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As the NHS celebrates its 70th birthday this year, we thought it would be the perfect mile marker to look back and see how the NHS’s vision to become paperless is progressing. In 2013, the then health secretary Jeremy Hunt stated, “The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution” and set out a plan for the NHS to be fully digital by 2018. Now that date has all but passed and the new deadline of 2020 is looming.
One of the major focus areas of this mammoth digitisation project is the conversion of paper patient files to electronic notes allowing secure sharing of information with patients and clinicians. As a result, the vision is to help doctors more effectively diagnose patients, reduce medical errors, and provide safer care, not to mention better use of expensive NHS real estate and redeployment of records management staff to assist an already stretched labour force. With these clear tangible benefits, it’s surprising to see that a lot of trusts are still yet to commit to digitisation. Perhaps a combination of positive tales from digital exemplars versus negative disaster stories from failed projects make it difficult to see how and where to start the digitisation of patient notes.
In theory, this is one of the simplest projects for an IT project team to pick up but with huge volumes requiring capturing in a time critical manner, a massive peak at the very start of the project, ongoing complex logistics, significant increase in administrative staff, processing rules and compliance it soon becomes a much larger and complex challenge. Add in to the equation additional real estate and procurement of technology to deliver the project and you can start to understand where the nervousness to commit is coming from.
Looking at previous projects and the differing approaches, many different methodologies have been used with the NHS. A common approach has been to look to “fully outsource” the scanning of patient records. This allows the risk to sit with the service provider but comes at a price. In addition to the cost model, there is also a level of loss of control as a trust has to allow one of its most important assets to go off site to an external party. Another common approach is to take on the scanning “in-house”. Here the risk sits firmly with the trust and many have attempted this approach without understanding the sheer scale of the ‘production line’ involved in capturing the number of records required in the early stages of such projects.
An approach that has been successful is a hybrid of the above approaches whereby an external outsource company takes on the initial peak of the project. This saves a trust from a potentially huge investment in scanning hardware, software, recruitment, training and infrastructure that will become obsolete within the first year. The internal records management team can then take over the longer-term ‘thin file’ processing that may continue for several years. This both avoids a large short-term influx of staff and also assists with job security for the current records management staff. The onus is then on the outsource provider to re-use the infrastructure for another client, hence no one trust has to bear the cost of the infrastructure that they required for only a short time period.
At the start of investigating a trust’s path into a paperless environment, it is key to work with a provider who can be flexible and also seek guidance from others who have already undergone this journey.
A final thought…If you walked into your bank to ask for a loan (presuming for a second you don’t have a phone application and your branch wasn’t long since closed) and the bank clerk walked into the back office, retrieved a paper based file and started to asses this file to ascertain if your request could be approved, would you be impressed? The reason the NHS gets away with working in this historic manner in many cases is simple - because it’s so good at how it copes with the demands and limited resources it has to deal with and is the pride of the nation. Surely though, it can only improve with more digitisation helping to make the task easier and the process more efficient?
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