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What do you do if you've got medical records stretching some 10 miles, taking up valuable NHS real estate over several hospital sites? You don't necessarily want to destroy them: even much older notes can contain vital clues to a patient's condition today and, in any case, you're creating new records all the time, which need to be housed and which contain information about patients that clinicians need.

The challenge for the NHS to capture the vast amount of intelligence from the paper documents and make it useful - at the same time as releasing vital space.

Aintree University Hospital Trust is one trust to take this on. "We had to find a way of managing what was a very large record store - we were going to have to build another building. and didn't have the capital to do that," says Mike Pearson, consultant physician and professor of clinical evaluation, "So we had to come up with another solution."

Aintree had its medical record library scanned by Capita TDS and, using advanced Optical Character Recognition (OCR) software, added intelligence to the data that was harvested. The medical records are now electronic, can be accessed by more than one clinician or coder at a time (within strict governance protocols), and have been customised so that the most useful documents can be retrieved within two or three clicks.

The OCR software has allowed the most commonly used forms for each specialty to be recognised and filed so that, for example, the clinician can view the latest echocardiogram and, importantly, can then look at it in context by examining the pages which succeed and precede it in the record. This, says Pearson, gives a sense of the record being in 3D rather than on a 2D screen. At Aintree, it's been a big success. It is also taking the trust towards the goal of, if not paperless by 2018, then certainly 'paper-lite'.

Scanning and digitising the paper record seems an obvious thing to do, but past attempts have faltered because the technology simply hasn't been up to it. Vijay Magon, managing director of CCube Solutions (developers of the software used at Aintree) has more than 20 years' experience in the electronic document management industry, so is deeply familiar with the challenges of moving away from 'paper-heavy': "To get a clinician to move away from paper, that record needs to be as complete as possible," he says. "In fact, what you have to provide is something that is better than paper. With recognition technology, you can get the software to make sense of the data trapped within the paper record. The key is making that information available quickly and easily, so that you don't have to leaf through pieces of paper: you don't have to search for a record, you don't have to navigate through endless pages, and you don't have to press too many buttons to get to the information you need."

High quality scanning is of course vital, as Neil Murphy, Kodak Alaris' UK sales manager for document imaging, explains: "Our scanners range from low to high volume, as was required on these CCube Solutions projects. But it's no good having that speed if it doesn't feed documents reliably - you don't want documents getting jammed up. Our scanners are designed to feed documents of different lengths and different thicknesses, and are very robust at high speeds."

Scanning just one set of notes can involve "normal" pieces of uniform A4 paper but can also include results of varying sizes and thickness and even lengthy documents such as an ECG tracing. Some can also be hard to read. "We're looking for maximum image quality," says Murphy.

He senses that the end of the National Programme for IT has led to an upsurge in interest in scanning and digitising records. "There's a lot more of this going on now that the national programme has effectively ended. Now there's the opportunity for individual trusts to find the solution that's right for them. People's needs vary, but these are exciting and interesting times, with great opportunities to improve things for clinicians and for patients."

It can also mean significant performance gains, says Jacqui Page, divisional general manager for surgery with Milton Keynes Hospital Foundation Trust. Ms. Page, who led the trust's move to digitise its entire patient records library, says the investment is already beginning to pay off in terms of patient safety and cost efficiencies.

One of the main benefits has been in ensuring that patients attending outpatients are always seen with their notes: "Like other trusts, our medical records retrieval rate was about 98 per cent - that meant that 15 to 20 patients a day were seen without notes or, on rare occasions, had to have their surgery cancelled. This has been a real transformational project and since it was put in place, there hasn't been a single patient cancelled because of no notes; that's a real achievement"

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