Special Report: Document Management

For many NHS trusts, electronic document management systems are a way to free up space and help improve patient pathways, but are there more benefits to be explored? Andrea Downey investigates.

For years digital leaders in the NHS have been pushing towards a paperless healthcare system, with electronic document management systems (EDMS) playing a big role in managing medical records and other vital documents.

According to data from Digital Health Intelligence, while 155 NHS organisations have a system installed, there are still 73 which do not.

For many, the push to go paperless has felt like an uphill battle and while we may not be over the hill just yet, the role of the EDMS has become more than just a space-saving way to store documents.

As with most healthcare technology, the Covid-19 pandemic forced the digital maturity of the NHS into the spotlight. As a result, many suppliers are now looking beyond simply storing medical records electronically and towards using EDMS to modernise electronic patient records (EPRs) and data utilisation.

Slow and steady wins the race?

While the Digital Health Intelligence special report on EDMS in 2020 and 2021 highlighted a clear hunger for digital transformation, there hasn’t been as much movement in this area as expected.

In July 2021 NHS Shared Business Services launched a framework for document storage, records management and integrated solutions which covers both paper storage, digitisation and EDMS.

There are 17 suppliers on the framework, which NHS organisations can directly award a contract too, or hold a competition with to see which supplier is best suited to their needs.

However, the purpose of EDMS largely remains the same as it was originally designed for: electronically storing patient information. But it has far greater potential, according to Vijay Magon, managing director of CCube.

“The EPR is still viewed as a kind of ‘holy grail’ for both the NHS and its IT suppliers, but what we have to remember is that legacy records are almost entirely based on paper – so the paper-based processes in the NHS contribute to most of the inefficiencies,” he says.

“In recent years, creation of new patient information is largely electronic. If we aren’t able to marry up the two, then there is a high risk of a clinician looking at, and potentially making decisions, based on an incomplete record.

“Trusts are now looking at ways to deliver a single record to a clinician or administrator, with absolute confidence that they are viewing 100% of the available information on that patient.”

Paperlite to patient care

For Mike Seel, innovation lead at IMMJ Systems, EDMS not only helps a trust cut back on its paper use – an often expensive use of resources – but also allows staff to focus more on patient care.

“In truth, these systems are excellent at gathering structured data and ensuring that from the moment they are implemented, they can help an organisation to cut down on their paper creation dramatically,” he says.

“The move to cloud computing has allowed the EDMS to be hosted on public, private and hybrid cloud solutions and the need for on-premise infrastructure has been removed. This allows healthcare organisations to get back to doing what they do best, treating patients and not worrying about how many servers are needed for storage of the records.”

The company is currently seeing an increase in the number of integrations they’re asked to manage, including HL7 and FHIR messages, patient administration (PAS) and EPR structured demographics, different document feeds from results systems and transcription systems, Seel explains.

Steve Burton, clinical systems sales director at Civica, agrees that EDMS have a role to play in delivering safe care. He says the systems have always been designed to support going paperless, but as they’ve evolved, they’ve delivered a number of other benefits.

“An EDMS enables clinicians to deliver more effective care to patients, powering a single clinical view at the point of care, by accessing patient records electronically, delivering a quicker, safer and more cost-effective service,” he says.

“They are key to the delivery of a paperless NHS and enables a hospital trust to remove paper records entirely, in line with the NHS long term plan and Wachter review.”

A traditional example

In January this year the Hillingdon Hospital NHS Trust’s opthamology department went live with IMMJ Systems Mediviewer EDMS. It has now been rolled out to 10 clinical specialities in a bid to digitise patient records.

The system allows the hospital to scan, index and archive paper medical records, and access them through a user interface.

MediViewer has also been integrated with the Hillingdon Care Record, for a robust view of patient health records, and will also be integrated with the trust’s new Cerner EPR when it goes live later this year.

Early feedback from the trust has been positive. Brinda Chetty, lead nurse for digital implementation said the technology is easy to use and its speed means the response time is almost instantaneous. Other consultants were pleased with the customisable navigation and search options available.

While projects like this are promising, the EDMS landscape across the NHS still has some way to go. Discussion with suppliers of the technology suggest the health system has barely begun to unlock the potential of these systems.

A UK-first integration

CCube Solutions recently became the first supplier in the UK to successfully integrate and embed its electronic document and records management system (EDRM) with Cerner’s Millennium EPR.

Some 80million scanned legacy patient records were integrated with the EPR at Milton Keynes University Hospital NHS Foundation Trust, meaning the trust’s 3,800 staff have immediate access to patient notes contained in CCube’s EDRM through the Millennium system.

The trust has been using CCube’s EDRM for more than 10 years with the system evolving from being the centre of how scanned records were kept to being a key part of the EPR.
CIO at the trust Craig York said at the time: “It’s important for us to have a secure and reliable records system where there’s no room for clinical staff to get into patient safety issues.”

Harnessing the power of data

A key capability of EDMS that is yet to be fully unlocked is supporting research capabilities. The resource of patient information they provide has the potential to be immeasurable in future health research – using anonymised patient data, of course.

Civica’s Burton explains they can be used to mine data to observe clinical outcomes, hence providing researchers with a greater understanding of disease and how to treat it.

“An EDMS can support the mining of unstructured patient data to identify clinical outcomes across a large cross section of patients, over an extended time. This can be integrated into the research and clinical trial processes where the NHS work with pharmaceutical companies,” he says.

While IMMJ’s Seel notes the time-savings that can be made using EDMS for research rather than accessing physical records in a medial record library.

“Now, with the power of optical character recognition and being able to search for specific conditions, diagnosis, drugs that were given to a patient decades ago…researchers have more intelligent data to utilise in their studies and trials,” he adds.

“As the technology progresses, expect to see more powerful search engines become available across all of the data held within the EDM repository, meaning that the power of the data can be harnessed in more efficient ways, such as natural language processing.”

Predictions for the future

The future of EDMS is looking bright, if you ask Seel. He says that as the systems evolve, they’re likely to help trusts make proactive decision about healthcare.

Both Seel and Burton see EDMS playing a role in integrated care systems (ICS), particularly around supporting population health.

“Over the next few years as EDMS begin harvesting data from their documents, we expect to see an uptake in integrations with Business Intelligence tools. This will provide healthcare systems with the data they need to make more pro-active decisions,” Seel says.

“We expect most major systems to adopt an ICS-wide strategy and being able to provide their information to all organisations with the wider healthcare system of a specific geography.”

Burton adds: “There will be a greater use of an EDMS across an ICS and to support digital pathways of care in conjunction with a trust’s EPR.”

But there is caution too, perhaps an all too familiar caution for those working with tech in the NHS. There isn’t a one-size-fits-all solution when it comes to technology, trusts must ensure they are choosing a future-proof solution that meets its specific needs.

“Realising adoption of an EDMS is a challenge. Many organisations have attempted to digitise and implement a system but have not succeeded past the first speciality,” Seel explains.

“Ultimately a piece of technology is only as good as the process by which it digitises, the team that implements it and change managers that transform the services to set end users up for success.

“Providing adequate resources, not just for the supplier, but also from the organisation is the only way to ensure adoption and realise the cash releasing benefits that are strived for.”

CCube’s Magon has a much simpler message for trust’s not currently investing in EDMS – why isn’t everyone doing it?
“It has been done, is being done, and is saving the NHS millions each year,” he says.