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Tips for digitising your patient notes

Dr Neil Paul relates his practice's experience of scanning patient notes into its computer system and highlights a new service that is now available.

How much valuable space are medical records using at your practice? (Image: iStock)
How much valuable space are medical records using at your practice? (Image: iStock)

I recently visited a local practice's new branch surgery for a look around. A modern design on a council estate next to a couple of other new buildings, it looked very nice and clean.

It has dedicated free parking and, despite being in a rougher area, it did not look like Fort Knox.

During the tour I was proudly shown a massive room upstairs at the back of the surgery with special archive-style bookcases that wind backwards and forwards for paper medical notes.

This records storage system had needed a specially strengthened floor, but the GP partner showing me around was pleased with it as it had freed up a lot of space at his main surgery. We discussed how nice it would be if we could get rid of paper medical records altogether.

Digital storage

At our practice we have 'digitised' our paper notes which are currently stored in the roof space and which we are now planning to store off site.

When we moved into our premises some eight years ago, we had a big notes room in the middle of our clinical area.

Despite moving into the biggest building possible at the time, after two years or so we decided more space and more consulting rooms were needed. The only place we could expand into was the notes room.

We looked at various solutions and came across a company willing to digitise our notes. For an extra fee they would summarise any notes we hadn’t already summarised.

We had an interesting time. The company brought a van that was parked outside the surgery for about two weeks.Their staff all had to sign our confidentiality agreements and had been vetted appropriately.

They were lead by an ex-sergeant major who was very impressive and they had an amazing production line going. Boxes of notes went out to the van. The notes were taken out of their envelopes, sorted into sections and left to flatten for a time.

The company used an industrial-sized scanner to copy the notes into our clinical system and the quality of the scanned notes was impressive.

The team then vacuum-sealed the now unfolded notes in plastic wrappers and gave them back to us. We filed them in the loft freeing up the notes room, which has become three consulting rooms and a mini common room.

Sealed packets

The images were scanned onto Docman in a special archive folder.

It all went very well. The biggest problem was that some of our doctors found it really difficult to stop asking for the paper notes and breaking open the sealed packages.

The idea was that once sealed the packages shouldn’t be opened. I’m not sure if these doctors' problem was to do with inadequate training on how to use the Docman system or if it arose because the each set of notes had been scanned into one multipage file with no search function.

Over the years this need to look at the hard copies of notes has died down, which is why is seems sensible to move the paper records off site altogether.

UK-wide scanning service

Given our practice’s experience and the fact my wife’s practice is still using its paper notes, I was interested to hear of a new service offered to all GP practices in the UK.

Called e-LGS - the 'LG' refers to Lloyd George notes envelopes - the service was created through a partnership between St Helens & Knowsley NHS Trust’s Health Informatics Service (StHK HIS) and electronic document and records management software vendor, CCube Solutions.

For £3 a medical record e-LGS will scan your notes and store them off site for five years.Practices get access to the records through a web browser and each record is divided into sections.

For a 10,000 patient practice the cost is £30,000 to clear a space in your surgery.

However there may be some other benefits:

  • Solicitors wanting copies of notes can be dealt with much more efficiently – just print them off rather than photocopy them.
  • If you are filling in a report and want details from the past, you can log onto the website and find the answer.  no more waiting for a receptionist to find the envelope.

It is interesting that e-LGS does not actually destroy the original Lloyd George envelopes (although it does destroy their contents) but keeps the envelopes in storage.

However e-LGS does say that ‘some practices might actually want the physical records back once scanned. StHK HIS will work to accommodate specific requirements if possible.’

After five years the e-LGS will give you the all notes on a DVD if you do not want to pay for continued access online.

Tips for digitisng patient notes

If freeing up space is the main reason for digitising patients’ notes and, whether the practice does this itself or pays a scanning service, it is sensible to consider the points below.

Tips for digitisng records
  • Consider how long have you been fully computerised (the longer the better). Do you scan letters now? If so, do you file them in the notes? If so you will be wasting money scanning them again.

  • Is it worth culling the notes before scanning them? The time taken to do it seems to outweigh the benefit so I would just scan the lot.

  • Check the quality of scanning by doing random checks, especially on flimsy sheets and on non-standard sized pieces of paper.

  • Make sure the note removal and scanning procedure is as secure and confidential as possible. Think how embarrassing would it to be if a ‘lost’ box of your practice’s notes was found in a public place and this was reported in the national media.

  • Invest in making sure your clinicians and admin team know how to access the old notes without requesting the paper ones and wasting expensive time.

  • Speak to practices that have already digitised notes for other tips and advice.

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