Features

Digital case management: paper to pixels

20 March 2020

Senior matron Julie Plant explains how the children’s service in Wolverhampton ditched its 100% paper-based recording system and switched to digital case management.

The Royal Wolverhampton NHS Trust (RWT) is one of the largest healthcare providers in the Black Country and West Midlands, providing primary, secondary, community and tertiary care services to a combined population of 450,000 people. We are also one of the largest acute providers in the West Midlands.

RWT’s strategic direction over the next three years is driven by the fact that the health and care system needs to modernise in order to meet the needs of our communities and the wider population. As part of this, we continue to implement innovative solutions for improvement, and to ensure that our clients and wider communities continue to receive the highest levels of care.

Through working closely with health and social care partners, we hope to see greater community-based care. Services will be integrated and based on the principle of multidisciplinary working among health and care professionals, while clients will be supported to manage their own care. This approach will enable us to remove unnecessary duplication, and ensure resources are used effectively.

Always innovating

Through the collaboration and support of our staff, stakeholders and the communities with which we work, our greater community-based ambitions can be achieved. We also want clients to know that we are working tirelessly to deliver safe and clinically effective services to ensure they experience the highest standards of care.

To achieve this, we foster a culture that embraces innovation, and our 0 to 19 service is one of the latest examples. RWT’s 0 to 19 service includes health visiting, school nursing and the Partnering Families Team for pregnant women, children and young people and their families. Clinically, the services are provided by qualified health visitors, school nurses and midwives, and supported by a range of clinical and clerical colleagues.

As part of the new 0 to 19 service model, we recently turned our focus to case management. Case management processes are often manual and paper-based, which can lead to inefficiencies in data entry, security and storage space. These issues are exacerbated by inefficient systems, which are generally paper-based and cannot meet the demands placed upon them.


Staying private

Digital case management systems offer a heightened level of security over paper-based approaches, providing comprehensive role-based security, which allows different data access levels to be granted to different user types and teams.

We also have a policy for the safe storage of tablets by individuals: do not leave in car overnight or in an unlocked office, and so on.


Going digital

Our case management was, at the beginning of 2019, 100% paper-based. We subsequently made a clean break from using paper records by making the whole process digital, and bringing it in line with the NHS Long-term plan (NHS England, 2019).

Paper-based forms and loose paper created problems on a daily basis, and affected time available, the quality of data and ultimately the overall efficiency of the 0 to 19 service.

Paper recording also generated further implications around storage, security, and consistency of data, which resulted in impacts not only for us as practitioners, but also for management and the clients themselves.

Understanding the power of next-generation technology challenged our thinking and we’ve been able to recognise how technology can best support us. Moving to a cloud-based digital case management system has helped us respond to the changing environment, update the way in which we deliver the service, and change the way practitioners work.

We went from contract signature to live in less than six months with case management system ECLIPSE, produced by OLM.  

Practitioners across the 0 to 19 team were involved in the development of ECLIPSE with OLM. They put forward ideas to tailor the direction of development and help create a case management solution that worked for the team using it on a day-to-day basis, for example at OLM workshops.

Involving practitioners in this way is quite unique and, in our experience, this step should be a mandatory part of the process.

Tablets were assigned to individuals so all team members look after their own.

Taking this approach has ensured that it works for us. The electronic case management system does what we need and how we need it to. It also encouraged buy-in from our team, and they have been enthusiastic about using ECLIPSE from the start. Rather than seeing it as disrupting established ways of working, embarking on this project was viewed as a welcome step forward.

Complete collaboration

Data is now accurate and up to date. This is enhanced through multi-agency access, whereby all frontline services that have contact with the individual can add thoughts and observations; through collaboration and interoperability, we have a complete holistic view of children and young people.

Details such as the relationship of the client to family, friends, police and school can securely be added to the system. This has an impact on the quality of information, and reduces the possibilities of data error or duplication. All of this saves time and keeps our team up to date on each service users circumstances.

Each multidisciplinary team member has a unique login with a personalised screen based on their tasks and workflows. Data entry is much easier, and it has provided the ability to record in new ways. Our team is no longer confined to the office when updating notes, or locating information, as all the data is accessible in one place.

Holistic overview

We can now work from anywhere, writing notes directly into the system while with the individual, or from the office, the car, anywhere. This added flexibility has freed up staff time, allowing more time to be spent on the frontline with children, young people and their families.

We’ve also ensured that ECLIPSE is easily adaptable and we’re able to customise the system quickly and easily ourselves, allowing us to keep up with changes in legislation or best practice.

Such improvements to our working processes are an enormous step forward. We now have a holistic view of the children and young people using our service at the click of a button. We no longer need to dig out manual records stored in multiple locations because the team can access any record from a mobile device at any location.

By having remote access, our team is no longer confined to the office. This means that the data is more accurate and up to date, so multi-agency users are assured that they have the most current information.

Reporting is also provided in the system: for example, the number of smokers in a household. In the past, such reporting was a manual process in which each member of staff was asked to provide the relevant numbers. This practical saving means that all the data required to be able to do our jobs is in a single system.

One of the key improvements is time savings. By using new digital forms and new ways of working, we have secured efficiencies of up to 70 hours a day across the team. This equates to an additional 350 appointments each week.

Positive impacts

Travel is reduced through the mobile responsive nature of the case management solution. As notes can now be updated anywhere, at any time, up to 480 miles are being saved a day – causing a positive financial and environmental impact.

This has also resulted in between 6000 and 7000 additional appointments during the first five months of the go-live.

Each child’s contact with our new 0 to 19 service is now fully trackable, which enables us to focus on good outcomes for children and families. We are confident we can continue to secure further benefits as the project continues to expand, and our plan is to open it up to more practitioners this year.  

Julie Plant is senior matron, children’s services, The Royal Wolverhampton NHS Trust.


The digital benefits for 0 to 19 services

  • Removes all paper-based forms
  • Secures significant time-savings: 70 hours per day across the RWT team
  • Reduces travel time: 480 miles a day for the RWT team
  • Improves working process for practitioners
  • More accurate, up-to-date data
  • Greater collaboration with other organisations

Collective views of the team


Resources  


References

NHS England. (2019) NHS long-term plan. See: england.nhs.uk/long-term-plan (accessed 9 March 2020).

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