Critical success factors for electronic document and records management (EDRM)

Moving from paper to digital records is one of the biggest transformation projects faced by NHS trusts, as it involves adopting new processes for everyone, across a range of specialist health areas. 

Finding the right balance between affordable levels of file preparation, whilst ensuring this does not disrupt hospital processes or efficiencies, is a challenge. Technology can help, as can learning the lessons from other digital transformations — above all, though, a robust and flexible approach to project management is essential. 

Many years of being at the forefront of implementing electronic document and records management (EDRM) solutions has taught us the following:

Prioritise clinical engagement. 

It’s fundamental to ensure that your clinical community is involved from the outset. This includes providing input to the business case, supplier evaluation and selection, testing and implementation. A clinical advisory group should be established with representation across as many specialities as possible.

Enlist the support of a strong chief clinical information officer. 

The chief clinical information officer (CCIO) will have a good understanding of how the IT strategy will support clinical practice, and what the main drivers are for implementing an EDRM.

Assess your internal capabilities to establish the level of support you will require from an EDRM expert supplier. 

Having a strong internal project team, supported with supplier resources, is a cost-effective approach. Building your internal project team may involve recruiting staff on a temporary or contract basis. Consider using trust staff that have a good understanding of operational processes to support your NHS digital transformation team. Your supplier could advise on the expertise required for some of these roles, based on previous experience during digital deployments. The strength of your internal project team will help to identify the level of consultancy and support you will need from your supplier. 

Get to grips with your forms/documentation. 

Historically, it’s unlikely that your patient notes will contain much barcoded material. Technology that takes an automated approach to indexing will, therefore, help. This should involve working with clinicians to identify key clinical documents, and then defining recognition rules. However, you should work with your health record committee to identify how ‘scanner friendly’ forms will be designed going forward, and how barcodes will be applied. This will make future indexing and retrieval much easier.

Appreciate the scale and importance of the scanning challenge.

The scanning function is pivotal to the success of your programme. It must be able to keep pace with your local service level agreements (SLAs). Doctors will want to access digitised patient records at least 24 hours before their clinics. New material generated from outpatient and inpatient encounters will also be required promptly. 

As the roll out of your electronic document and records management solution progresses, you may require a flexible scanning arrangement that allows the volume to be scaled up or down. Make sure this implementation approach is agreed with your supplier. Understanding your activity levels — such as outpatient attendances per day, and varying case note size, depending upon speciality — will help determine the scanning throughput required.

Measuring benefits. 

Be realistic about the savings that can be made with the introduction of an electronic document management (EDM)/electronic medical record (EMR) solution. 

The following should be considered:

• Estate cost savings from reduced storage requirements.

• Eliminating/replacing tasks currently undertaken by admin and clerical staff associated with tracking and handling case notes. A centralised function could be established to take on responsibility for clinic preparation and achieve economies of scale.

• Reduction in health records resources versus the scanning resources required.

• Initiatives such as a centralised clinic preparation service for ongoing clinic material. This may include scanning incoming referrals in advance of clinic. A number of savings could be made within such services. 

• Calculating the cost of not scanning your patients’ records. If you do not implement an EDRM solution, what would be the anticipated growth of your patients’ records and associated cost in health records, staffing and facilities?

Make access to information fast and easy to locate. 

The clinician will not want to wait whilst large patient records/documents are loaded or spend disproportionate amounts of time trying to find key pieces of information. Work with clinicians to ensure your system is easy to use and performs well.

An electronic document and records management solution will enable savings to be made. However, clinical service leads need to be actively involved in identifying and delivering efficiencies, and a system that meets users’ needs can help make that task easier.

Find out more about EDRM solutions below.