Despite the challenges of meeting an ambitious 2018 target of going digital, many NHS trusts are making significant headway. From Liverpool Heart and Chest Hospital removing paper-based notes hospital-wide in a single step, by integrating an enterprise content management solution with its clinical management system, to Ipswich Hospital NHS Trust's strategy of harnessing advanced actuarial analysis and GIS systems for demand management, innovative strategies to meeting the nation's future healthcare needs are being developed.
But across the NHS, many continue to grapple with unstructured data, which often has to be tracked down by staff, leading to delays, errors, cost and lost records. Such access is a prerequisite for informed clinical decisions, where the failure to capture and process data swiftly and accurately could strike at the heart of healthcare provision and lead to increased risk to the patient.
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Even in a mature electronic health record (EHR) system, as much as one quarter of all patient information remains outside the system. And it is not a challenge exclusive to the NHS, with many international healthcare organisations struggling with how best to handle paper records. Interestingly, they also share the same issues around handling data relating to referrals, discharge processes and ambulance patient information report forms.
Those providers that succeed in assimilating unstructured patient data, from referral letters to test results, into core operations will benefit from increased efficiency and reduced costs, while improving patient care.
The issue of paper records is partly addressable by scanning them into an electronic storage system and making the information accessible all in one place in a content management (ECM) solution. A well-designed patient-centric enterprise content management solution can enhance the ability of a patient to provide information in advance of the consultation. This way the clinician would have the opportunity to review all the information ahead of the consultation with the patient, giving the consultant more time to care.
Healthcare providers who have smooth processes to capture and access all the right data and do not need to constantly ask patients to repeat information, are improving the patient experience. This also increases the likelihood of patients requesting that they are referred to a specific Trust.
There are also financial implications resulting from inefficient data handling. A Trust’s ability to provide good quality information to commissioners will ultimately impinge on the reimbursement that the Trust receives. It is no secret that there a number of Trusts who are not receiving the level of reimbursement that they are entitled to, as they are unable to provide quality data to their commissioners.
Addressing this issue requires a focused approach. The first step is to identify the ways in which information is captured, from paper, diagnostic and digital images and the array of different forms in use. Many of these will be duplicated and content audits of healthcare organisations typically uncover a potential reduction in the number of forms in use through deduplication of at least 30%.
> See also: NHS Trust heads demand extra funding to achieve government's paperless initiative
For technology professionals, the key is to understand the nature of the unstructured content faced by each department. Too often providers simply replicate existing processes electronically. The aim is not just to automate processes, which may contain errors that would be exacerbate, but to take advantage of further improvement.
The next step is to stop generating new paper. Realistically, this may mean paper-independence, where processes could be executed on paper but not necessarily be dependent on paper for their execution. One scenario, for example, could be the case of senior staff, who may be unwilling to adapt to an electronic system. Paper forms need to become electronic. Where paper sent from outside the trust, this should be digitised at the point of entry, not the end of the process.
In a tight economic climate, the scrutiny of any expenditure will continue. The expected process improvement and cost savings should, therefore, be benchmarked from outset and followed up and monitored throughout the process. Return on investment benchmarks could include savings from externally rented storage space; the freeing up of valuable space for revenue-generating clinical purposes; reputational benefits, as the patient experience improves, making it more likely that the commissioners will choose to do business with you; more effective use of existing IT investment; and cost savings in space and staff time. In addition, reducing risk and liability will result in a reduction in the level of funding required for this particular purpose.
The scale of the challenge faced by organisations, from trusts to clinical commissioning groups, in tackling unstructured patient data is clear. While managers and clinicians charged with resolving this issue may feel that they have been handed an insurmountable task, a successful outcome should lead to improved information handling, cost savings and enhanced patient care.
Steve Rudland is healthcare practice manager (EMEA) at Hyland, creator of OnBase