EHI focus on: EDT Hub in Salford

Daniel Alexander and Dr Owain Thomas.

“It’s very easy to say you want to send things electronically,” says NHS Salford IT project manager Daniel Alexander. The difficult part is making it happen.

But despite some “technical difficulties” - and a few IT-resistant GPs - the city’s primary care trust has managed to get a good way towards making its paperless dream a reality.

Meeting targets

Initially, primary and secondary care organisations in Salford needed to find a way to meet government targets for discharge summaries to be sent to GPs.

In April 2010, the target reduced from 72 to 24 hours, and the previous November NHS Salford and the Salford Royal NHS Foundation Trust turned to PCTI’s EDT Hub to send the summaries electronically.

Two years on, 47 of the 51 practices in the NHS Salford area are using PCTI’s Docman electronic document management system and connected to the hub; with the final four due to come online in the next few months. More than 32,000 discharge summaries have been sent electronically so far.

Plans are also well underway to have all clinical letters delivered via the EDT Hub, instead of the post. A trial of letters being sent from the hospital’s renal unit started in October and all departments that use Medisec software are due to go-live by April next year.

That represents a huge chunk of practices’ workloads, as Salford GPs receive 80% of their correspondence from Salford Royal. The two organisations often collaborate on IT projects and share the ongoing costs of the hub project.

Getting systems in use

GP IT clinical lead for Hundreds Health Consortia, Dr Owain Thomas, says convincing 150-200 GPs of the benefits of electronic document delivery was not always easy. As with anywhere else, Salford GPs were at varying stages of their career and had different levels of IT acceptance.

“Having doctors reading letters on their computers rather than on paper is quite a big culture change for some people; there are huge benefits, but it’s taken some time for people to come around,” he says.

When the project began, Docman was installed in 80% of Salford practices. But Alexander visited every one individually and discovered that some were not usingthe document management system to its full capacity.

The PCT decided to take up another PCTI product, iWorkflow, that allows practices to set rules about how Docman delivers documents around the practice.

This provided the necessary encouragement to get all practices signed up to the hub project. The workflow system allows GPs to do in one or two presses of a button what would previously have taken nine or ten steps.

“With 95% of documents I can now just press one or two buttons,” Dr Thomas says. “It simplifies [document management] so it has helped get 100% coverage for the hub.”

Paper copies of records continued to be sent after the full practice roll-out in November 2010 until May this year.

“That really answered a lot of the concerns that practices had about this being a novel way of doing it. People saw there weren’t discrepancies between what they got in paper and electronic form,” Dr Thomas explains. “It’s quite amazing how reliant we are already on it.”

He estimates that his practice still receives about 150 letters a day through the postal system, in comparison to between 15 and 20 discharge summaries electronically. Within three to four months, though, it will only be letters from outside the Salford area that arrive in the post.

Time and cost savings

Alexander explains that for those hospital departments that don’t use Medisec, PCTI software called Print Capture is being installed. This allows any users on the N3 network to generate correspondence and reports electronically which can then be sent via the hub.

He says the eventual aim is to link in with the Greater Manchester Electronic Clinical Correspondence Project so that non-Salford patients can also have electronic documents sent directly to their practice.

Currently, the hub recognises if the patient is registered in Salford and sends it to the appropriate practice. If they are not registered, a copy is printed off and posted.

Those distributed to Docman-EDT enabled practices can be directly filed into the GP clinical system.The receiving system recognises Read codes and diagnoses. It highlights so users can decide whether to input the information into the record.

Dr Thomas says the time savings of the electronic system are very real for GPs. He adds that as the demands on administrative staff and GPs are exponentially increasing, this leaves staff better able to cope with their increasing workload.

Patient care and safety improves because discharge summaries are now arriving at the right practice within a reasonable time and are not getting lost on the way. Another key benefit is that GPs are now alerted if there is a change made to the summary such as a prescription being altered.

“It was really important to all of us that we did this as well as we could and did it not just to tick boxes, but to get a system that we were all happy with and was as good as it could be,” he concludes.

PCTI now has EDT Hubs installed at 54 sites around the UK. Salford was the third or fourth to take the system on and Alexander has given three talks around Englandabout how they implemented it.

“I think a few people are quite envious because we have a system that works and delivers at the end of the day, whereas others are still scratching their heads about what direction to take,” he says.