Medical Records is a Mess, What do I Do?

1. Medical Records is a Mess, What do I Do? John Thornbury Director of ICT - Worcestershire Health Informatics Service

2. 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

3. 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

4. Worcestershire Acute Hospitals – essential facts 3 Major Sites

5. Scope of Presentation • Current issues • Options available • Benefits of EDM

6. 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

7. Problems • Misfiling of documents • Documents never filed • Records lost • Multiple records-PAS &Paper • Specialty notes-ophthalmology • Time taken to find relevant information • Only available where paper is

8. Problems • No auditing of who has viewed record • Records left in insecure areas • Difficult to control access • Records physically lost

9. 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 not official • hoarding • VFM Medical Secretaries office

10. Paper related risks over last year

11. Current Situation

12. 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 complete- hopefully • Metadata tags can speed up access • Single view (if linked with path etc)

13. 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

14. The Risks • Implementation Risks: • Flexibility of Accessibility –WiFi and devices • TUPE • Culture • Clinical Acceptance and usability • Payment by results • Security

15. Why are we going for EDM • 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 80% of information still on paper despite NCRS etc

16. 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

17. 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.

18. 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

19. Knowledge People Process Technology Critical Success Factors Key to Success is an overarching Strategy incorporating EDM, not left as island

20. Conclusion • No other way forward • This is despite the fact that implementation is complex and large risks have to be managed

21. Questions