In January 2013, the Trust sent over 18,000 patient letters electronically using Docman Hub. The Trust is now sending Discharge Summaries from A&E and Outpatient departments electronically with an aim to integrate further clinical correspondence through Docman Hub and increase the volume of documents that will be sent electronically.
Streamlining the transfer of information
The primary function of the medical discharge summary is to support the continuity of care as the patient returns to the care of the primary care provider. St Helens and Knowsley Teaching Hospitals NHS Trust previously generated approximately 7000 medical discharges per month utilising a paper-based, manual process. Approximately 85% of paper medical discharge summaries are for patients registered to St. Helens, Halton and Knowsley GPs.
Delivery of a paper letter can be time consuming to process and transfer to a GP practice. The process often takes days; however, by utilising an electronic system, a streamlined process enables the seamless transfer of patient letters electronically between organisations without putting patient care on hold, resulting in a seamless and immediate transfer of a patient’s care.
Safer and improved delivery of GP correspondence
The objectives of the Docman Hub project were for the delivery of the electronic discharge summaries containing clear, concise and legible information to GPs to lead to safer and improved continuity of care between secondary and primary providers. The discharge is distributed to GPs with a comprehensive audit trail with the knowledge that every letter can be tracked and confirmed delivery.
It is accepted the legibility of the information recorded on the paper discharge summary, specifically the ‘To Take Out’ (TTO), discharge medications data was of an inconsistent quality due to the hand written nature and manual amendments to the original information.
The approach at the Trust is that the electronic discharge summary becomes a live document from the moment the patient is admitted to hospital. The development of a comprehensive electronic discharge template which is used across the Trust for in-patient discharge is designed to ensure that GPs receive appropriate information in a timely and secure manner.
- GPs, patients and carers have, over many years, expressed discontent about the generally poor quality of paper discharge summaries. In order to address this problem, a standardised electronic Discharge summary has been developed.
- The electronic discharge summary ensures comprehensive and consistent information based upon guidance from the Academy of Royal Colleges and tailored for speciality specific input, and is delivered to GPs in a timely manner.
- The deployment of ICE eDischarge commenced in late December with appropriate training and user support as required.
- The initial rollout focused on Medical and Surgical inpatient wards, moving onto deployment in associated assessment areas across Whiston and St. Helens hospitals.
- eDischarge summaries will be applicable to inpatient discharge, transfers and deceased patients.
A paper process is time consuming and costly
Sending the discharge summary using a postal system means the Trust needs to print, manually handle the letter, transport it, insert into an envelope, frank and transport the letter to a mail room. The cost of sending a paper letter is between 50p and £1 per letter and incurs a process of up to 1 minute per letter to manually handle the letter before it reaches the courier service.
Distribution of poor quality data to Primary Care may lead to:
- Serious incidents occurring
- Staff and patients being put at risk through invalid or incorrect decisions being made about a patient’s care
- Loss of confidence in the validity of the recorded information
- Adverse results from the Healthcare Commission through the Annual Health Check.
- Poor management decisions within or about the Trust
- Loss of income to the Trust (through payment-by-results)
Docman Hub is a multi-directional document transfer platform that provides a secure, reliable and flexible platform for the electronic communication of documentation between secondary, primary and social care providers.
Docman Hub captures documents from Secondary Care systems and distributes them to GP practices.
Docman Hub is one of the most commonly used solutions for sending and receiving electronic patient letters directly to and from GP practices. Practices using Docman receive electronic documents directly from the Hub into
Docman’s workflow engine. The benefits include no requirement for scanning, auto-patient matching, pre-populated filing fields and significantly improved document processing time.
Docman GP provides a complete electronic document management, messaging and workflow solution for over 6,000 GP practices. Docman simplifies workflow processes by easily presenting electronic letters in front of individuals to review, comment, highlight or note simple actions. GPs will spend less time on administrative tasks, whilst being able to access information from any computer in the practice and be up to date with a patient’s record instantly.
Sending letters electronically
The point at which a patient’s care transfers from a hospital to their GP is critical, with clear advantages in being able to send patient discharge summaries electronically during the handover. Sending the discharge summary electronically has obvious benefits – both in terms of the timely transfer of this essential information, as well as minimising re-keying of information and thus the possibility for errors to arise, ultimately resulting in safer care for patients.
This describes the key business benefits that will be derived as part of the delivery of this project are listed below:
- Distribution of eDischarges for all inpatients who are registered to St. Helens, Halton and Knowsley GPs and are treated in St.Helens and Whiston hospitals
- Provision of a structured, consistent and comprehensive format for data entry based upon Academy of Royal Colleges and Department of Health and Connecting for Health guidance
- Integration with core Trust systems permitting data to be automatically populated into the eDischarge summary
- Permits the monitoring of the status of all eDischarge summaries
- Eliminates the need for completion of a hardcopy discharge summary
- Contains clear and legible information
Wider benefits include:
- Timely delivery of inpatient clinical information to GPs
- Improved quality of clinical information to GPs
- Increased GP awareness of patients being treated/admitted to hospital
- Safer and more efficient transfer of a patient care between providers
- Time saving efficiencies by eliminating the paper process
- Cost savings, i.e. no need for paper/forms/postage/envelopes
Neil Darvill, Director of Informatics at the Trust explains “The aim of the project was to automate the process of sending documents to practices and to transfer information in a speedy way. Before Docman we had a mixed economy of how practices managed paper in their practice, but with Docman the process is now consistent and streamlined.”
“Interoperability was a key driver for us in the project, transmitting timely information to GPs from providers directly in to their workflow process in Docman. Following a roll-out of Docman a few years ago with GPs in the area liking the solution it was a sensible approach to introduce Docman Hub.”
“By delivering documents in to Docman it removes the scanning process, practices benefit from pre-populate filing fields and the document is sharply workflowed. A practice can also electronically summarise and code the letter to ensure data quality through a simple process.”
“Outpatient letters from the local hospital and A&E information is being sent and we are rolling out discharge summaries. We are working with the local community trust to send even more documents electronically to GP practices.”
“Feedback from practices is very positive with information being received within 24 hours after an event. A paper process could take two weeks, the document would need to be scanned in and only then it would be available for the GP. By using an electronic process the information is received in a clear format and not handwritten notes. The project has been part of improving communication to the audience and making a positive change to all stakeholders.”
“A letter sent through the post could be received 3 to 4 weeks after an event and then it would need to be manually handled by someone to process. This involved various processes and these interim steps have either been removed or have been significantly reduced by implementing an electronic process. This creates a process that is secure, efficient and ensures data quality, all vital elements when dealing with the care of a patient. A practice can reject a letter received in error, so that the document can go back to the source straight away to be dealt with, where a paper process would cause huge delay. By receiving information electronically, GPs receive the information they need in a timely way allowing them to deliver more efficient continuous care for a patient by having the information readily at their fingertips. An electronic process can also assist practices plot trends, for example patients attending A&E.”
“We aim to expand the project to community care providers, the 111 service and Out of Hours services so that we can deliver as much information electronically as possible. This provides an evolution to the project and improves the granularity to become paper free.”