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Are hybrid solutions for medical records the real-life answer to the digital conundrum?

By Stefan Chetty, Director of Public Services, Restore Records Management



It’s now been more than 10 years since the then Health Secretary Jeremy Hunt first announced an ambition for the NHS to go paperless. So, this isn’t a bad time to take stock of where we are and what should happen next.

Hunt’s initial target was for the NHS to be fully digital by 2018, a date which already seems like ancient history, and which always felt a little ambitious.

There’s nothing wrong with being ambitious, of course – but, equally, there’s a significant value in being realistic and opening your eyes to alternative solutions.

Roll forward a decade and many Trusts have gone digital, with various levels of success. But in terms of being paperless? That’s still a long way off.

Our evaluation at Restore Records Management, based on our wide experience of working in the sector for many years, is that reliance on paper in the NHS has gone from around 70 per cent to almost 50 per cent, but it certainly hasn’t gone away.

We estimate there are over 100 million physical records still stored by NHS Trusts across the country, many of them housed in Health Records libraries sat right in the centre of hospitals – in prime clinical space that could be better used for direct patient care.

Time to widen the goal

The focus has been on ‘going digital’ but there’s a middle ground to aim for – a hybrid solution which some people are calling ‘paperlite’ rather than ‘paperless.’

For most Trusts it would cost 10s of millions of pounds to scan all their documents at a cost of £10-£15 a record.

Most Trusts have at least a million records – and the larger ones considerably more.

Finding a commonsense answer

Of course, if you ask any NHS Trust whether they dream of going fully digital, then it’s quite possible the majority will say ‘yes.’  

For many it remains the best possible solution.

But there’s a growing realisation that other viable options can also deliver on a promise to optimise patient records and deliver better service.

Hybrid systems are now available which allow key records, those which are used or required most often, to be scanned whilst legacy records remain on paper in storage – but are still barcoded and accessible when needed.

This is a common-sense answer to an age-old problem – and one that can save Trusts money whilst also making it easier to go fully digital in future if they decide to do so.

Don’t digitise everything

If there’s one rule all Trusts should follow when it comes to medical records, it is: don’t digitise everything.

Why scan every single record when there are many in storage you may never need to access?

It doesn’t make financial sense – and it doesn’t lead to better patient care.

So, now, especially in the current era of a cost-of-living crisis, high inflation and squeezed budgets, is the time to be realistic about how fast some Trusts can travel.

Time to consider how a hybrid environment in which digital and physical records live efficiently side by side could be a strong solution.

Where should Trusts start?

The first step is for NHS Trusts to look at their patient records inventory and consider how best it can be optimised, putting aside a narrative that an entirely digital solution is the only way there.

Many Trusts have made giant strides in the digital field and seen improvements in patient care as a result.

But the historic pressure to scan everything and remove paper altogether is flawed and has lacked a cohesive vision.

Even Trusts who were ahead of the game and who jumped on the digital bandwagon early, are facing issues.

Technology has moved on significantly – and what looked like a perfect solution ten years ago can now, already, seem out of date.

Some of those who in the past wanted to be exemplars of going digital didn’t think about data capture carefully.

They scanned records to view as a PDF on a screen, without maximising the value from this process.

The reality is it can be even more clunky than having a paper folder.

You have a 200-page PDF to search through on screen, which isn’t easy – and as a result, many clinicians still prefer a paper folder.

Outsourcing records and clinic prep

There’s been a tendency for NHS Trusts to hang onto a tradition of keeping patient records onsite in a Health Records Library.

Perhaps they feel that because records are nearby, they will be easier to access – and safer.

The reality is different.

Records regularly go missing in the Health Records Library because they are not returned and not tracked.

Perhaps they get left on a desk somewhere.

Perhaps clinicians collect them the night before an appointment to be certain they are at hand when needed – but nobody else on site knows about it.

So, when they are required for a second appointment they appear ‘missing.’

Outsourcing records management, including clinic prep, can resolve this issue through bespoke solutions.

A record management partner which uses staff who used to work in the NHS can add sector knowledge into the mix, helping to create a user guide to standardise the clinic prep process and then run the service themselves.

Under such a system, patient records can be ordered through an online portal and are only delivered the day before they are needed.

Then they are returned to storage, which means you’ll always know where they are. It’s a good example of a hybrid system which delivers results.

Scan on demand

NHS Trusts often worry about being unable to access files in an emergency and hold back from utilising off-site storage.

But it is rare that files are required ‘right this minute.’ If records are needed quickly, they can be scanned on demand, and sent back to the Trust digitally.

This is often a faster option than searching for them in an overstretched onsite library. Emergency physical delivery is also an option.

Would digital make that process even quicker? Well, yes, it would.

But it’s worth considering whether you are ever likely to need it any faster – or whether a hybrid solution delivers optimisation at a cost that is better value.

Paperless remains a long-term vision for Trusts and nobody is saying it doesn’t bring real benefits.

But for many, ‘paperlite’ is providing a viable alternative which will also make it easier and cheaper to go fully digital in future.

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