Dutch hospital embarks on long-term digital archive project

The advantages of digital medical records are well known: Electronic archives are more easily searchable than paper files, they take up far less physical space, and individual reports are unlikely to get misfiled or simply lost. The benefits seem so impressive that one hospital in the Netherlands has decided to digitize its entire 30-year archive of hard-copy medical records.

Academisch Ziekenhuis Maastricht (AZM), a 715-bed teaching and research hospital linked to Maastricht University, currently operates with a mixture of hard- and soft-copy patient records. Between 70% and 80% of radiological images are produced in digital format and stored on a PACS, according to Huub Mulders, medical administration manager at AZM.

An additional 1.13 million paper- and film-based clinical patient records, comprising past imaging exams, lab results, and doctors' notes, occupy 9 km of running archive space, however. Hospital staff will be working from now until 2007 to completely digitize the back files, using two high-volume scanners.

"It is certainly going to be labor-intensive," Mulders said. "We will have to prepare all the medical records by hand for scanning. Any iron clips have to be removed, and the pages have to be flat. It takes time to sort the different components and do to this for every record."

Newly digitized records will then be accessible through a Web-based archiving and retrieval solution. This system will remain separate from the PACS archive at first, though searching access will be offered hospital-wide once sufficient records have been digitized.

"The digital archive will constitute a major contribution to the realization of a full-blown electronic patient record," Mulders said.

Data digitization will also help the hospital meet legal requirements on medical record storage. Because the hospital is an academic institution, it is bound by the Dutch medical treatment act (WGBO) to hold any records related to research for 10 years. Patients undergoing treatment for certain illnesses can have their files held for longer, and a small number of documents from all clinical research records must be held for 115 years.

The Dutch Parliament is considering plans to raise the standard 10-year holding period, according to Mulders. A change to 20 or 25 years, for example, could have significant impact on storage costs and space constraints in academic hospitals that are working with 10-year hard-copy archives at present. Digital filing will also make it easier to find records that are old enough to be discarded, Mulders said.

"Our hospital board has been brave to adopt this solution now, but it will be compensated by the rewards," he said. "We are probably the first to do this, but we won't be the last. I expect this will eventually happen in all hospitals like ours. It is only a matter of time."