When I visited Dumfries and Galloway in 1999, information technology was described as “a black hole.” The hospital didn’t have electronic records and people struggled to access the internet. Now it has what may be the best electronic record system in Scotland.
Doctors, nurses, and others in the hospitals in the region can access the full hospital records of their patients. Unlike other hospitals in Scotland, all of the paper records have been scanned and entered into the electronic records. “This can mean scrolling through pages and pages,” one doctor told me.
The health board paid for the scanning because it means that they can do without the need to store records in the new building—a saving of about £1.2 million. It has also saved on staff costs: people no longer need to shift paper records around the building. (Old records cannot yet be destroyed completely because of the potential need to investigate old abuses—like the sexual abuse of patients that occurred in some English hospitals.)
Doctors, nurses, and others enter new information into the records in three main ways. Firstly, doctors dictate discharge letters and letters after outpatient appointments, and then they are typed by secretaries and put into the record and sent straight to GPs once authorised by the doctors. (The hospital has experimented with voice recognition but isn’t ready to introduce it yet.) Secondly, doctors and others can type notes straight into the record. Thirdly, doctors can write and draw notes on standard sheets that through barcodes identify them, and these are then scanned and entered into the record.
Currently, the hospital are scanning 25 000 pieces of paper a day. The plan is to produce standardised, electronic forms for all types of care: so far one has been produced for colposcopy.
The IT department has had to stitch together some 247 different databases to produce its record system, but Graham Gault, the IT director, thinks it much more sensible to do this than try and replace them with one grand system—as went so badly wrong in England. People have evolved those databases to meet their needs, so it makes no sense to try and replace them. Scotland has used a portal system to connect different databases, and eventually health workers in one board should be able to access records from other boards.
Data are stored on servers in the new hospital and the health board headquarters linked by fibreoptic cables. The health board shares servers with the council, halving the cost. Eventually, data will be stored in the cloud (as is data from Amazon, Apple, Google, etc), but the NHS is not yet ready for that, worrying about patient data being out of its control.
Dumfries and Galloway does use some telecare for consultations with diabetic patients in Stranraer, but it hopes to make much greater use of patients consulting online.
Patients currently don’t have access to their records, but the Scottish government has promised that they will do by 2020.
Richard Smith was the editor of The BMJ until 2004.
Competing interests: None declared.