Tech mandate puts information management high on NHS agenda
Written by Louisa Wetton
Electronic patient records and digitised casualty admission cards can help Trusts meet NHS information management objectives and improve operational standards, says PHS Data Solutions managing director Anthony Pearlgood
The first Mandate between the Government and the NHS Commissioning Board has been published, setting out the ambitions for the Health Service over the next two years. From a technology standpoint, a key objective within the Mandate is to ensure that, by 2015, everyone will be able to book their GP appointments, order a repeat prescription and talk to their GP online.
This latest Mandate follows numerous other technology and data handling initiatives. These include The Nursing Technology Fund, aimed at supporting NHS staff with new technology paid for by a £100m allocation and the £260m NHS England ‘Safer Hospitals, Safer Wards’ Technology Fund, both of which were fully approved in December 2013.
A key aim of most of these initiatives is to support a move away from paper-based systems for patient notes and prescriptions towards integrated electronic care records and the development of e-prescribing and e-referral systems.
Improved care through better information management
In some hospitals, this shift towards digitisation of patient records is already underway, with the joint objectives of accelerating patient care, cutting waiting lists and enabling more straightforward information-sharing between departments. Crucially, the latest Mandate between the Government and the NHS Commissioning Board aims to prevent situations where patients have to repeat their medical history because the hospital does not have access to their records.
In addition, the technology underpinning the changes could help staff deliver a better quality of patient care. Specifically, it has the potential to reduce time spent trawling through patient notes and help get the correct insight to the relevant practitioner at the right time. This particular objective is a key aspect of Government policy aimed at ‘making the NHS more efficient and less bureaucratic.’
While digitisation will clearly have an important role to play in improving current document and records management processes in healthcare, the requirement to work with some legacy paper records will still remain.
When embarking on such wide-scale technology initiatives, a further challenge for healthcare professionals is that, while there is clearly a strong business case for electronic patient records, the challenge of moving away from largely paper-intensive processes may be daunting. According to data obtained from a recent Freedom of Information request currently, around 61 per cent of nurses still use handwritten notes, charts or verbal communication to share patient details, medication notes and discharge instructions.
Rather than replacing paper entirely, a ‘paper-lite’ system involving document scanning and classification technologies could therefore offer a less disruptive means of improving information management in healthcare. The scanning aspect of the technology digitises paper documents, eliminating the need to continually transport cumbersome files around hospitals.
Meanwhile, using easily-configured classification software to automatically read and classify paper records, clinicians and administrators can look back at specific correspondence or case areas within a pre-specified timeline, saving time and increasing access to information on an ad-hoc basis.
Used alongside an archiving solution, document classification software also guarantees that the correct retention and disposal policy can be quickly identified and data cleansing can be carried out on existing records. This approach ensures compliance, while further increasing the level of process automation.
Meanwhile, for those many documents which do not have to be physically retained, a secure on-site or off-site shredding service would ensure that confidential documents are disposed of in a controlled and fully-compliant way.
Efficient framework for casualty records
As part of the national programme for the rollout of electronic patient records, Trusts will also need to digitise casualty admissions cards. In turn, this will enable authorised users within the organisation to access records efficiently from any PC within the department.
For those yet to implement a Trust-wide electronic system, the introduction of a basic imaging and document retrieval can be an effective first step. This solution allows completed documentation to be scanned, indexed from pre-printed barcodes and stored in a document repository for easy future access.
If this retrieval solution is based on open standard technologies, the data can also easily be migrated at any future point – most likely when an organisation-wide solution is underway. This low-risk approach is therefore well-suited for Trusts piloting the use of scanning, or looking to make A&E administration more efficient, while at the same time finding cost savings.
In a busy NHS Trust, it’s unlikely that any single technology solution or records management can be seamlessly implemented with no disruption to practice. As such, instead of limiting choice to an in-house solution or a purely outsourced service, it can make more sense for Trusts to have the option to combine both approaches in order to meet the exact needs of the organisation.
By gradually automating document and records management processes and adapting them to suit the individual requirements of each Trust, time and cost-conscious healthcare providers will be better equipped to achieve the Government’s vision for a digitally-enabled healthcare service.
How UiPath robots are helping with the NHS backlog
The COVID-19 pandemic has caused many hospitals to have logistical nightmares, as backlogs of surgeries built up as a result of cancellations. The BMJ has estimated it will take the UK's National Health Service (NHS) a year and a half to recover.
However software robots can help, by automating computer-based processes such as replenishing inventory, managing patient bookings, and digitising patient files. Mark O’Connor, Public Sector Director for Ireland at UiPath, tells us how they deployed robots at Mater Hospital in Dublin, saving clinicians valuable time.
When Did Mater Hospital implement the software robots - was it specifically to address the challenges of the pandemic?
The need for automation at Mater Hospital pre-existed the pandemic but it was the onset of COVID-19 that got the team to turn to the technology and start introducing software robots into the workflow of doctors and nurses.
The pandemic placed an increased administrative strain on the Infection Prevention and Control (IPC) department at Mater Hospital in Dublin. To combat the problem and ensure that nurses could spend more time with their patients and less time on admin, the IPC deployed its first software robots in March 2020.
The IPC at Mater plans to continue using robots to manage data around drug resistant microbes such as MRSA once the COVID-19 crisis subsides.
What tasks do they perform?
In the IPC at Mater Hospital, software robots have taken the task of reporting COVID-19 test results. Pre-automation, the process created during the 2003 SARS outbreak required a clinician to log into the laboratory system, extract a disease code and then manually enter the results into a data platform. This was hugely time consuming, taking up to three hours of a nurse’s day.
UiPath software robots are now responsible for this task. They process the data in a fraction of the time, distributing patient results in minutes and consequently freeing up to 18 hours of each IPC nurse’s time each week, and up to 936 hours over the course of a year. As a result, the healthcare professionals can spend more time caring for their patients and less time on repetitive tasks and admin work.
Is there any possibility of error with software robots, compared to humans?
By nature, humans are prone to make mistakes, especially when working under pressure, under strict deadlines and while handling a large volume of data while performing repetitive tasks.
Once taught the process, software robots, on the other hand, will follow the same steps every time without the risk of the inevitable human error. Simply speaking, robots can perform data-intensive tasks more quickly and accurately than humans can.
Which members of staff benefit the most, and what can they do with the time saved?
In the case of Mater Hospital, the IPC unit has adopted a robot for every nurse approach. This means that every nurse in the department has access to a robot to help reduce the burden of their admin work. Rather than spending time entering test results, they can focus on the work that requires their human ingenuity, empathy and skill – taking care of their patients.
In other sectors, the story is no different. Every job will have some repetitive nature to it. Whether that be a finance department processing thousands of invoices a day or simply having to send one daily email. If a task is repetitive and data-intensive, the chances are that a software robot can help. Just like with the nurses in the IPC, these employees can then focus on handling exceptions and on work that requires decision making or creativity - the work that people enjoy doing.
How can software robots most benefit healthcare providers both during a pandemic and beyond?
When the COVID-19 outbreak hit, software robots were deployed to lessen the administrative strain healthcare professionals were facing and give them more time to care for an increased number of patients. With hospitals around the world at capacity, every moment with a patient counted.
Now, the NHS and other healthcare providers face a huge backlog of routine surgeries and procedures following cancellations during the pandemic. In the UK alone, 5 million people are waiting for treatment and it’s estimated that this could cause 6,400 excess deaths by the end of next year if the problem isn’t rectified.
Many healthcare organisations have now acquired the skills needed to deploy automation, therefore it will be easier for them to build more robots to respond to the backlog going forwards. Software robots that had been processing registrations at COVID test sites, for example, could now be taught how to schedule procedures, process patient details or even manage procurement and recruitment to help streamline the processes associated with the backlog. The possibilities are vast.
The technology, however, should not be considered a short-term, tactical and reactive solution that can be deployed in times of crisis. Automation has the power to solve systematic problems that healthcare providers face year-round. Hospital managers should consider the wider challenge of dealing with endless repetitive work that saps the energy of professionals and turns attention away from patient care and discuss how investing in a long-term automation project could help alleviate these issues.
How widely adopted is this technology in healthcare at the moment?
Automation was being used in healthcare around the world before the pandemic, but the COVID-19 outbreak has certainly accelerated the trend.
Automation’s reach is wide. From the NHS Shared Business Service in the UK to the Cleveland Clinic in the US and healthcare organisations in the likes of Norway, India and Canada, we see a huge range of healthcare providers deploying automation technology.
Many healthcare providers, however, are still in the early stages of their journeys or are just discovering automation’s potential because of the pandemic. I expect to see the deployment of software robots in healthcare grow over the coming years as its benefits continue to be realised globally.
How do you see this technology evolving in the future?
If one thing is certain, it’s that the technology will continue to evolve and grow over time – and I believe there will come a point in time when all processes that can be automated, will be automated. This is known as the fully automated enterprise.
By joining all automation projects into one enterprise-wide effort, the healthcare industry can tap into the full benefits of the technology. This will involve software robots becoming increasingly intelligent in order to reach and improve more processes. Integrating the capabilities of Artificial Intelligence and Machine Learning into automation, for example, will allow providers to reach non-rule-based processes too.
We are already seeing steps towards this being taken by NHS Shared Business Service, for example. The organisation, which provides non-clinical services to around two-thirds of all NHS provider trusts and every clinical commissioning organisation in the UK, is working to create an entire eco-system of robots. It believes that no automation should be looked at in isolation, but rather the technology should stretch across departments and functions. As such, inefficiencies in the care pathway can be significantly reduced, saving healthcare providers a substantial amount of time and money.