Note perfect

Moving to entirely electronic patient records may be the goal for most trusts, but in the majority of hospitals paper will be around for some time to come.

This is prompting some providers to look at alternative ways of managing those paper records accurately and efficiently and providing clinicians with the information they contain in a timely manner.

Problems and answers

For Walsall Hospitals NHS Trust, managing case notes for its acute services was becoming an issue, not least because of rising demand from patients.

The trust, which runs a 550-bed district general hospital, serving a population of 250,000 to 300,000 people, has merged two sites into one. Overall, it now holds some 400,000 paper records.

“The problem we had was that some notes were not available for clinics or for theatre,” explains Trevor Gregg, head of health records.

“Doctors can’t see patients if the notes are not available. It was damaging our credibility with our consultants, and it had an impact on our income. It was also bad for patient confidence.”

Instead of scanning or inputting the entire patient record – which would be a laborious and expensive process – the trust opted for a system that tracks the physical case note folders as they move out of the patient records library and around the hospital.

“We are some way away from paperless records,” says Gregg. “We might get to ‘paper light’ and we have electronic document record management. But paperless records were impossible at the time, and we needed a quick solution to the problem.”

The records management system, developed by 3M and implemented by MCP, is based around radio frequency identification, or RFID.

It uses electronic tags that effectively replace the card-based index systems the hospital used previously. These relied heavily on hospital staff calling up the health record department each time a patient’s folder was moved.

Hospital staff now swipe folders using sensor pads, located at nursing stations and other high-traffic areas. Staff can also use a handheld device to locate files in store.

Using RFID technology allows large numbers of files to be scanned in or out at the same time; the pads can handle six or seven files at one go.

Gregg says the new tracking system does away with the time-consuming process of tracking patient records, as well as the need to make calls to patient records to update the location or tracer cards.

Records’ locations are now available on 250 PCs located throughout the hospital. “It has made life a lot easier, and cut retrieval times,” Gregg says.

Pilots, roll-outs and results

The trust started with a six-month trial in urology and breast surgery. Urology was picked because of the (difficult) layout of the departmental offices, and breast surgery because of the clinical need for a quick turnaround of notes.

 After the trial, the trust rolled out the system across the hospital. The health records department sent mobile tagging teams to other areas that depended heavily on paper notes, such as maternity. In addition, the trust focused on outpatient departments, as outpatients – and their doctors – were most inconvenienced if notes failed to arrive on time.

Once the six-month trial finished, the actual roll out took just weeks, thanks in part to the mobile tagging teams.

The project champion was the hospital’s medical director, Mike Browne, and the deployment was also supported by training and communications, which produced various support materials including a video for staff.

The video now forms part of the new staff induction course at the trust. The project was also inexpensive, costing £150,000 split between MCP and 3M.

By the autumn of 2009, Walsall Manor Hospital had tagged more than 123,000 records. However, the rate of tagging is expected to slow. The most frequently used notes are now in the system, and many of the others might never be accessed at all.

“We have to keep notes for eight years, and putting tags in notes that are six or seven years old might be a waste of money,” explains Gregg. However, if a doctor does call up an older record, it will be tagged and logged into the system before it leaves the patient records store.

The results of the project have been dramatic, especially given the relatively modest sums of money involved. The system will pay for itself within a year, and the hospital has already benefited from fewer cancelled appointments and better use of clinic time.

“From a records department point of view, we have fewer spurious calls, better staff morale, better IT skills and everyone is now using the system,” says Gregg. Internal checks show that the system is recording the location of patients’ files accurately.

Consultants’ feedback has been positive, as there are fewer incidents of missing or late notes, a fact that improves patients’ confidence in the trust too.

The E-Health Insider Awards 2010 in association with BT seek out and reward outstanding work within the UK healthcare IT sector. Entries are open now on the dedicated awards website.

www.ehealthawards.com

The deadline for entries is 4 June.

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