Going digital, is it what we need?

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 Blood
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Records management ensures that useful information is kept, whilst redundant, outdated and trivial content is removed.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.

Creation:

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…

Fall-backs

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.

Success

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:  

This blog post has been written at the request of Geraldine Strathdee (@DrG_NHS), National Clinical Director of Mental Health for England.

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Is ‘Oops?’ a good enough defense…

Part of good records management is about have defensible disposition.  This a very americanised phrase but basically means that you have a reason behind why you have disposed of a record e.g.  It’s met it’s retention period and is no longer required.

But what happens when it is required, and records are not available, who is to blame? Freshly hitting the newspaper story lines was this today for Police Scotland:

Assistant Chief Constable Wayne Mawson told members of the justice committee that 20,086 stop-search records were corrupted last year – the source of the recent furore over consensual searches on children – as a result of “a computer programmer pressing the wrong button”.

He explained: “They [the records] had been properly put on the system by the officers as a result of stopping and searching people, but we lost the outcome of it as a computer programming error.”

I have recently been writing a destruction process for the reviewing and disposition of patient records, and I can quite categorically say that it’s not easy to delete something forever, there is a lot more effort to it than you’d realise including the amount of times you have to consider whether any back up’s or restoring of the system data willl bring the records back once you’ve deleted it.  You can easily delete it from the user interface but the main culprit is what’s in the background.

I would say, from experience, is that it is harder to delete than it is to keep hold of records.  What’s so difficult about leaving it on your servers forever more?  Yes you are contravening data protection and causing more of a problem for budget prediction but if you never deleted anything any more… If someone said to you that there was a one big red button that says ‘delete’, then they are wrong.

In order to permanently delete, you have to know what you were doing and in any case, a computer programmer would not have made the decision to delete by themselves.

Corruption is not deletion.

The word corrupt when used as an adjective literally means “utterly broken”

An image that might appear for a corrupt record:

corrupt file error

In these kind of instances, where corruption is possible. This should be identified before using the programme and have a disaster recovery process available in the event that this does happen.  In this case, you’d be able to identify a file from the last back up. Yes you may lose *some* records but not twenty thousand.  In any event, you’d only lose enough for the last day’s worth in which the officers in question would be able to reenter any notes for last ones as they’d be in a 12 hour period.  There must have been a conscience decision to not restore from a previous back up and let the records go.

Good records management is about having accessibility, reliability and integrity of the records you have in your possession. If you don’t have that, you may as well go home now.

This example of poor records management is one for the history books entitled ‘How to lose your reputation in one media statement’

Keep records managing,

RMGirl

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How bad is that error?

When records management finally gets a mention in the press or in the recommendations outcome of an investigation or incident, it’s usually that records were never kept or were destroyed too soon?
The core concepts of creating a record should mean that a record has content, context and structure and a record isn’t a record unless it covers the 5 W’s, who what where when and why.

But what happens when a record is complete but is either inaccurate or on the incorrect persons record? What are the actual consequences? By this I don’t meant the consequences to an organisation but to the person that you’ve written about?

As a child, I was in the same school year as a boy who had the same DOB as me but also the same name as my brother, to which we regularly received detention letters. It later turned out after months of receiving letters for detention classes and my brother being taken to task on it by my parents that actually they weren’t for him at all. This only came to light when we received lost property for 13 year not a 16 year old, and it transpired that the school had placed my brothers photo on the wrong profile and vice versa and so it was easy as to say, a teacher would walk into the office and point the naughty child out via school photo selection and a letter was sent. This meant my brother spent many an hour in his bedroom “thinking about his actions” for something he didn’t do.

Moreover; I have recently applied for life cover insurance, and for this I needed to give permission for the health company to contact my GP to release a statement or summary of my records. I was given an initial quote subject to all other checks. My result came back that they were happy to insure me but the insurance was going to increase but they didn’t say why.
The suspicion in me is that surely they’ve read something in my GP summary that they didn’t like which makes me higher risk?

This can happen to many people, for instance people get turned down for fostering because of errors on their records, where for example a safeguarding issue has been placed in error.
People get medication / repeat prescriptions stopped because they’ve been discharged after someone has placed on their record that they have been imprisoned yet they are actually walking the street.
But this doesn’t just affect the public sector; this can be in the private sector as well. What about; credit checks / banking errors that stops people from getting a mortgage?
Now these errors are becoming more and more regular, as organisations move forward with electronic systems, it’s no longer as simple as to just rip the record out or cross out the error. It wasn’t as easy to pick the wrong clients paper record up as more often than not, you wouldn’t have two people’s very similar paper records about your person.

Electronic records have seen an increase of these errors because it’s so simple to search up a person with the wrong details but when is this error a record keeping incident?
Is it at the point of which a person who the record is about is affected? or is it as soon as the issue has been written? In some ways, as soon as you’ve written the wrong record, it is an incident but that’s not helpful operationally.

You need to inspire people to correct errors and thank them for notifying you, not make a drama out of the incident.

But what if you discover that it’s not just the once that it happens, if it’s more than once per member of staff? How would a member of the public feel? How should record keeping errors on electronic systems be dealt with?
I feel like I’m spiraling here, the more I write, the more questions I have for myself.
If anyone has any thoughts on this, please get in touch.

Keep records managing,

RMGirl

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There’s a Records Manager in all of us.

So this afternoon has seen me taking care of some home paperwork,  now given I’m a Records Manager I’m in my element here but I’m just as bad as everyone else about letting those personal records get on top of me.

SO, here goes some top tips for managing your records at home, at home we are not particular bound to any legislation that requires us to keep records but they are super useful when looking for stuff especially when it comes to financial related records.

Remember that at all times you should be able to get paperwork from the organisation that sent it to you, however, they are notorious for charging you for second copies – something to do with administration costs blah blah blaaaaah…  So without further ado:

Manage records at all times…when you receive it do something with it….. don’t just pile it up

Consider how long you really need to keep records and regularly clear them out.
Where there is a paperless option, go with it…  use the systems the organisations offer you but be aware of your online footprint and change passwords regularly, keeping your anti-virus up to date.

Of those systems… don’t print it unless you need to, leave it electronic,  at least you’ll know where it is and you won’t need an expensive filing cabinet to store printed goods.

Don’t write your passwords down.  It’s easy to lose a book of passwords and open yourself up to all manner of issues.

Buy a Safe that is fire proof,  Store all documents that are expensive to recreate, these include Passport, Driving licence (paper part), Birth certificate,  House Insurance, Car Insurance, Other insurance, Mortgage statement etc. Things you cannot replace without going to some effort or perhaps are irreplaceable (I have some family history stuff in mine too).   The fire proof safe will not necessarily protect your records entirely,  but it will give you extra couple of hours of time that you wouldn’t get without a safe.  The cheaper the safe is the less security it will give you.

Store files in a year related folder,  not a company/type based folder.   Much easier to just pick one folder up and shred the contents than it is to go through several folders.   You can always file it in A-Z after you’ve stored it in year, just to make it easier to find.

Get rid of appointment diaries after a year.   If you have a smart phone consider moving over to the diary it offers you.

If you don’t need it anymore, shred anything that has your personal details on it, don’t leave yourself open to ID theft.  I recently bought a decent shredder from Tesco, £25.   It’s cross cut (important!), and it didn’t burn out after 20 pages!   it’s not the basic shredder, but the cheap price should scream out at you. I’ve tried them, they don’t last.

If it hasn’t got your personal details on it,  recycle it.  Do your bit for the environment.

If you have any other concerns around your home record keeping, please do get in touch, I’d be happy to advise,  doing something about the pile of paper work is better than doing nothing.

Keep Records Managing
RMGirl

p.s. It’s true I was doing it:

B7Ab2FTCUAA8Smo.jpg-large

For the avoidance of any doubt, that’s out of date pet insurance with out of date address on the top there.  Enjoy!

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Is the data still held?

At the end of the Records Management Lifecycle, you have the disposition stage.  The disposition stage can consist of many methods or formats.   Recycling,  Confidential Waste, Deletion, Degausser, Decommission, Transfer to Archive either electronically or physically and so on.

But the question is, when you delete something electronically is it still held? How do you know? If you don’t know, perhaps you should find out.

Earlier this evening, albeit it not personal data, I discovered that when I delete my recorded programmes from my Sky Planner.  I do not actually permanently delete the data.  I discovered on an accidental left click, that there is a deleted category in which I have the opportunity to ‘Restore’ or ‘Permanently Delete’. So, I then promptly sat there as a good Records Management Girl and permanently deleted everything I could see, I discovered it had held programmes right back to November 2014. I mean surely,  deleting them the first time was enough? No.

In any case,  had my planner been personal data and I had continued to be unaware that the deleted category folder was there,  the data would have still been held in the eyes of the ICO and for point of clarity,  just because you didn’t know, is not a reasonable excuse.  You should at all times know what your programmes are capable of doing before installing them.

So that got me thinking has this ever happened to you?  and by that I don’t mean your Sky Planner.  I mean deleting something and it not actually gone?

Why do we have programmes that do not allow us to delete data?  Now you could understand *old* programmes… but new ones?

I as a Records Manager in my professional capacity and proper job (yes, proper as in paid) I constantly fend off people who find a wonderful programme that would solve all of their problems but on interogation I discover the programmes cannot delete the data you put in, out.  One in particular that looked great,  but right in the bottom corner it said “Powered by Microsoft Access” …I could hear my inner RMGirl screaming inside “WHY! WHHHHHHHYYYY!”  Needless to say I was scratched off that managers christmas card list with a blunt paperclip end.

But it doesn’t just stop there,  ESR.   Electronic Staffing Record, a programme that was pushed down to all NHS Trust’s from Central Government to use as a staff record.  It holds sensitive data that cannot be deleted but any human resources person I speak to cannot see a problem with it because its data they require to facilitate doing their job.  The long term plan of what happens when staff die, why would you need to keep their sickness record?  or their ethnic background and marital status along with their next of kin is not something that is considered and perhaps should really be looked into.

The general consensus is that once they “archive” the data, it is decommissioned and no longer in use. YES… but what about the Data Protection Act and the lovely principle 4 ?   Yeah,  I thought not.

We all do this with our deleted items in our email or the trash can on your desk top, or the recycling bin you have outside your house, until its physically left your property  and you can no longer retrieve that item. The information is still held.    Has no one seen The Big Bang Theory episode where they accidentally shred a document and because its only strip shred they manage to stick it back together?

For the love of all things round, if not for the sake of your electronic goods and speeding them up, for 2015, empty your deleted items folders on everything so you can confidently say that you do not hold the items you once delete*

And for my last tip of today, remember that you should at all times be able to delete or export the information out of a programme that you implement whether you want to do it or not, it should always be an option.

Keep Records Managing.

E

*obviously deletion is only rightful deletion once it has met its retention period,  I’m not** encouraging people to delete just because they can.

**legal disclaimer inserted. hah. 😀

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It’s not longer a threat, it’s a promise…

I’ve been back in a Records Management Position for just over a year and today I actually looked inside a record, I had a small chuckle to myself as I read the sign off of a referral letter from years gone by that said “Please see this boy and sort him out” … How time has changed.

But has it? Not really, not for the SAR workers, the archivists, the info professionals who deal with old records and have to look at horrendous contents of said records, whether they be old or new.

14 months on and I still think about the service users I read about. It’s not very often they cross my mind, but I’ve not forgotten nor do I think I ever will. I still remember the images I conjured up from reading such descriptive details or seeing actual photos along with the countless 1000’s of pages of reading about the inner parts of someone’s life.

I feel bad sometimes because one of my coping methods is black humour, I laugh it off or I’d cry but sometimes the crying is only way of releasing what’s actually inside.

The thoughts on this was rectified purely because this issue has risen again, I’ve come across colleagues in the sector who are suffering from the stress of the content of records they come across and we’re a year on and no further forward.

I’m no longer doing the SARS and generally I can choose when I want to read a file, but for some this is their bread and butter, just as it was for me last year and I know exactly how they feel when there’s no support out there for this kind of work.

I intend to get something organised, whether it be advice/fact sheets/ phone numbers or some training…

Something has to change.

Watch this space.

RMGirl.

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Poor Records Keeping doesnt always cause a disaster…

… or atleast it wasn’t for me.

I’ve recently submitted a complaint to a company for my poor customer service. My email was long and quite rambling but it must have struck home when I picked up on their motto that they failed to achieve in making my shopping easy and my complaint was dealt with as I thought very efficiently. 

So lets backtrack and give you an overview, for the sake of google spiders and the wonders of the web this item I bought was a ‘blender’.

I ordered the blender one Saturday afternoon from the Bristol shop (Store A) via the telephone.  The sales clerk told me that they didn’t have the size blender that I required however one of their other stores did (Store B).   I told them I needed the blender very quickly for a party I was holding and that I needed it shipping on express.  I paid for it over the phone.

Following a long few days, it appeared the blender had been placed on standard delivery from Store B and had been sent to their mail order company to send to me rather than direct.

I rang and complained. Store A told me they couldn’t get the blender too me on time.  I said I was going nearby Store B and I could pick up the blender there.  Store A told me that I’d need to buy the blender again but from Store B but because of the hassle Store B would give me 20% off.  I rang Store B store and paid for the blender in advance to secure my item minus the 20%.

I picked the blender up from Store B and all was fabulous. 

When I returned home, I returned the Store A blender that had subsequently arrived to the mail order depot for refund as it was free postage.  I wasn’t going to spend yet more money returning it to Store A when I had the free postage sitting in front of me especially as it was heavy.

I wrote the long winded complaint email at this point.

I received a call in which a manager from the headquarters advised me not only would I receive a refund for the Store A Blender, but I’d receive the Store B Blender refund as well and that I could keep the Store B Blender free gratis as an apology.   I thought great!  Fabulous. Problem solved.

Sure enough, same day my credit card was credited with both refunds, one from Store A… One from Store B.  The way I paid.  Within the week I had 2 receipts through the post documenting the refund.

3 weeks down the line I receive a cheque from the mail order depot with the amount for the Store A Blender.

Now this Blender isn’t an overly expensive Blender.   I sat and toyed with the idea of telling the company that they’ve sent me yet another payment and I haven’t yet decided …  surely it isn’t my fault they have poor Record Keeping?

The question brings… how many times does this happen? 

This isn’t a disaster in which someone has died, far from it.  They have the ability to work together as a nation wide store but it seems their mail order depot that ships internationally doesn’t seem to connect with their stores.

What would you do in this case?  Short of flogging myself to them for some Record Management work…. Would you ring and for go the extra payment or just bank it and not bother telling them their Record Management practices are terrible?

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