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
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Information Manager – Walsall
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Director of informatics –
Walsall/Wolverhampton (ERDIP site)
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ICT – Director of ICT Worcestershire
Worcestershire Acute Hospitals – essential facts

Large acute, serving a population of more than 550,000
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800+ beds on 3 main sites
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Turnover £264 million in 2006/07, 5,500 wte staff
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100,000 I/Ps, 400,000 O/Ps, 100,000 A+E attendances
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Key Issues – PFI on one site!
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Historical deficit - £30m
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2008/9 efficiency saving £12m
Worcestershire Acute Hospitals – essential facts
3 Major Sites
Scope of Presentation
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Current issues
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Options available
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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
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Problems
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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
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No auditing of who has viewed record
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Records left in insecure areas
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Difficult to control access
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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

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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
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Experience of back office EDM
Reviewed options
Placed advert in OJU
122 responses
Competitive Dialogue Process

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Benefit of enabling development of specification
rather than rigid Output based specification
Down to final 2 suppliers
Criteria for selection
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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
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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 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