St Helens and Knowsley shuts library door

Neil Darvill, director of informatics for the St Helens and Knowsley health informatics service, says that it closed the trust's library for external use in October, and reckons it is therefore the first to stop using paper records in operational practice. The trust no longer sends patient records to wards in paper form, and instead scans those needed to the trust's electronic document management system (EDMS), which uses software from C Cube and Kodak scanners. Darvill said that the £1.2m project is set to save at least £3.2m in its first five years, with savings reaching £1.4m annually when the library is completely closed in 2014. The trust has already cut nine full time equivalent posts, with 51 remaining in the department. "We're still losing posts. We'll go down to something around 45," he said, adding that a recruitment freeze and use of temporary staff is making this possible through staff turnover rather than redundancies. The trust originally expected to get a return on its investment in 2.5 years, but has already done so. "The library is shrinking quicker than we expected," Darvill said, as the trust had not planned on scrapping paper records at the end of their retention periods, in many cases eight years. Of about 750,000 records when it started the project, the trust has scanned some 135,000 – made up of 41.3m pages – with a similar number having expired. The electronic patients record system accepts notes from clinicians either on paper – in which case they are scanned immediately – or electronically. For the latter, the digital forms have been designed to mimic the paper ones they replaced, making them familiar and allowing doctors to include diagrams. "It's a new way of working, and some have taken time to adapt, but most clinicians have found it easier than they thought they would," said Dr Francis Andrews, clinical director for intensive care at the trust and also a consultant. Andrews said that clinical acceptance by doctors at the trust's has been boosted by the incorporation of improvements to the system suggested by doctors. "We said 'Could it be a bit faster?' and it's extremely fast now," he said. Another idea, of incorporating thumbnails of pages to allow clinicians to flick through an electronic document, has also been introduced. He said that having notes available electronically is potentially beneficial to all patients. Previously, it took 48 hours for paper notes to appear: "Now at 3 o'clock in the morning, I can click on EDMS and bring up the patient's notes, and the problems they've had in the past," he said. This can allow patients to leave accident and emergency more quickly if the notes reveal an existing negative test for a possible condition, and also alerts doctors if they have rare conditions, particularly with the heart, kidneys or chest. It also makes for better auditing and swifter corrections, Andrews added, such as if a junior doctor misses a subtle fracture on an emergency scan. As these images are available through the EDMS as soon as they have been examined by a specialist, the emergency team can immediately decide whether to recall the patient. Darvill said that the system will be extended to other NHS users in the area, as his service provides facilities for all of the local health economy. It is planning a pilot scheme with local GPs, and expects to make it available to all 92 GP practices in the area by the end of March 2011. He added that it would be possible to open the EDMS to patients, if appropriate security was added, to meet the government's policy of opening access and control of records to patients. "For at least 150,000 of our current records, and more and more everyday, if the government said it would be a great idea to provide online access to records we could do it tomorrow," he said.