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100% digital records.Just what the doctor ordered.Linda WattsGDE Programme Manager and Head of Health RecordsImperial College Healthcare NHS Trust
Context• About Imperial College Healthcare NHS Trust
• And a little about me
Our approach to digitisation of paper records• Pay our own way
• Digital at point of care first
How we've done it• Freeing up funds
• Partnering with experts
• Preparing and piloting
• Lessons and results to date
The future: 0 paper records
Agenda
Context
3 7/17/2019
4 7/17/2019
Imperial College Healthcare NHS Trust
One of the largest trusts
One of 11 AHSCs
11,800 staff
1,000,000+ appointments
One of 4 MTCs in Greater London
Queen Charlotte’s & Chelsea
• Maternity, neonatal, women’s care
• Research
Hammersmith• Specialist care, including
renal, haematology, cancer, cardiac
• 24/7 London heart attack centre
St Mary’s• Wide range of acute
and specialist services
• 24/7 London MTC
Western Eye
• Eye care with 24/7 A&E
Charing Cross
• Wide range of acute and specialist services
• 24/7 London hyper acute stroke unit (HASU)
• Hub for integrated care
Plus a growing range of community-based specialist and integrated care services
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GDE Programme Manager and Head of Health Records
Head of Health Records
Since August 2016
Remit to completely digitise patient records
Building on prior experience
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GDE Programme Manager and Head of Health Records
Head of Health Records
Since August 2016
Remit to completely digitise patient records
Building on prior experience
GDE Programme Manager
Imperial named a global digital exemplar in March 2017
Together with fast follower:Chelsea and Westminster Hospital NHS Foundation Trust
7 7/17/2019
GDE Programme Manager and Head of Health Records
Head of Health Records
Since August 2016
Remit to completely digitise patient records
Building on prior experience
GDE Programme Manager
Care Information Exchange: largest patient portal in England
Bedside monitoring: released 20,000 hours to patient care
Cerner implementation at Chelsea & Westminster NHS Foundation Trust
Device connectivity and closed loop medications, bloods & milk
The digitisation challengeand our approach
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9 7/17/2019
Patient records: the digitisation challenge
Electronic health record (EHR)
Old paper-based processes
Hybrid working
Legacy paper records
New digital processes
+
1. Pays for itself
Imperial's approach to digitisation of paper records
2017 2018 2019 2020 2021 2022
£3.8m £2.6m £0.5m
Budget timeline
• No GDE funding • No other investment
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Imperial's approach to digitisation of paper records
2. Digital at point of care first
ClinDocs live within ~1 year:
Capture notes digitally before scanning legacy notes
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Imperial's approach to digitisation of paper records
2. Digital at point of care first
ClinDocs live within ~1 year:
Capture notes digitally before scanning legacy notes
More usual procedure
Still generating paper records post EHR
Getting used to accessing scanned legacy notes before capturing digitally
Seems easier,so why not?
vs.
vs.
vs.
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Why digital at point of care first?
Imperial
Folder contains outcome form only
Notes captured digitally in EHR
No action needed
Other hospital
Folder contains paper forms for handwritten notes (plus outcome form)
Notes scanned to EHR and paper versions destroyed
Patient coming to outpatient clinic
Legacy notes scanned to EHR 1-2 weeks before appointment
At clinic there's a physical folder
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Why digital at point of care first?
Other hospital
Notes scanned to EHR and paper versions destroyed
= Staff to manage scanning and destruction
= Increase in consumables
= Potential increase in staffing
= Struggle to digitise without extra budget
= Comfortable process, potentially resistance to change
Imperial
No action needed
15 7/17/2019
Why digital at point of care first?
Other hospital
Notes scanned to EHR and paper versions destroyed
= Staff to manage scanning and destruction
= Increase in consumables
= Potential increase in staffing
= Struggle to digitise without extra budget
= Comfortable process, potentially resistance to change
Imperial
No action needed
16 7/17/2019
Why digital at point of care first?
Other hospital
Notes scanned to EHR and paper versions destroyed
Others have struggled
Imperial
No action needed
Experience with scanning has been far easier than anticipated
The Imperial story
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Our starting position
Onsite
4 libraries for active patient records
750,000–1,000,000 records
113 records staff
Offsite
Crown Records Management
1.5m boxes, ~12 records per box
= 18m records, ~150 pages per record
£3.8m budget
~2.8bn pages in total to scanStart with 4m records (~600m pages)
Then assess
2016 2017 2018 2019
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Freeing up funds part 1: redeploy staff
Audit of records use in clinics
To understand what 12-18 months of digital capture meant for use of paper records
2016 2017 2018 2019
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Freeing up funds part 1: redeploy staff
Audit of records use in clinics
To understand what 12-18 months of digital capture meant for use of paper records
30% returned paper files unused
Almost all agreed to stop receiving them
Enabling us to:
• Stop plans to recruit (freeing up budget set aside)
• Redeploy ~40 staff (freeing up their salaries)
2016 2017 2018 2019
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Freeing up funds part 2: address offsite inefficiencies
Box-based storage is inefficient
There must be a better way
Xerox confirmed that open-rack storage would save a lot
Why Xerox?
ResponsiveCaringKnowledgeable
2016 2017 2018 2019
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Appointing an expert digitisation provider
Three responses to tender
Xerox top for quality and lowest cost
2016 2017 2018 2019
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Phase 1: pre-pilot preparation
Bedding in, learning
Setting up scanning profile and processes
Setting up in-house scanning
• For exceptions to digital capture, eg drawings, consent
• Small volume, efficient to do in-house
• Xerox advised on hardware and trained our staff
Developing legacy viewer: a basic EDM
• To give time to decide on final EDM solution
202016 2017 18 2019
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Phase 2: digitisation pilot
Western Eye Hospital
A single speciality: relatively 'standalone'
But broadly representative
• Outpatients, inpatients
• Theatres, A&E
• Shared patients
And big enough: ~30,000 files
202016 2017 18 2019
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Phase 2: digitisation pilot
How it worked (and continues to work)
Clinician (speciality) by clinician (speciality)
202016 2017 18 2019
On-demand scanning:5-day turnaround
Working through all onsite records+
Supplemented by scanning from offsite store if necessary
Retain scanned pages for 2 months for QA, then destroy
• Formal QA for random %
• Informal through use
Continually evaluate
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Phase 3: continuing rollout
Apply lessons learned
Our approach paid off:Nothing fundamental to change
Hiccups quickly cured by Xerox responsiveness and flexibility
It really helps to have the right partner
20192016 2017 2018
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Phase 3: continuing rollout
Apply lessons learned
Our approach paid off:Nothing fundamental to change
Hiccups quickly cured by Xerox responsiveness and flexibility
It really helps to have the right partner
20192016 2017 2018
Do consider your speciality rollout order:
Smallest to largest?
Largest to smallest
Seems easierMinimises crossover
BUT: may create greater resistance
Build positive momentum
Use crossover to help
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Results so far
StaffJan 2017
113Jan 2018
73Mid 2019
58
Care Information Exchange
Largest patient portal in the world
Space
547m2
Still to come
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Electronic document management (EDM) rollout
SaaS
UKCloudhosting
N3/HSCNaccessible
MediViewerfromIMMJ
Systems
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Digitisation continues
Space
Hammersmith
489m2
Charing Cross
whole floor =23-bed ward
5-year strategy
0paper records
Offsite storage costs
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Contact us
Alexis Rufus
General Manager, UK Public Sector, Xerox
E: [email protected]: +44 (0) 7713 191746 https://www.linkedin.com/in/alexisrufus
www.xerox.co.uk
33 7/17/2019
www.xerox.co.uk/HPC19
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