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Medical Matters

15 December 2006

Needing access to over one million records, how does Luton and Dunstable Hospital NHS Foundation they
manage to make sure that these records are out of sight, but not out of reach? It’s a major op for Harrow
Green as Paul Sharville found as he went behind the scenes

THE LUTON AND DUNSTABLE HOSPITAL NHS Foundation Trust (L&D) is responsible for well over one million healthcare documents – from patient records to dental impressions. A large number of these are stored offsite by Harrow Green’s records management division, and a single record could be needed back at A&E within ten minutes. Storing patient records and other hospital files is the sharp end of records management (RM). Comparing hospital RM to conventional business storage of things like leases, accounts and legal records is like comparing patient transport to an emergency paramedic unit. It’s a highly dynamic environment where the RM provider has to be instantly available, equipped for the job and quick off the mark.

In March Harrow Green was awarded a fouryear contract to manage the off-site storage requirements of the L&D. Last year, the L&D provided healthcare service for 71,000 inpatients and day case patients, 200,000 outpatients, 80,000 A&E patients, and 4,000 babies were born at the hospital. Every single one of them will have generated a hospital record that has to be kept for a minimum of eight years, as did the patients of the year before, the year before that, and so on. Children and maternity records have to be kept for twenty-five years, mental health notes and pathology records for thirty. Even those who have died must have their records kept for eight years.

The types of records are as varied as the patients, coming from every department in the hospital with some of them dating as far back as 1936. As well as general patient records, between them the L&D and Harrow Green store dental impressions, x-rays, theatre logs, fracture packs, maternity notes, A&E records and files from the L&D’s Obesity Research Centre.

To manage the stored inventory and delivery programme for the L&D, Harrow Green uses O’Neil’s RS-SQL product, a specialist RM software application with wireless mobile and web applications that can manage millions of records, including intake, work orders, real-time tracking, retrieval, delivery and invoicing. RSSQL’s primary interface is a unique barcode that holds an impressive amount of information on the record itself, the contract and the file-naming protocols of the individual client which, in L&D’s case, is the ubiquitous ‘hospital number’ solely referred to in every transaction.

Getting to records quickly, keeping track of them while in transit, and keeping the system fully updated is crucial to the L&D contract, given the records’ personal nature, irreplaceability and sometimes urgent status. RS-SQL is a highly accurate ‘fingerprinting’ system that delivers extremely fast ‘find and retrieve’ results, including automated ‘route planning’ that plots the shortest journey around a large warehouse to find dozens of unrelated files. RS-Mobile, another O’Neil product, provides point-to-point tracking via wireless handheld devices that scan each record at key stages of its journey and updates the central system along the way.

Cross referencing
One of the most powerful features of the system is its ability to deal with multiple storage protocols (for example, the different ways in which clients identify their own records) and still generate just one barcode that has built into it all of the necessary ‘translations’ to find a single record without any manual cross-referencing. On the L&D contract, Harrow Green had to migrate unique identifiers belonging to the previous supplier, get the system to translate them into Harrow Green’s identifier, cross-reference the two to provide the inventory information, and still be able to find the record instantly when the L&D quotes its unique hospital number.

“This is where RS-SQL proves itself as a heavyweight,” says Jez Tibbetts, National Quality and Compliance Manager for Harrow Green’s RM division. “It allows us to write our own queries for the migration of different filing systems and render disparate storage protocols immediately compatible and all speaking the same language. With the L&D contract, the system was put to the test on day one, when we had to get 750,000 records out of the previous supplier’s warehouse and into our own – and in the system – as quickly as possible.”

The migration took four months, but the majority of that time was spent on the physical collection: 2,500 records collected twice a day from the previous supplier’s warehouse. The automatic query processing that interrogated, manipulated and migrated the data from the previous provider to Harrow Green took just
three days.

Some elements of the transfer, however, could not be addressed by the available technology. A key feature of the contract is the ongoing annual uplift of records from the hospital’s own storage facility and its placement in Harrow Green’s warehouse. The hospital keeps records in house for two years, after which a full year’s worth of records are taken off site to make room for the latest year’s storage at the hospital. By the time Harrow Green was appointed, 30,000 records for 2004 were already overdue for uplift.

To make matters more complicated, the L&D stores all of its records under a ‘terminal digit filing system’ meaning that records are not stored in date order. “That was something we could only overcome with good old-fashioned methodical manpower,” says Jez Tibbetts. “We placed an operative at the hospital whose only job for three months was to hand pick each of the 30,000 records.”

Delivery schedule
At the heart of the service is a twice-daily delivery schedule to the hospital to drop off patient records that have become active because of an admission or outpatient visit. Harrow Green delivers around 200 patient records and other files every day, each of which is transacted through the O’Neil point-to-point system. ,Warehouse operatives and drivers each have their own handheld data units into which they enter confirmation of each step in the process, whereupon all of the data units and the central server are updated with the latest tracking information on the whereabouts of each record.

“This is where we put customer service right at the top of the list,” says Jez Tibbetts, “even, unfortunately, before the home and social lives of our team members. We fully understand and respect that this could be a life or death situation, so we need to respond accordingly. If the facility is closed, we can open up in fifteen minutes and have the file at the hospital in less than an hour. On one occasion, during working hours, we delivered a file to the L&D in eight minutes. This is where system and service become indivisible.”

When discussing modern RM, the headline grabber tends to be contract volume. What sets the Luton & Dunstable NHS Trust programme apart from other RM programmes is the amount of daily, sometimes hourly, activity demanded by the contract. Being able to respond to this when RM is normally quite a ‘slow moving’ event in terms of file requests and delivery schedules was a deciding factor during the procurement

Patients first
“Our RM service provider needs to recognise that, first and foremost, we are dealing with information on real people,” says Gillian Alloway, Health Records Service Manager at the L&D. “When a patient arrives at the hospital and needs our care and attention, it is my department’s responsibility to have their personal information available sometimes within minutes in the case of emergency admissions, even if that person hasn’t had any dealings with the hospital for several years. This is a fundamental, sometimes decisive aspect of good patient care. We can only do this with an off-site storage service that will instantly find and pick the right record from many thousands, delivered by a service commitment to get that record to the hospital in the shortest possible time.”

It is here that human service levels need to match the powerful O’Neil infrastructure. Jez Tibbetts comments: “The inventory management system is highly intelligent and robust. It will find a single record in seconds. But if it then takes two days to get that record to the client, the service has failed, despite the impressive backend that drives it. The O’Neil system was a relatively easy concept to sell. It’s a global standard used throughout RM. What we found ourselves focusing on were service-driven elements: managing the huge uplift from the previous provider, the regular uplift of records from the hospital, and most importantly the daily delivery and emergency provision. Not once did we suggest that the hospital compromise to match how we do things. If anything it was the other way round. O’Neil provides the accuracy and efficiency we need, but we won on how we shaped the service around what the Trust needed.”

“The migration from our previous supplier is almost complete, and that’s a great relief because now we can begin to see the service working to its full potential,” comments Gillian Alloway from the L&D. “From a client perspective, it’s just what the doctor ordered, as long as everyone remembers that when it comes to patient information, what the doctor orders, the doctor gets.”

Record Delivery: how it works
Step 1
Records requested by hospital via fax, email or phone
Step 2
System searched, files found, work order created
Step 3
Mobile unit loaded with ‘pick list’
Step 4
System plots shortest route around warehouse
Step 5
Records found and extracted
Step 6
Records scanned again, system updated
Step 7
Vehicle loaded
Step 8
Records delivered to hospital
Step 9
Records scanned, verified and handed over. Delivery complete

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