Medical Records is a Mess, What do We Do? John Thornbury

Medical Records is a Mess, What do
We Do?
John Thornbury
Director of ICT - Worcestershire
Health Informatics Service
My Background
z Clinical
Scientist – Medical
Microbiologist in Birmingham)
z Cancer
Research – at Aston University
z Information
Manager – Walsall
z Director
of informatics –
Walsall/Wolverhampton (ERDIP site)
z ICT
– Director of ICT Worcestershire
Worcestershire Acute Hospitals – essential facts
z
One of the Larger non-teaching Trust in England,
serving a population of more than 550,000
z
800+ beds on 3 main sites
z
Turnover £264 million in 2006/07, 5,500 wte staff
z
100,000 I/Ps, 400,000 O/Ps, 100,000 A+E attendances
z
Key Issues – PFI on one site!
z
Historical deficit - £30m
z
2008/9 efficiency saving £12m
Scope of Presentation
z Current
issues
z Options
available
z Benefits
of EDM
issues
z3
Trusts merged into one
z Little attention paid to records
management
z Just put together
z New PAS no de duplication
z Culture “keep hold of record or never see
again”
z Paper cashing notes i.e. never complete
Problems with Paper - Clinical
z
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z
z
z
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Misfiling of documents
Documents never filed
Records lost
Multiple records
Specialty notes
Time taken to find relevant
information
Problems with Paper - Security
z No
auditing of who has viewed record
z Records
z Difficult
left in insecure areas
to control access
z Records
physically lost
Problems with Paper – Paper Management
z
Filing and retrieving of paper records
z
Policies for Retention & Disposal
z
Health & Safety
z
Space
z
Transport
z
Multiple stores
z
Cost
Medical Secretaries office
Records Related Incidents reported
Jan. to Dec. 2007
Incidents by Subcategory and Type
Clinical
Incidents
Clinical Near
Miss
Total
Missing, unavailable or late arrival of medical notes
59
82
141
Information/results not recorded in notes/on charts
17
21
38
2
2
4
Missing letters or charts/paperwork filed in wrong notes
14
55
69
Results incorrect/delayed or unavailable
25
16
41
Incorrect details/information on notes/charts/requests/database
20
34
54
2
0
2
Patient identification
15
37
52
Labelling error on laboratory specimens/requests
20
37
57
0
1
1
Theatre list details incorrect
12
34
46
Appointment recording error
4
5
9
Specimens-Missing
4
1
5
194
325
519
Duplicate records/registration numbers
X-rays missing, unavailable, filed incorrectly
Record Illegible
Totals:
Potential Benefits of EDM –
Clinical
(as integrated part of electronic patient record
strategy)
z Information available when required
z Available
simultaneously in multiple
places
z Electronic records are more complete
z Research
z Future – better structured to aid care
pathways and decision support
Why now?
z
Situation with dual systems is getting worse –
with combination of paper and multiple
electronic systems
z
Technology now has the capacity in terms of
storage, processing power and display
capability to support EDM for health records
Technology still has a way to go – portable
devices, data input methods (PACS clinically
accepted)
z
Why EDM & Why Now?
z Problems
with Paper
Clinical
z Paper Management
z Security
z
z Potential
z Not
Benefits of EDM
part of NCRS – additional service
z Why
Now !!!
Why Not Now? – The Risks
z Implementation
Risks:
Flexibility of Accessibility –WiFi and devices
z TUPE
z Culture
z
z Clinical
Acceptance and usability
z Impact
on Clinical Throughput
z Security
Why are we going for EDM
80% of information still on paper
z Danger
of multiple systems
z We have to keep records for up to
25years(HSC98/053)
z Hoarding by Medical Secretaries
z Inefficient paper processing
z H&S issues
What did we do
z Reviewed
options
z Placed advert in OJU
z 122 responses
z Competitive Dialogue Process
z
Benefit of enabling development of
specification rather than rigid Output based
specification
z Down
to final supplier
Criteria for selection
z
z
z
z
z
z
z
z
z
z
z
z
z
z
Reduce the financial costs associated with storage of records and the clinical
administration service (short term and long term)
Develop a health records service that is able to flex to meet current and future changes,
both local and national
Improve existing timeliness and responsiveness of case note availability to support the
treatment of the patient.
Develop the ability to access clinical information from multiple sources at the same
time, therefore reducing clinical risk to the patients and clinical staff
Maintain accurate and timely clinical record keeping
Reduce administration duties required by clinical staff.
Provide a safer working environment
Support the process of continual improvement, but ensure that implementation of any
transformation is quick.
Enable effective advance planning of department(s) workload.
Compatible with the National electronic patient records strategy.
Maximise existing and future technology leading to a paperless service with no paperbased systems
Improve efficiency of workflow in all associated administration areas, therefore eliminating
duplication and delay
Provide KPI information as a by-product of the solution, to use as a management tool for
performance managing teams and monitoring SLAs
Integrate with other solutions that the hospital may have / may want to have in the future.
Options
z
z
z
z
z
z
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Option 1 – do nothing – keep Droitwich and existing
commercial stores
Option 2 – commercial company to take over library
management
Option 3 – commercial company to manage archive
records, but set up a smaller in-house library for recent
notes
Option 4 – digitise all existing and future notes
Option 5 – WAHT to run a digitise on demand service
Option 6 – commercial company to run a storage
service digitise on demand service
Option 7 – do minimum changes to maintain existing
library and systems to be safe
Critical Success Factor
Key to Success is an overarching
Strategy incorporating EDM,
not left as island
Knowledge
People
Process
Technology
Conclusion
z No
other way forward
z This
is despite the fact that
implementation is complex and large
risks have to be managed