Making digital technology work for NHS Trusts – how logistics management is impacting on cost improvement programmes

Individual NHS trusts are under significant pressure to reduce costs whilst still improving the quality of care provided. Despite this, the medical records department – or Health Records Service (HRS) – often gets overlooked in a trust’s cost improvement programme (CIP)

Left largely unchanged for decades, the average HRS manages thousands of paper health records every day and, as such, instances of missing case notes are common. For this reason, many NHS trusts are turning to healthcare logistics management to improve processes, enhance patient experiences and give tighter control over paper-based records.

The challenges of manual tracking

Unreliable case note availability poses a direct threat to patient safety – missing notes lead to delayed or cancelled appointments. To mitigate this, trusts engage in the practice of records tracking.

Tracking is the recording of file locations – from secretaries and ward clerks to nursing staff and the HRS – in order to allow trust staff to locate files quickly. Historically, the tracking systems in place have lacked intuitive technology and often, haven’t supported the correct audit trails. For example, tracking files outside of the library is traditionally done via a manual check-out procedure which, as a tedious process, is often not performed at all. This has a significant impact on records clerks who are subsequently required to look through piles of records to find a specific patient file, not to mention nursing staff time spent locating files rather than being able to focus on patient care.

The method of filing records within hospital libraries can be cumbersome too. Many libraries use a sequential filing system which means that when files are returned, they must be checked in, pre-sorted and then inserted into their pre-designated place by put-away staff. This process can take an entire day.

Therefore, with significant financial and qualitative risks associated with continuing to operate the HRS in this way, what improvements can be made? Hospitals nationwide are exploring a transition to Electronic Document Management (EDM) in line with the Government’s goal of achieving a paperless NHS by 2020.

However, implementing an EDM solution is a big commitment, involving a two to three-year programme that costs in the region of £3 million and generates no savings until fully online. Therefore, whilst full digitalisation may be the ultimate goal for many NHS trusts, this huge investment with little immediate return often makes the project seem impossible for an institution trying to cut costs today.

Getting past failed and unaffordable EDM strategies

A key recommendation from the Carter Review for the Department of Health, which details how the NHS can save £5 billion, is that trusts should "aim to work in collaboration both with national procurement strategies and other trusts to explore common systems adoption, e.g. efficient electronic catalogues using retail system standards and adopting GS1".

Supporting this approach, iFIT™ (Intelligent File and Inventory Tracking) is Idox Health’s healthcare logistics management platform designed for hospitals. It is a process management tool that also utilises RFID technology to provide a breadcrumb trail for item movement, supporting a suite of pre-built automated processes specific to the management of hospital assets and health records. It is also currently the only application fully compliant with all GS1 keys as mandated by the National Health Service Executive.

Case notes are tagged with a Radio Frequency Identification (RFID) tag that carries a unique GS1 compliant number. RFID sensors on the premises then record which items were at that sensor location at that specific time. In areas not covered by fixed sensors, objects can be found and tracked to other locations using hand-held devices which work in a similar way to metal detectors.

HRS overheads have subsequently been dramatically reduced following rollout of iFIT™ technology, by: minimising the amount of time staff spend tracking, searching for and re-filing notes; eliminating pre-sorting with the introduction of Location-Based Filing; and releasing floor space in line with the recommendations of the Carter Review. In addition, an organisation pursuing a full EDM strategy can rely on iFIT™ to provide a full inventory of active and inactive case notes, identifying all – both physical and electronic – records and their current location.

Whilst iFIT™ is not a replacement for digitisation, it delivers significant efficiency savings by helping a trust identify which case notes should be scanned. These immediate savings enable trusts to create the necessary headroom in their budgets to implement EDM cost-effectively.

Cutting today’s operating costs to fund tomorrow’s requirements

Good logistics management drives tangible business benefits for a hospital.

Recently, Barking, Havering and Redbridge NHS Trust presented the results of their implementation of iFIT™. They reported achieving 85% of their business case in five months, with specific areas achieving a fivefold increase in efficiency. They were able to successfully reduce department overheads by automating labour-intensive processes, generating between 30% and 40% staff savings, as well as undertake statutory reporting, improve estate-wide tracking capabilities, release 20% of library space, and significantly reduce staff time engaged in filing and search activities. They also outlined additional benefits such as improved staff morale and reporting capabilities driving visibility and performance.

To date, iFIT™ is currently tracking more than 13 million live healthcare records across 12 sites.

Medical records management is just one example of healthcare logistics management. As a multi-purpose platform, iFIT™ has also been implemented to manage mobile hospital assets and is being further expanded to track pathology specimens, pharmaceuticals, supplies and hospital staff.

To find out more about iFIT™ and how it is supporting across the health sector, please visit the dedicated Idox Health solutions page.