This is of significant operational and clinical importance to the health board given EDRMS has become the primary database for all patient information. It is heavily used every day by over 5,000 registered users and, to date, contains in excess of 13.5 million documents for circa 1.2 million patients.
One of 14 regional health boards in Scotland, NHS Forth Valley provides healthcare to a population of more than 300,000 people in central Scotland - an area covering Clackmannanshire, Falkirk and Stirling. It employs around 8,000 staff in total.
In terms of implementing an overall electronic patient record (EPR) for the organisation to meet its ‘paper lite’ and digital transformation goals, NHS Forth Valley’s strategy has involved integrating numerous specialist IT systems and using a clinical portal to provide clinicians and other health professionals easy access. EDRMS sits at the heart of this as the overall patient records store, holding both scanned and ‘born’ electronic information which underpins a variety of clinical services.
NHS Forth Valley is a long term customer of CCube Solutions dating back 16 years. The upgrade project started during the Coronavirus pandemic and was recently completed.
Anne Fielding, NHS Forth Valley’s EDMS project team leader, explains, “Covid obviously delayed our progress, but we’re now fully operational with version 4. We love the system - it’s so easy to use, offers various tools for managing documents and the reliability and speed of presenting larger documents via a browser is better. CCube Solutions has also been very responsive to tailoring EDRMS to how we want to work.”
To complete the EDRMS update to version 4 ,all data had to be migrated to fit the new platform architecture which is fully web-based, supporting documentation written, users trained and some IT infrastructure upgraded.
EDRMS version 4 delivers a variety of key benefits
Role-based access. The right digitised health records are available at the touch of a button to staff at any time based on their job function and how they like to work.
Vijay Magon, CCube Solutions’ managing director, says, “Essentially, we’ve put a lot of effort with version 4 to empower users so they have a wider choice in terms of how they use the system. They can really configure it to suit their own needs and the information they want to see.” For example, a clinician in an outpatient’s department will likely want the system set up so a dashboard is presented showing them which patients are scheduled and their chronological order. They then just have to click on the individual and the patient record launches. A secretary may be more interested in seeing the last referral letters when they login. The system can easily be changed so this is displayed to them first.
Administrative staff will have other system requirements such as the ability to scan documents to a patient’s record, the merging and deleting of files, correcting data duplications and exporting information for GDPR and SAR 1 purposes. This can all be set up and tailored for them.
Different views of the record now offered. Users can also navigate a patient’s record in different ways depending on their requirements. For example, ‘case note view’ directly replicates the legacy physical paper notes with tabs used to divide each section or specialty. A new ‘timeline view’ has been introduced. This shows a patient’s journey through the health system and treatments given.
Extensive systems integration and interoperability capabilities. Given NHS Forth Valley uses a combination of best of breed systems to make up its overall EPR, system integration is fundamentally important. Utilising non-proprietary software standards, EDRMS version 4 comes with a number of document importers to facilitate this.
Fielding says, “EDRMS supports HL7 message interfaces and APIs 2 . This means patient information created in other systems or received via PDF can be automatically saved in the central EDRMS repository for clinicians to see in one place.”
For example, HL7 messaging technology is used to import information from systems such as SCI Store and TrakCare, the health board’s patient administration system, along with communications generated as part of the Scottish Digital Dermatology Appointments Service (DDAS).
Dr Fiona Craig, consultant dermatologist, explains, “We deal with a huge volume of patients. They’re asked to upload their own photos of their skin condition for a clinician to review prior to a virtual consultation. This is then stored in EDRMS once received, along with clinical notes. Both are then easily accessed by opening the clinical portal.”
Similarly, EDRMS is used to store SCI Gateway 3 messages received from around 50 GP surgeries in NHS Forth Valley’s catchment area. This helps streamline the GP to health board referral process.
Dr Jonathan Begley, a GP at Viewfield Medical Practice, Stirling, explains, “Once a patient is accepted by an acute speciality by phone, acute referral documentation from our EMIS system can be sent electronically to NHS Forth Valley. This information is saved directly to the patient’s electronic record which our secondary care colleagues then access. They open the clinical portal and click on the clinical communications tab which takes them straight into EDRMS. This replaces using email inboxes for specialities which large teams of rotating clinicians don‘t always have access to, such that it’s a pathway now embedded in general use - 450 referrals are made like this every month.”
In addition, during the Coronavirus pandemic, another system – EDT Hub for Docman – was used by NHS Forth Valley to share Covid test results stored in EDRMS back out to GPs, with meta data also provided so that this information could be easily imported into their EMIS systems.
Expanded scanning capacity. As part of the version 4 update, additional server-based capture scanning capabilities have been introduced to streamline the paper digitisation process for NHS Forth Valley. This includes the ability to scan both c0lour and black and white documents in one batch, along with features to improved quality assurance.
Magon concludes, “NHS Forth Valley is one of three health boards in Scotland we support, the other two being NHS Orkney and NHS Grampian. Our EDRMS enhances patient safety, improves clinical effectiveness, increases security and saves money. With the release of version 4, we’ve made it much easier for health professionals to use the software as they want rather than being tied to how the IT works. That’s demonstrably shown at NHS Forth Valley where EDRMS is now fundamentally important to deliver care at the point of need.”