I’ve been doing records management for over a decade, In that time I’ve worked for a mental health trust, I’ve also worked with NHS England, HSCIC, Department of Health, Information Governance Alliance and the National Archives along with doing external advisor work for the Parliamentary Health Ombudsman Service on investigations and I can say happily that I loved every moment of it. Working in health is rewarding, inspiring and interesting and records management is something I’m very passionate about.
Good records management ensures:
- Access and availability of information
- Integrity of information
- Legal, regulatory and business retention of information
- Defensible disposition
- Protection and security of information.
Records management is the life-blood of an organisation. It has many similar traits to the blood that keeps us alive.
|Records management needs to happen all the time, not as a one-off exercise – when records are not management the organisation is in trouble.||Blood needs to keep circulating – if the blood stops, the body is in trouble.|
|Records management gets information to where it is needed to keep the organisation working.||Blood takes the nutrients around the body to keep it working.|
|If records are not managed effectively, the cost to the organisation is high in time, money and unreliable evidence for decision-making.||If poison or infection enters the bloodstream, the body becomes ill.|
|Records management ensures that useful information is kept, whilst redundant, outdated and trivial content is removed.||Blood takes waste products away for disposal so that they don’t clog up the system.|
Records management covers the creation, use, secure storage, accessing, utilisation, governance and disposition, but what are consultants and SHO’s, the people on the ground savings the lives of the people like you and me, interested in? Creation/Access/Integrity.
Records provide evidence:
- What, where, when and how an activity was done
- Why it was done in a particular way
- Who was involved
- Who was affected
- What was the outcome of the activity
The questions above are needed to form a full story of the activities that a health practitioner undertook that day… but in the ever changing world demanding more time and cuts from practitioners, they need to be able to do this and they need to do it fast. Not necessarily speed up their job of treating the patient but be able to document what they do with streamlined processes. Practitioners have allocated time, they need to be able to treat the patient and document it within that time, not sit there for 3 hours after they met the patient filling out systems or paperwork.
Overbearing, overwhelming and understaffed processes using hybrid information systems are a thing of the past. Electronic Patient Records (EPR) is where it is at. Going digital, being paperless and having everything at the touch of the button is where health need to be heading towards.
I recently wrote a paperless strategy, for the Trust I was working for, it was identified that my plans within the strategy were fantastic but a little too adventurous for the EPR we had in place. Luck would have it that we were mid-process for changing our system in order to meet the needs of the 21st century because at that very point, it was more than easy to have a paper record in every locality or service you had attended. This didn’t include records on two different EPR systems or potential to have records at Offsite Storage! This was just by being a young woman in a tier 4 bed; let alone having had 20 years of history, an adoption, marriage, divorce, witness protection or by being transgender.
The Tunbridge Report from 1965 ‘The standardisation of Hospital Records’ recommended:
- Standardised records
- Standardisation of documents
- The use of the NHS number as the single identifier
- Data processing and the use of electronic forms of mechanisation
- Standard discharge summaries
- Education for doctors
Yet we still seem to struggle with these 50 years on…
I can type faster than I can write, but I’ve realised that I’m a rare breed. There are fall backs to going digital, you have many staff who continue to struggle with the use of the information systems, but this isn’t to say they won’t learn… it just needs to be easy to use with good interactive readable interface that when you enter a piece of information once, that’s the only time you have to do it. Systems nowadays have the capability to auto-populate fields.
The systems need to be SPINE compliant so that it validates who your patients are with the national database too. You need a system that has the ability to talk to other systems that GP’s use without huge costs. The database that is kept up to date by the patients local GP because at the end of the day, mental health patients can be feel better for years and then end up with a relapse later in life. The chances of your locally held data being up to date and having integrity, whether it being paper or electronic, are slim to none unless it is regularly updated by the GP. In any case, your local data should be disposed of after certain time periods in accordance with the Data Protection Act 1998 and the Mental Health Act 1983.
Another fall back on being digital is the reliance on electricity, business continuity is a huge risk factor for being able to carry out your duties. If the servers fall over or your network connection fails, you need a back-up plan. This back up plan should not be to revert to your paper records. You need to think outside the box, using none network based mobile devices to achieve the same result without the need to enter the information twice once the systems are back up and running. Business continuity is not a sexy subject but it’s an important topic.
Going digital has such bad connotations because ‘It’s been tried before, it will never happen’, I beg to differ. The last time it happened, we never had the systems/software & devices that we have now. The only issue now is that you have to pay for it. It’s expensive, good systems don’t come cheap nor do the people who implement them. As they say you pay peanuts, you get monkeys. If electronic records are not carefully implemented they can cause as many problems as they solve.
It’s all too common to also prepare the now, when considering a new system, you need to consider the Trust’s long term strategy. Consider that what happens if you gain new services? Can the system accommodate it or do you need add-ons? Don’t expect a system to just be able to do what you need it to do and expect it continue running effectively! Consider the long term future.
I also don’t believe that the government requirement to be paperless by 2018 is achievable, not in the way people seem to think paperless exists. Going digital should be done a risk-based approach appreciating the need for the patient’s safety and experience being the utmost priority and remember that not all paper systems can be replaced. You might have services in areas that have not connectivity, so make allowances.
The key to any success in the implementation is the engagement with your staff, at the end of the day, as a records manager I might know how best a system works in order to get the money’s worth or use it’s functionality to its best… but if it’s not going to be used, then what’s the point? Asking the people on the ground what they want a system to do and meet those expectations. More often than not, all a health practitioner is interested in being there for the patient when they need them. The more time you require them to be on the PC completing the ‘red-tape’ the less engagement you will get when it comes to rolling out a new fancy system. The harder to make it for them, the more they will disengage. Also train those that train others, train secretaries in the presence of their doctors so that they both receive the same message at the same time.
There are enthusiasts with going digital, take them with you but don’t forget about the rest, one size does not fit all. Something things will make it harder for a clinician but if you can justify the need (patient safety) you have a defence mechanism. If it doesn’t give you benefit with patient safety and experience, you will obstruct your implementation. Human error will always occur, it’s a fact of life, but it’s more likely to occur if your system is not implemented appropriately. It was easier in the paper days to remove errors but now if your EPR bucket is leaking, the optimization will go in but the accountability will leak out. When implementation takes place, consider all the holes in the ‘swiss cheese’.
The other issue is don’t over do it; keep it simple. Too many alerts on a system can lead to the practitioners ignoring them. Too much information can be worse than none at all.
Once implementation is complete, don’t believe it’s the end. Any project may come to an end, but the need for business as usual will remain. Test how the system is working X months down the line. If you really want to know what’s going on in a hospital ask the secretaries or the porters!!
So to answer my original blog post question; is going digital what we need? Yes. It is, but it’s not as simple as that. Invest time and money in doing it right the first time and your staff will love you forever. Take your time, do it once, do it right.
The next post coming up is a digital alternative to Alex Langford’s 24 hours of Admin in Mental Health: https://psychiatrysho.wordpress.com/2015/11/02/24-hours-of-admin-in-mental-health-services/ …
This blog post has been written at the request of Geraldine Strathdee (@DrG_NHS), National Clinical Director of Mental Health for England.