The Walton Centre is a major neuroscience NHS hospital located in Liverpool. It is the only standalone specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services. With the help of Apogee Corporation and its secure document scanning and data capture services, The Walton Centre has successfully digitised 95% (to date) of its patient records, with the remainder underway, leading to significant improvements in clinical efficiency, patient safety and staff deployment.
The background
Back in 2019, a Care Quality Commission (CQC) inspection highlighted The Walton Centre’s mix of paper and digital patient records as a clinical risk. The location of physical case notes was often not being tracked, therefore, it was difficult for clinicians to access complete patient information during appointments and when making important decisions about care.
Despite multiple internal attempts to transition fully to digital records, the trust encountered a number of logistical, technical and financial barriers. Concerns ranged from managing large-scale scanning to data governance and the potential inability to use the records effectively once digitised.
The use of physical records also presented space and compliance challenges. Accommodating new paper-based patient data was increasingly problematic. Records were stored across the site, including in unsafe areas such as corridors and loft spaces, which was identified as an increased fire risk. With the NHS Green Plan also pushing for paper-light operations by 2026 as part of a drive towards sustainable practices, the need for change was mounting.
The solution
In the latter half of 2023, the trust conducted a rigorous tender process and assessed four providers, during which Apogee stood out for its technical capabilities and flexible, collaborative approach. The Apogee team visited the site to understand the challenges first-hand, invested in a proof-of-concept project, demonstrating robust, secure management of sensitive patient records and ensuring the trust was comfortable with a potential partnership before any contracts were signed.
Benchmarked against the other providers, Apogee also scored highest in quality, cost, responsiveness and time-to-completion metrics.
After being awarded the contract, Apogee implemented a secure system to begin digitising The Walton Centre’s paper patient records. Each record was tracked from collection to scanning for full visibility. This process included securely boxing and barcoding physical records for real-time tracking of each box from site to a scanning centre. All scanned documents were then seamlessly integrated into the trust’s electronic patient record (EPR) system. Apogee’s skilled coding team created an audit trail for each document and conducted thorough quality assurance checks, while ensuring BS10008 compliance throughout.
Apogee supported both the digitisation of the trust’s medical records and the implementation of an in-house scanning facility incorporating both legacy and end of episode scanning, thereby delivering sustainability of digital patient records, while further enhancing the clinical user experience.
The new in-house scanning facility allows any new paper generated in the trust to be made available within the EPR within seven days of the patient’s discharge. Powered by AI and ML capabilities, this documentation is automatically catalogued and searchable, enabling clinicians to easily access patient medical information, saving them time and significantly improving the accuracy of medical processes.
“Due to previous tracking issues caused by the combination of physical and digital files, The Walton Centre team were understandably concerned about the potential consequences of case notes being transported across the country for scanning – particularly if they were needed at short-notice to support a patient, for example. Part of the proof-of-concept stage involved securely boxing and barcoding a set of eight records so they could be fully tracked at all times with supporting software. We implemented an audit trail at every stage to ensure peace of mind,” said Mark McManus, Regional Sales Director, Apogee Corporation.
Across the entire digitisation process, Apogee was able to reassure The Walton Centre that it was fully protecting patient data through its International Organisation for Standardisation (ISO) and British Standards (BS) accreditations. Apogee’s adherence to these standards encompasses all aspects of both physical and digital security in transit and at rest.
As McManus explained: “The first step is ensuring that we have the most up-to-date patient metadata and we do this by linking with the trust’s patient administration system (PAS) to ensure all paper records match the patient ID at every stage of the process”.
The outcome
Ninety-five percent of patient records have now been scanned and digitised. This has enabled clinicians to rapidly retrieve vital patient data, including medical histories, previous treatments and medical device information. Previously labour-intensive processes, like searching through paper files, are now streamlined, reducing admin workload, improving access to vital information and enhancing clinical safety.
This has allowed The Walton Centre to save so much time that it has enabled them to redeploy medical records staff to support other departments, contributing to enhanced operational efficiencies and a faster flow of patients into the hospital. By enabling patients to be seen faster and allowing clinicians to instantly draw on the latest up-to-date clinical records, the digitisation process has contributed to a better patient experience.
The move also supports NHS sustainability targets by reducing the need for paper document creation, and physical case note storage, helping the trust reach its goal of become ‘paper light’ by 2026 and increase the digital maturity of the organisation in line with the NHS Digital Strategy.
Equally, the digitisation process has helped free up space for vital staff facilities at the trust. The Walton Centre is now planning to repurpose one of its rooms previously used as storage into a communal staff room and it has also allowed the Trust to consider using previously occupied estate for growing services, such as thrombectomy stroke interventions.
Sam Holman, Head of Transformation and Corporate Operations at The Walton Centre NHS Foundation Trust, said: “Apogee has been an exceptional partner in our Digital Transformation journey. Their approach has been seamless and professional, and they’ve consistently demonstrated themselves to be more than just a supplier – they’re an integrated extension of our team. Due to the complexities of the digitalisation process and sheer volume of paper records we had within the trust, we were naturally nervous about undertaking this project. But whenever we’ve encountered challenges, Apogee has responded with expertise and commitment, providing solutions that have truly supported our operational objectives.“
The future
Following the digitisation of existing case records, The Walton Centre implemented a streamlined process for scanning new documents. Following scanning on-site, items are processed through a number of quality assurance checks, both internally and from Apogee, before moving into the EPR system.
Moving forward, Apogee will help the trust to track which documents are being scanned most frequently, such as PMP assessments or fluid balance charts and use that insight to prioritise which forms to digitise within the EPR next.
Looking further ahead, the project’s success has prompted additional digital initiatives across the trust, including the optimisation of nursing workflows based on Apogee’s solution. This ensures future Digital Transformations remain strategically aligned and patient-focused.
Holman spoke further about the partnership:
How has the digitisation of patient records impacted patient care outcomes or treatment times?
As an outstanding CQC Action from 2019, the clinical risk of having a patient record in numerous locations (paper and electronic) had been consistently raised with the Trust Board. Patients were often seen in clinic without the paper case note, either because it was either deemed as not needed or was inaccurately tracked in the system and not located in time., This meant clinicians frequently relied solely on the electronic patient record to make clinical decisions.
Digitising over 100,000 paper case notes has almost completely mitigated this risk. With all legacy paper case notes scanned, clinicians have full access to patient records for informed clinical decision making. This has reduced the risk rating score on the risk register, provided more assurance and improved access to patient records that was not there before.
The digitisation project also involved a full workforce review and staffing restructure. With libraries of case notes no longer required and maintenance and retrieval eliminated, staff were relocated to other services to address backlogs and other patient related outcomes. For instance, more staff were redeployed into The Walton Centre’s Patient Access Centre, reducing the referral registration backlog from 5,000 patients to on-the-day registration within just three months – a huge achievement and KPI not met since COVID-19 in 2020.
Clearing the registration backlog has enabled faster triage, earlier GP advice and onward care and reduced delays in directing to appropriate care pathways, without further administrative delays. One year on, this KPI has been maintained and patient communication complaint themes have declined.
How does the digitisation initiative align with The Walton Centre’s overall digital strategy?
‘Paper free’ has been prioritised as one of the organisation’s Strategic Priority Ambitions and aligns with The Walton Centre’s commitment to the wider Greener NHS ambition to be paper light by 2026. The NHS’s new 10-year plan also clearly states the move from ‘analogue to digital’ as one of its three core goals and deliverables to be achieved by 2035. The digitisation of paper records is a huge step forward in The Walton Centre’s plan to meet this target.
How did Apogee ensure compliance with NHS data governance standards, and what lessons were learned?
Prior to starting any work with Apogee, a full Data Protection Impact Assessment (DPIA) was completed to ensure that regulatory and Data Protection Toolkit compliance before signing any contracts. The DPIA followed The Walton Centre’s internal governance standards and frameworks and upon completion, Apogee proposed a full proof of concept to demonstrate their commitment to data security and assurance. This was carried out on seven patient files to ensure full visibility, auditability and quality assurance was obtained from collection to scanning – all before finalising contact.
Lessons were learnt throughout the journey, which kept the project evolving and changing. For example, it became clear that internal processes were needed to address patient misfiles that occurred prior to scanning, as clinicians required a way to digitally flag these and relocate files linked to the incorrect patient record.
What feedback have clinical and non-clinical staff given about the new digital access systems?
Clinical teams value not only having full access to the patient record, but having it categorised by case note section, just as it would be in a physical case note. This added functionality is enabled through the ‘day forward’ scanning process implemented and designed with Apogee. It allows for the consistent scanning of current records after the scanning of the ‘legacy backlog’ was completed.
Clinicians at The Walton Centre still rely on paper, as the Electronic Patient Record (EPR) has not yet digitised all forms that clinicians use on a day-to-day basis. To prevent new paper records and libraries from forming, an in-house ‘day forward’ process was created to scan newly generated paper records – designed with both clinicians and admin teams in mind.
Significant time was put spent identifying a catalogue of paper forms still in use, creating blank templates of each form and assigning naming conventions to categorise and allocate digital filing locations. These were then programmed into the scanning solution, allowing any scanned documents to be automatically named and filed without the need for input from admin teams. The beauty of this also means that clinicians can search the EPR for specific forms, without the need to scroll and search through documents.
The thorough preparation of the scanning processes has resulted in efficient admin processes and easier access for clinicians, with both groups sharing positive feedback.
