Northampton General Hospital NHS Trust is digitising its paper-based records in order to boost the governance around its processes and improve the care it gives to patients.
That work is being led by Hugo Mathias, CIO and director of IT at Northampton General Hospital NHS Trust, who explained at the Alfresco Day event in London how his organisation is using Alfresco content management technology to help track and trace elective pathway management across the trust.
Matthias refers to the recently published NHS Long Term Plan, which presents a strategy for improving the quality of patient care and health outcomes. He suggested his aim as part of that improvement process is to help make his own trust become digitally enabled:
It's a big challenge. We are very paper-based at the moment. The digital enablement – which is where I come in – is trying to create a county-wide shared care record and to digitise the hospital. To do that, my strategic plan is to stop the paper coming into the hospital. So we're working on things like critical-noting solutions and back-office automation, where we’re using Alfresco to help us get rid of the paper.
To provide some sense of the scale of the problem, Mathias says his trust has about 15 people working full-time and scanning paper documents at the moment. These workers would need to continue this process for 22 years in order to scan all the existing paperwork and patient records:
So we have to rethink how we're going to do that. We need to make the data available, so that’s about related security and data-warehouse developments. And then we need to focus on sharing the data because, if we're going to become an information-led hospital, then I need to find a way to share this data out.”
Mathias suggests that the way he tends to look at this information management challenge is to think about the various components that would help to create a vision of the perfect, patient-centred hospital:
When a patient comes in, the information follows them – it then goes to the cloud. That would enable a virtual case management tool, which means that the patient can then feed information back into the system; they can then book appointments, get reminders, monitor themselves, and pre-empt tests. All of that can happen, that's what we're aiming for and that's our utopia. It’s where we're trying to get to from a patient perspective.
Mathias explains that clinical requirements for data are different, because each speciality within the hospital has its own requirements and consultant need a specific view of data that helps explain patient needs. Executives in the trust, meanwhile, will using data to analyse broader public health and to consider the overall view of the hospital. Mathias said he believes data has four use cases: clinical decisions, information management, governance arrangements, and personal access for self-service, particularly in terms of patient care:
Essentially, we're trying to get people to do the right thing at the right time. So in terms of for my strategy moving forward, the reason we ended up buying Alfresco is because it gives me flexibility and provides the platform to look after data, to create more data and then to manage that data.
Mathias's team is using tools to scan paper across the trust and then turn the information in these documents into structured data. That structured data can then be used around the organisation and can be used to help shape future care across the Northamptonshire region.
Using data to create better healthcare outcomes
When it comes to potential benefits of digitisation, Mathias focuses on how structured data could be used to improve processes in operational areas, such as Elective Pathway Management (EPM). He explained how an elective appointment is one where a patient goes to the hospital for a non-emergency condition. Mathias explains that specific rules govern the EPM process – patients should be seen and treated within an 18-week timeframe: six weeks to see the doctor, six weeks to see get their tests done, and six weeks to receive their treatment:
That's the perfect treatment. But you've got many different specialties and there's many different potential problems. And this is causing a problem for the whole trust because we’ve got to get our performance right.
He points out that a series of issues – such as non-arrivals, patients being referred to other hospitals, or a requirement to see another consultant – can affect that 18-week timeline. It’s crucial the trust can keep a track on patients and ensure targets are met, both in terms of governance and healthcare:
We don't want someone to be forgotten. Our challenge is to make sure we have the best pathway for the patient, and that we’re accurate.
The trust also needs to be aware of the reasons why patients might not be seen within the 18-week timeframe. So the team has built a tool within Alfresco to filter potential factors and to discover the top reasons for potential delays:
What we essentially want is the clinical software to provide one version of the truth. We’re pulling the information we have into Alfresco, using some SQL queries over the top of that report, and giving that as a top-level view to our staff. Our staff then look at it, check everything’s been validated and look at whether there’s potentially better pathways. They'll then update the status and that data feeds back into the clinical system.
This iterative approach to elective processes helps clinical staff to have a much greater awareness of potential challenges within the healthcare system. With 300,000 outpatient appointments to manage each year, Mathias said the hope is that digitisation will help ensure better healthcare for patients:
We've got ways of tracking the actions taken and getting feedback, so that I can performance-manage the staff and get good data through. Because in order for me to create an information-led hospital, I need good quality data – I need people doing this right. We all want better healthcare outcomes.