Sarah Perkins Associate Director of Operations & Performance, Project lead for the introduction of Electronic Clinical Document Management. The project involved the re- provision of the paper based medical records into a scanned( digital ) format for County Durham & Darlington NHS Foundation Trust. The Trust provides health care to a population 550,000 across County Durham and Darlington on multiple sites and employs 8000 staff. The Trust had approx. 900,000 paper files containing on average 230 pages of clinical information, the files were used in all medical settings, i.e. out-patient appointments, planned surgery and emergency admissions. The project involved reorganising the current files, deciding how they would be scanned, installing software to view the records, training staff to use the software and agreeing the new processes in a paper light environment

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Changing from paper based
health records to a digital
version - ECDM
Sarah Perkins
Associate Director of Operations and Performance

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What will the presentation include
What is Electronic Clinical Document Management (ECDM)
What were the options considered for an ECDM solution
What are the benefits
Clinician engagement – how do we involve 8,000 staff
How will ECDM change working practices
Project Management arrangements
What have I learnt

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What is ECDM?
Electronic version of current paper health record – approx
900,000 in existence
Paper record is scanned when required, and destroyed (within
agreed timescale)
Electronic record made available using a software application
Contents of the record is indexed to aid presentation and retrieval
Opportunities to introduce electronic forms and closer interaction
with other electronic systems

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The Previous Situation 1

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The Previous Situation 3

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The Previous Situation 2

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Clinical Benefits of ECDM
Notes can be accessed 24x7 securely from any Trust location leading to
timely diagnostics and treatment
Notes available across Acute and Community teams supporting
integrated pathways (and potentially other providers in the future)
Notes available instantaneously:
Removes the current paper-trail of requesting, finding and
transporting notes
No cancelled clinics due to notes not being available
Multiple people can access a set of notes simultaneously
Provides flexibility in where we provide care from

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Clinical Benefits of ECDM
Opportunity to use electronic forms to aid clinical
recording
Removal of the clinical risk caused by loose filing

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Further Benefits
Reduced costs for:
Medical Records staff
Storing paper records
Transporting records
Stationary (paper folders etc)
Staff efficiency savings in terms of time locating
records (e.g. Medical Secretaries)

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How were clinicians engaged
At the start of the procurement process
3 clinicians on ‘evaluation team’:
Helped develop Trust requirements
Assessed supplier demonstrations
Visited other Trusts as supplier ‘reference sites’
Advised on contract contents and provided clinical assurance
Trust events (January 30th
and 31st
2012)
Over 600 attendees
326 people provided feedback
151 stated a preferred supplier
98 people volunteered to be involved going forward
On going road shows
Clinical reference group – all decisions about devices/layout of software
made by clinicans

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How it change the way clinicians work?
No trolley with piles of paper notes
Notes are scanned ahead of clinics
Clinician access record electronically
Notes are written onto history sheet, which is subsequently
scanned and incorporated into main electronic record
Supplier has to make record available to contractual response
times (e.g. 3 hours for emergency), initially returning the paper
record if required.

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What was the impacts on our staff?
Health Records staff had the option of transferring to the supplier,
or being re-deployed within the Trust in some cases
Transferring staff will had full TUPE rights
Staff had to undergo a significant transformation by working with
electronic health records as opposed to paper – mandatory for all
consultants

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Management risks that were identified
Forming a suitably skilled team in time for the project
Trusts acceptance of ECDM and the willingness/ability to change
The Trusts ability to manage any other significant transformations taking
place during the ECDM project timescale
The model and scale proposed has not been successfully implemented
in another Trust
The project remaining consistent to the planned objectives and scope, in
order to realise the benefits envisaged.
Maintaining the clinical engagement for the project

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Project Management
Project planned to be 13 month implementation
Stage 1 January 2013
TNT started to work with current Medical Records service
4 months from contract signature
Stage 2 August 201 3is services going live
Pilot department go-live
Trust-wide over 4 month period including pilot
Project team
Staff to plan and support the changes to working processes in
order to maximise the benefits
Human resource and communications staff to support the
transformation
IM&T staff for integration to Trust systems and device roll-out

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What have I learnt
Private companies were not as ‘expert’ as they thought
they were
Project management was crucial
Communication skills, how to connect with 8,000 staff

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Any Questions?