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4/1/2013
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Can British Docs Give Up Envelopes As Storage?

New digitizing service threatens to send the Lloyd George envelope, a century-old record-keeping medium used by British family doctors, to that file cabinet in the sky.

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In 1911, a famous British Prime Minister, David Lloyd George, shepherded some of the U.K's first-ever public health insurance schemes into law. To help cope with the reforms, a special new form of information storage medium – the 5-inch-by-7-inch "Lloyd George" envelope -- was developed.

Rather amazingly 102 years on, many British local doctor surgeries and clinics still use the once-innovative manila envelope. British doctors now use many online systems while consulting patients, but many primary care facilities still keep the bulk of their information on paper.

It's time to lay the Lloyd Georges to rest, say proponents of more modern ways. "Lloyd Georges take up racks and racks of storage space right at the front of local NHS [national health service] offices that could and should be used for better purposes," said Neil Darvill, director of informatics at an NHS tech provider that says it's started to finally help British general practitioners retire all that paper.

[ Find out how a prominent UK cancer center is cutting down on paper. Read U.K. Cancer Doctors Stop Lugging Suitcases Of Documents. ]

Darvill works for St Helens & Knowsley Health Informatics Service, one of a small group of British health informatics shared service providers that work exclusively for NHS customers. His team is, for example, currently supplying IT products and support for six NHS organizations, encompassing 14,000 users at 155 sites.

St Helens has been working mainly with big hospitals so far, but now it's branching out, looking to offer a digitization service to turn all those manila Lloyd Georges into bits and bytes for local clinics as well, said Darvill, using electronic document management technology from CCube Solutions.

The new digitization service is called e-LGS, short for Electronic Lloyd George Records Service, a fully managed service to digitize, archive and host this form of paper patient records. The service extends what has been learned in successfully digitizing records in hospitals. It provides a pickup service of Lloyd George records by NHS-employed drivers, document scanning, secure data hosting, training and support, plus appropriate software licenses and quarterly records updates.

The promise: all the contents of the venerable Lloyd George envelope can be made available online for GPs and staff to view using a custom-developed portal, which digitally replicates the contents of the old paper record. The e-version even reproduces the four main sections of the format that doctors' staffs know and love: patient correspondence, continuation sheets, results and summary reports. The goal, said Darvill, is to free up space, improve efficiency, make patient information instantly available when required, and remove risk, all of which should add up to administration savings. Authorized users can access the portals using a standard browser on desktop PCs or laptops with broadband connectivity provided by the NHS National Network (N3) or via the NHS' so-called Community of Interest Networks.

The space the envelopes used to take up in doctors' offices now can be used as consulting rooms or a larger, more patient-friendly reception area, he noted. The quality of scanned records will be the same if not better than paper, said Darvill, whose service requires a designated member of a clinic's staff to approve a percentage of the records scanned prior to disposal. The service uses a waste disposal specialist authorized to shred confidential information to destroy the old records.

St Helens has signed up 85 surgeries so far in the Liverpool areas of Halton, Knowsley and St Helens. One, the Grove House Practice in Runcorn, says it is already turning its entire Lloyd George library of 13,000 legacy patient records into the new format. In total, the participating clinics treat 500,000 patients, which calls for digitizing approximately 28 million pages of text and will take about a year to complete, said Darville.

Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital The Right Health IT Priorities? issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)

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