Medical Records is a Mess, What do I Do? John Thornbury Director of ICT - Worcestershire Health Informatics Service My Background Clinical Scientist – Medical Microbiologist in Birmingham) Cancer Research – at Aston University Information Manager – Walsall Director of informatics – Walsall/Wolverhampton (ERDIP site) ICT – Director of ICT Worcestershire Worcestershire Acute Hospitals – essential facts Large acute, serving a population of more than 550,000 800+ beds on 3 main sites Turnover £264 million in 2006/07, 5,500 wte staff 100,000 I/Ps, 400,000 O/Ps, 100,000 A+E attendances Key Issues – PFI on one site! Historical deficit - £30m 2008/9 efficiency saving £12m Worcestershire Acute Hospitals – essential facts 3 Major Sites Scope of Presentation Current issues Options available Benefits of EDM issues 3 Trusts merged into one Little attention paid to records management Just put together New PAS no de duplication - 2004 Culture “keep hold of record or never see again” Paper chasing notes i.e. never complete Problems Misfiling of documents Documents never filed Records lost Multiple records-PAS &Paper Specialty notesophthalmology Time taken to find relevant information Only available where paper is Problems No auditing of who has viewed record Records left in insecure areas Difficult to control access Records physically lost Problems with Paper – Locally Filing and retrieving of paper records Policies for Retention & Disposal not followed Health & Safety - HSE bought in by unions Lack of Space- despite off site stores Transport - poor service across multiple sites Multiple stores within sites some Medical Secretaries office not official hoarding VFM Paper related risks over last year 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: Current Situation Potential Benefits of EDM – Clinical (as integrated part of electronic patient record strategy) Information available when required Available simultaneously in multiple places Electronic records are more completehopefully Metadata tags can speed up access Single view (if linked with path etc) Why now? Situation with multiple systems is getting worse – with combination of paper and multiple electronic systems Technology now available Paper handling and associated problems 18 weeks and seamless care The Risks Implementation Risks: Flexibility of Accessibility –WiFi and devices TUPE Culture Clinical Acceptance and usability Payment by results Security Why are we going for EDM 80% of information still on paper despite NCRS etc Danger of multiple systems We have to keep records for up to 25years(HSC98/053) Hoarding by Medical Secretaries Inefficient paper processing H&S issues What did we do Experience of back office EDM Reviewed options Placed advert in OJU 122 responses Competitive Dialogue Process Benefit of enabling development of specification rather than rigid Output based specification Down to final 2 suppliers Criteria for selection 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 paper-based 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 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 Factors Key to Success is an overarching Strategy incorporating EDM, not left as island Knowledge People Process Technology Conclusion No other way forward This is despite the fact that implementation is complex and large risks have to be managed Questions