly-faster access to patient information

Chief clinical information officer, Dr Gregor Peden, said that there were two key drivers to the project.

“We were using the digital records as the cornerstone of the rest of the Digital Future strategy so we needed some form of digital repository in order to feed all of our other projects into,” he added.

“Plus, we had literally run out of physical space, the records library was full, and we had already expanded into a temporary building at the back of the hospital.

“It was either build somewhere else to store paper, or invest to digitise that information, free up the space, and hand it back to the hospital to be repurposed.”

Kodak Alaris business’ partner, MISL, won the tender to digitise the entire medical records archive.

As all records had to remain readily accessible to clinicians throughout the project lifecycle, they had to remain on the island.

In order to meet this requirement, MISL appointed Alaris reseller, Manx Business Solutions, to manage the back scanning programme.

MISL specified Kodak i5850S Production Scanners and Capture Pro Software, which quickly converts batches of paper into high-quality images, to power through the bulk scanning of all legacy files. Kodak i3400 Scanners were supplied to conduct day-forward scanning on site.

The staff used the scanners from Alaris to scan the paper records directly into the hospital’s MediViewer Electronic Document Management (EDM) solution.

Built specifically for healthcare institutions by Alaris partner, IMMJ Systems; MediViewer indexes records with essential metadata, which can then be searched by patient, content type or location.

More than one person can access a record at any one time, which with paper is impossible; and the fact that multiple clinicians can discuss a patient over the phone while all looking at the same record, has been a complete game changer

Importantly, the solution is BS 10008: 2014 compliant, ensuring the patient record cannot be deleted or altered in any way, as well as providing a full audit trail.

Back scanning the 90,000 records was completed in just under 12 months, meaning the hospital achieved its goal to remove paper records by the end of 2018.

A business continuity element was built into the back scanning phase.

“We had to work on the basis that a patient may present to A&E while their records were being scanned offsite, so we put a two-tier urgent recall process in place”, explained Dr Peden.

“Essentially we could recall any record the same day or next day - we didn’t use it often, but for the 10 recalls that were requested, it worked efficiently.”

Ongoing day-forward scanning has been adopted with ease. All day-forward scanning packs are received by the medical records team with a pre-printed cover sheet with QR barcodes.

“As the documents are scanned, the MediViewer system recognises the patient and the clinical area. The medical records team simply scan into one central area and the software accurately reads the barcode and routes the files to all relevant records,” Dr Peden said.

“One of the key SLAs set is that all documents received have to be scanned and imported into MediViewer within a 24-hour window.

“Both the volume of documents - the team scan around 7,000 sheets a day - and the tight turnaround meant that robust, reliable scanners were a pre-requisite.

“The fact we haven’t breached this SLA in the 18 months since go live, speaks to the dedication of our scanning bureau and to the quality and reliability of the Kodak Alaris scanners.”

The project has delivered a number of clinical benefits.

Dr Peden explained: “Digitisation has afforded frontline medical and nursing staff with significantly-faster access to patient information.

“More than one person can access a record at any one time, which with paper is impossible; and the fact that multiple clinicians can discuss a patient over the phone while all looking at the same record, has been a complete game changer.”

The hospital has enjoyed a considerable reduction in the time and cost associated with manual filing, tracking, searching and retrieving records.

Five staff who used to manage records delivery have been moved onto other contract types, which has realised a cash benefit.

“We also have a satellite hospital in the north of the island, a 40 minute drive away – previously there was a notes transport service that would run notes over there and then bring them back to our records department at the end of the day. Now, as the records are digital, we no longer need to do this,” Dr Peden said.

With more than 16 million sheets of paper being eliminated, storage is no longer an issue.

In addition to digitising the entire medical records library, we have also made a significant dent in deceased and some specialty records which were stored in the loft and were originally out of scope

And the space previously used to house health records has been handed back to the hospital to be re-purposed.

Furthermore, as new records are created at the rate of approximately 7,000 sheets per day, they are automatically scanned and inserted into the EDM, which has removed the requirement to find more space to store paper records in the future.

“We have over achieved on our initial target. In addition to digitising the entire medical records library, we have also made a significant dent in deceased and some specialty records which were stored in the loft and were originally out of scope,” Dr Peden concluded.