Royal Free invests in EDM

Royal Free London NHS Foundation Trust will digitise 850,000 patient notes over the next three years using an electronic document management system from OpenText.

OpenText is providing the platform to manage and store the records on a seven-year contract, which will be hosted within Royal Free’s data centres.

The trust’s director of IM&T Will Smart said Royal Free has a library of 850,000 case notes and the plan is to scan all of these over the next 2-3 years, starting in the summer.

“Our strategy is effectively ‘scan on demand’, as patients are electively booked in we will pull their notes, scan and make them available,” he said.

“For those urgent cases or cases that come in non-electively, when they arrive in hospital we will pull their notes, send them to be scanned and they will be available within 24 hours.”

The historical records will initially be accessed as a separate application from the trust’s Cerner Millennium electronic patient record system, but the trust plans to integrate access to the historical notes into its EPR.

Smart said this is “not entirely feasible” while the trust is still under its National Programme for IT contract delivered by BT.

“We are in the process of exiting from the NPfIT, so one of the things we will be doing once we’re out of the BT data centre is integrating it into Cerner Millennium,” said Smart.

The trust has worked with a clinical reference group to develop a customised user interface, he added. This needed to be intuitive so has a “standard web-based look and feel”, is designed to be as easy to use as paper and involves a number of different ways in which clinicians can navigate the records.

Smart said the trust has maintained the tab structure of the clinical record in its digital form. It is scanning records at specialty level so clinicians can identify documents related to specific specialties and using a ‘cover flow’ view, similar to iTunes, that allows clinicians to flick through an inventory of what is available.

“The clinicians in the clinical reference group are positive about what they are seeing,” said Smart.

“We’re about to move into structured user acceptance testing, getting them to test in detail."

Smart said moving piles of paper records around the hospital is very resource intensive and paper can only be in one place at one time. By making records available electronically, the trust will prevent the cancelation of appointments because notes are unavailable and improve patient safety.

“The objective is to make sure the records are available where the patients are, at the point of care, so it will mean that clinicians will have access to much more rich clinical data then is possible with the paper record.”

The trust has rolled out tablet devices across all wards and some other areas such as A&E. Staff will be able to use these to access the EDM system.