NHS resources represent a strange conundrum – a vast budget, the fifth largest workforce in the world, and an immense property estate*. And it still isn't enough. Improvements in treatments, an ageing population, and pressure from other government departments places a huge burden on the NHS to achieve more with less, or at least with much the same. So finding ways to get the most out of existing resources is critical. And the pressure is increasingly on maximising the time spent on clinical care, and reducing the costs associated with administrative functions within the NHS estate.
One way to reduce administration, and simultaneously increase the physical space available for clinical care, is to digitise records and documents. In February this year the government announced plans to set aside £4b to promote the use of technology across the NHS. Speaking on the Andrew Marr Show in February, Health Secretary Jeremy Hunt said: "We know that proper investment in IT — it's not without its pitfalls — can save time for doctors and nurses and means they can spend more time with patients". The ring-fenced budget is thought to include £1.8b to help create a paper-free NHS and remove outdated technology like fax machines.
Tim Kelsey, NHS England’s National Director for Patients and Information and chair of the National Information Board, states: “Health and social care services in England must end the unnecessary reliance on paper in the treatment of patients. It’s key to making services safer, more effective and more efficient. Every day, care is held up, and patients are kept waiting while an army of people transport and store huge quantities of paper round our healthcare system.” Digitising medical records and administrative documents can't by itself ‘save' the NHS, but it is one approach that is proven to be successful across the board. Here is a brief example of how CAS helped one Trust to digitise and store records reducing wasted time and increasing efficiency.
Last year, CAS was appointed by Cambridgeshire Community Services NHS Trust (CCS), to relocate and digitise 20,000 patient health records. CCS provides high-quality care to diverse communities across Cambridgeshire, Norfolk, Suffolk and Bedfordshire. The Trust took over service provision for children and young people in the region from the Clinical Commissioning Group for Great Yarmouth and Waveney. As part of the previous provision of service, patient files were held at Lowestoft Hospital. The old system had been entirely manual and therefore uneconomical, requiring significant administration and multiple trips for caregivers from across the region to travel to Lowestoft when they needed to access a file. Files had to be retrieved from the library by hand, checked-out by the attending health care professional, reviewed and then returned.
CCS's base near Peterborough meant that the files had to be relocated, and at this point, the Trust took the decision to digitise those files which were in use. CAS proposed to enable increased effectiveness of record keeping and retrieval through three work streams: secure storage of records, digitising the records and online access to files.
Secure file storage
The first task was to transfer the files to the CAS medical records storage facility. First, the files were boxed in date-order for efficient on-demand retrieval later. Each file and the box in which it was stored were individually coded. The barcode identified the specific records contained in that box making retrieval easy and accurate. The barcodes are scanned using state-of-the-art RFID technology. Each box is scanned when being deposited or removed from storage, and the information is catalogued providing an accurate audit which can itself be accessed 24/7.
To digitise or archive?
Moving 20,000 patient records to a new location doesn't necessarily mean that every file needs to be digitised. The priority was to digitise records as and when needed. To achieve this, we developed our Scan-On-Demand service. Within two hours of a file request, it is retrieved from storage, prepared for scanning by an experienced document management professional, scanned, coded and the digital record added to the virtual record library. The original records are then returned to their storage box and replaced in the medical records archive. Of course, once scanned the records are then available immediately. Choosing to digitise files only when they are needed, rather than on mass, delivers a significant cost saving for the Trust.
Online access to records
The most important aspect of this project was that healthcare professionals across the region had to be able to access the documents online. To provide 24/7 access, CAS developed CAS-Cloud. CAS-Cloud is a completely secure and bespoke service. It runs on a bank of dedicated high-grade servers in a highly secure array at our HQ. Once the documents have been stored in CAS-Cloud, any activity performed on them is recorded. This comprehensive audit trail remains for the life of the material and delivers compliance with data management legislation.
Outcomes: more space, less administration
The relocation to a secure medical records storage facility and digitisation of active files has enabled primary care staff to deliver increased support to children and young people across the region. Administration time and costs have been reduced significantly, particularly the time care professionals have to spend travelling to the old facility to review and manage records. This has resulted in increased productivity, essential at a time when all NHS teams are under budget pressure. As an additional benefit, the secure storage facility also reduces errors and delivers an enhanced level of security for the confidential records offering peace-of-mind for patients, carers and families.
“As well as saving precious resources, technology can dramatically reduce errors. Urgent action is a moral imperative where paper is the currency of clinical practice.” Tim Kelsey.
Constant, and highly anticipated advances in medical treatments mean that our world-renowned NHS will continue to face pressure over resources. But, efficient document digitisation can lead to a paperless health service. And that helps every head-earned pound go a little bit further.
Tim Kelsey quoted from NHS England website, ‘Cutting reliance on paper will make patients safer, says NHS England’ 1 September 2015. https://www.england.nhs.uk/2015/09/cutting-reliance-on-paper/
- The budget for the NHS in England for 2015/16 is £116.4 billion. Source: The Department for Health Spending Review and Autumn Statement 2015.
- The NHS is the world's 5th largest employer with 1.7 million staff Source: World Economic Forum1) The US Department of Defense: 3.2 million. 2) The Chinese military, the People’s Liberation Army: 2.3 million. 3) Walmart: 2.1 million. 4) McDonald’s: 1.9 million.)
- The NHS estate in England owns approximately 35,000 buildings, 6.9 million hectares of land, and a total floor space for trust and primary care trust buildings estimated at 28.4 million square metres (Source: The Kings Fund ‘NHS buildings: obstacle or opportunity?')
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CAS provide comprehensive and secure document digitisation, information storage, shredding and facilities management services. For more than 20 years CAS have worked with NHS Trusts, Financial Services providers, and corporate and private clients. Our head office is just four miles from the City of London, supported by our advanced storage centres across the UK. CAS has an impressive array of International certifications (ISOs), which prove our compliance with the strictest national, European and international laws. They also demonstrate our commitment to provide innovative systems on security, confidentiality and quality control in keeping your files safe and well managed.
About Cambridgeshire Community Service NHS Trust
The Cambridgeshire Community Service (CCS) provides high-quality care to diverse communities across Cambridgeshire, Norfolk, Suffolk. The Trust has an annual budget of more than £110m and employs more than 2,200 staff. The Children and Young Person's Unit provides care and support across Cambridgeshire, Luton and Norfolk for children aged up to 19.