IT in healthcare pt3: Liverpool trusts aim to pull plug on paper records

The use of electronic patient records is delivering significant efficiency gains to trusts in and around the city

Lots of innovative technology, particularly around mobility, is being used to provide doctors, nurses and other clinical staff with real-time access to patient data. But much of the work going into modernising hospital IT is concerned with finding ways to eliminate paper records from back-end systems, so that clinicians and administrators can pull up digital information from wherever they happen to be, from any device.

In August, the Royal Liverpool and Broadgreen University Hospitals NHS Trust began piloting a web portal based on Carefx’s Fusionfx platform, which will give its 300 consultants instant access to a range of clinical data via the internet. The idea, says the trust’s ERP project manager, Alison Clare, is to provide up to 2,000 doctors, nurses and administrative staff with a way to access information from one portal using single sign on (SSO), which they would normally have to mine from up to 10 separate systems using different access credentials.

“There is a mix of files, some transactional episodes on patient records, as well as images, scans and word documents. This platform provides us with a portal that pulls information off all the usual systems and lets users access it from a single interface,” she says. “Nobody has to create a secondary database and staff do not have to remember seven or eight different passwords.”

The initial pilot will run for 12 months and is the first step in moving towards an electronic health record system – one that will allow more than one staff member to access a record at any one time and from any location, both inside and outside the hospital.

“A little bit further up the road we are also planning to join up with GPs to try to come to some kind of information and governance-sharing agreement, where we will also include information on medicines and drugs (MEDs) and allergies in the portal as well,” says Clare.

“The pilot allows us to see what works and what doesn’t, and to check data integrity between the portal and underlying systems. The portal is view-only, but some staff have a requirement to scan case notes and capture historical information, so we are looking at what tools we can use to meet that need.”

St Helens and Knowsley Teaching Hospitals NHS Trust is another Merseyside healthcare provider offering acute in-patient, out-patient, day case and emergency services to local communities. Following the implementation of an electronic document management system (EDMS) based on software supplied by C Cube Solutions and supplemented by Kodak scanners (see picture), St Helens & Knowsley reckons it is now the first NHS trust in England to stop using paper case notes in operational practice altogether.

“Guaranteed delivery of paper records wasn’t possible given the logistics involved in moving 7,000 records every day,” says the trust’s director of informatics, Neil Darvill. “With 90,000 new patients registered every year, this quantity was expanding exponentially. Every patient coming into the hospital is now seen using the system, and paper records are not delivered anymore.”

GP access is also being trialled, and it is expected that all 92 practices in the area will eventually log in to the system.

Ward staff access the system through desktop PCs, laptops and mobile PCs and see information such as patient name, appointment time, and last doctor’s letter on screen, as well as additional links (virtual chapters) into the EDMS that allow them to delve into the patients’ medical history.

The early systems put in place at Liverpool Broadgreen and St Helens & Knowsley may prove a precursor to the holy grail of healthcare IT – a single, national patient record system accessible to all.

“The system does not integrate with other NHS trusts – it is a solution for St Helens & Knowsley Teaching Hospital NHS Trust and the local health economy,” says Darvill. “Having said this, if the government decided to make records available to the public – as has been much reported – the hard work of digitising files has been done.”

Cost savings were very much in the mind of both trusts following health secretary Lansley’s proposals to shave £20bn from the NHS’s running costs by 2014. St Helens & Knowsley spent around £1.2m on hardware, software and consultancy, including the EDMS application and Kodak scanners, as well as additional file servers for backup and replication purposes. But it estimates it will save around £1.4m a year through being able to close its library, reduce the transportation costs associated with paper records, and reduce headcount through natural wastage.
Liverpool Broadgreen says return on investment is difficult to pinpoint at such an early stage of the system’s deployment, but it is confident savings will come.

“We will potentially see more patients or spend longer with them, as well as reduce the amount of paper we are producing,” Clare says. “If we can see immediately that a patient has been for a blood test, and do not have to contact them again because we have all the information at hand, that saves money.”

Any shared information or record access between multiple organisations always relies heavily on the underlying network, a part of the infrastructure that offers the versatility to support other ICT improvements. St Helens & Knowsley already had access to the NHS Community of Interest Network (COIN) – a shared LAN/WAN and data centre environment used by 340 NHS sites in the region – before the EDMS project began.

But for the Nestor Healthcare Group, a provider of health and social care staff to primary care and social care businesses across the UK, a more recent network upgrade also presented the opportunity to deploy voice over IP (VoIP) for the first time.

The company appointed Yorkshire-based network and security specialist ITogether to deploy and manage private DSL links offering up to 100Mbit/s of bandwidth at its 110 sites across the UK.

“A few weeks ago there was a major fault on the BT network that resulted in the loss of voice services (ISDN30) to one of our north London offices,” says Paul Clutten, IT operations manager for social care at the Nestor Healthcare Group.

“By using the new WAN links we managed to divert the calls to a second phone system within the WAN and bring the branch back online with no noticeable service degradation. We’re now looking to link up the phone systems on other sites to give us faster restoration. We’re also soon to start trials with ITogether on an automatic 3G failover solution, to offer the branch significant failure protection.”

By replacing the 34Mbit/s BT IPStream WAN with 100Mbit/s links, the company estimates it has cut its annual IT costs by 30 per cent, and improved the performance of its Citrix applications.

“The biggest bandwidth draw is probably print services and our VoIP trials, but with the new bandwidth and Citrix delivery, it is not something we really stress over any more,” says Clutten.

“When we can offer quality of service on the DSL lines, we should be in a position to mesh all the company phone systems and deliver local telephone numbers into the WAN via SIP trunking.”