OIT and The Electronic Patient Record
Document imaging had been considered for some time within Swindon & Marlborough NHS Trust before it actually came to be implemented. After several feasibility studies, options appraisals, business cases and cases of need, little progress was being made until the plans for a completely new hospital began to emerge. The Trust was chosen as one of the first wave PFI (Private Finance Initiative) redevelopment projects with the objective of replacing the hospital with a completely new facility on a green field site. Inevitable delays followed, trying to gain business case approval and resolving issues of affordability.
The pressure was on to tailor their requirements to what they could afford, as Head of Information Services Mike Bowes explains: "Document Imaging emerged as a viable alternative to the construction of a large record library, and it fitted with the new concept of Electronic Patient Records. Following extensive negotiations the PFI contract was signed on the basis that the new hospital would have only minimal storage facilities for health records, as they would be stored as images when not needed for clinical use." Thus the imaging project was born. The new hospital was to have approximately 50 square meters of floor space for records storage, and even with the use of mobile racking this would only provide 950 linear meters of shelving, giving less than half the space available at the previous site. So the project had to address the issue of how to provide a service in such limited surroundings.
At this stage the Trust decided to secure the services of specialist consultancy, CimTech, a branch of the University of Hertfordshire specializing in advice and guidance on document management implementations. “We commissioned CimTech to write our requirements specification and assist with supplier selection,” continues Mike Bowes, “The OJEC was published in January 2000 and from this we received 28 expressions of interest. Twenty-two of these companies were considered worthy of further consideration and were issued with our requirements specification. Eleven responded and from these we selected a short-list of four. Contract negotiations followed during which we were greatly assisted by the involvement of a purchasing consultant from the supplies authority.” This process culminated in the selection of preferred supplier, Optical Image Technology UK Ltd. - OITUK Ltd., part of the Genus Group, and contracts were signed in August 2000.
The contract was for the supply of a system that includes hardware software and services capable of meeting the Trust's key requirement: to reduce the amount of paper Health Records stored by approximately 50%. “In a practical sense this means we have a system that is capable of dealing with 1000 sets of notes per week for the next 100 weeks,” explains Bowes, “This we calculate is the volume we need to convert if we are to fit within our new home.” Much complementary work was needed with the involvement of the Trust's clinicians, to agree the rules surrounding what is scanned, what can be discarded (perhaps not surprisingly this is actually very little) and what will be recreated when patients are re-referred or re-attend as emergencies.
"We used to rely on microfilm as a method of archive but this was universally disliked by clinicians. So as document imaging is introduced microfilming has ceased and the staff re-deployed operating the imaging system."
Once agreement was reached these rules were incorporated into the operational policies of the Trust.
OIT’s DocFinity® system supplied by OITUK consists of 3 high-speed scanners, one mid-range scanner, 8 workstations, 2 servers and 3 printers. The DocFinity software includes DocFinity Imaging for scanning, indexing, retrieval and document management, and DocFinity HSM for Hierarchical Storage Management, DocFinity Print/Fax Server for print/fax serving, and the DocFinity IntraVIEWER® module for web-based access. Images are automatically backed up onto an optical jukebox via the DocFinity HSM Module. OIT’s DocFinity Imaging module includes a barcode recognition facility integrated with data fetched from the Trust’s Patient Administration System (PAS). The barcode recognition module was customized to automate the indexing process and simulate the physical casenote, complete with specialty codes. The system is setup with the MS SQL Server, which holds the index data, security, audit and management information.
The DocFinity system, along with a 100Mbit network segment linked to the main hospital network via a fiber optic cable. The optical jukebox is capable of holding 126 5.2Gb optical discs – this jukebox is managed via the DocFinity HSM module. The Trust's own sizing calculations conclude that each of these discs is capable of holding approximately 1000 sets of scanned notes. The task of production scanning has now begun in earnest. The official launch of the project was 15th November 2000, and with the date for moving to the new Hospital is currently 5th November 2002. Mike Bowes is keen to ensure that they start achieving the required targets for notes scanned in the not too distant future.
"I am confident the technology is more than sufficient for the task. If I have one concern it is our ability to prepare the notes for scanning at the rate required," he explains. "We used to rely on microfilm as a method of archive but this was universally disliked by clinicians. So as Document Imaging is introduced microfilming has ceased and the staff re-deployed operating the imaging system. Based on our previous experience with microfilming we have recruited a new team of people specifically to select and prepare notes for scanning. However most of these staff are new to the department and will need time to become fully trained. Until that time it's impossible to know if the resources will be sufficient. Given the risks associated with this element of the project contingency funds have been set aside in case we need to increase these resources." Imaging alone is not a complete solution to the NHS requirements for Electronic Patient Records, (or Electronic Health Records, as they are known in the United States), as Mike Bowes is the first to admit: "I am sure there are many more problems to solve before we get anywhere near being a paperless Health Records service. But we have made a good start and with the selection of the supplier for our EPR currently in its final stages, at least it's possible to see a path to that ultimate goal. For me this is a culmination of over 10 years work since we first considered alter-native methods of storage for our Health Records."
The DocFinity system includes five major server components: the DocFinity Imaging server for imaging, the DocFinity AutoARCHIVE server for DocFinity COLD-ERM, the DocFinity Workflow server for workflow, the DocFinity HSM server for storage management, and the DocFinity Print/Fax Server for print and fax output.
All OIT components are 32-bit, multi-threaded Windows NT applications. These applications can be run on a single machine, or distributed across multiple machines. In addition, configurations may include one or many instances of each server, which can run one or many threads per instance. This flexibility allows organizations to configure and scale the system to meet their needs.
All OIT server components run off the same SQL-compliant database. OIT supports most major relational databases, including Microsoft SQL Server, Oracle, Sybase, and Informix. The system’s database tables are fully documented, making it easier for organizations to make database-level customization if required.
