Features: June 21st, 2013

Tim Kelsey’s challenge to the NHS to deliver paper-free referrals by 2015 has been sanctioned by Health Secretary, Jeremy Hunt’s announcement that the NHS will be paperless by 2018. Recently, HIMSS Analytics has introduced the first Electronic Medical Records Adoption Model for Europe, which tracks an organisation’s progress to a fully electronic patient record. Steve Rudland, Healthcare Industry Manager at Hyland Software UK, discusses how hospitals can measure their progress towards paper-free patient care and the benefits that can be achieved.

Technology that delivers the right information, about the right patient, to the right clinician, at the right time is crucial to transform healthcare services. Most organisations will progress through various hybrid states as they move towards a paper-free electronic patient record (EPR).  However, up until this year, the only model for measuring the degree to which a facility was paper-free was the US-oriented HIMSS Electronic Medical Record Adoption Model (EMRAM). Although a number of European sites have embraced the model, it hasn’t been widely adopted because it isn’t relevant to the European experience.

Now, to understand the level of electronic medical record (EMR) capabilities in European healthcare, the Healthcare Information and Management Systems Society (HIMSS) has developed a European EMRAM based on the version it established in the US and Canada. As a result, European institutions can now identify their level of EMR capabilities, ranging from limited ancillary department systems (Stage 1) through to a paper-free EMR environment (Stage 7). Having such a measure in place makes it possible for NHS hospitals to assess how close they are to being paper-free in the run up to being paperless by 2018.

Achieving Stage 7, gives a hospital full control of its information regardless of its source or the repository that it resides in. Because they have full control of their information, Stage 7 hospitals realise improvement in their processes, streamlining operations and improving patient care. Full control of information also facilitates information sharing between institutions and this improves patient safety and clinical outcomes.

Adoption of the HIMSS EMRAM plays a beneficial role in NHS globalisation plans. If the NHS wishes to offer services globally, it needs to accept some global measures. The EMRAM is a global measure that aligns not only with the NHS domestic mandate to be paper-free, but also with its global ambitions.

Achieving Stage 7 

The process of becoming paper-free is a firm commitment.  Stages 1-5 of the EMRAM require a self-audit and focus on the implementation of suitable software. Stages 6 and 7 have an emphasis on how the software is being used to improve processes. Achievement of Stage 7 is subject to an on-site visit carried out by HIMSS to assess these processes.

To complete Stage 7, hospitals must meet a number of specific requirements, such as not using any paper charts and ensuring that 90 per cent of all clinician orders are made digitally. In addition, all critical documents must be imported or scanned into the system and available for viewing within 24 hours, while all non-critical documents must be scanned within 72 hours.

Moving forward with ECM  

Even with the most sophisticated EPR systems, at least 25 per cent of the information relating to a patient still lives outside of the EPR – on paper, in messaging systems or on other fileservers. To achieve Stage 7 and reap the benefits of moving to EPR, healthcare organisations should consider the implementation of an enterprise content management (ECM) solution. An ECM system provides a repository for all unstructured information, integrated with the EPR. This would deliver clinicians with a complete view of all patient information, without them having to leave the EPR.

Once a hospital has all of its information under control, its ability to improve clinical and business processes dramatically increases. Referrals, admissions, multi-disciplinary team processes, coding, billing and  subject access requests, all benefit from the automation and monitoring that an electronic document workflow brings.

It’s easy to shrug and say that a hospital will never be paper-free but it’s clearly a key priority for government and it’s not only possible with ECM, it’s being achieved around the world and measured via HIMSS. With a relevant EMRAM in place, NHS and other European hospitals have the perfect opportunity to drive industry standards, improve quality of care and patient satisfaction, while streamlining workflows and increasing efficiency.