Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Sunday, September 10, 2006

The Electronic Medical Record you Have When you Don’t Have One!

A week or so ago the following release caught my eye. One more acute hospital, I thought, has taken the sensible step of moving to a computerised patient record. The release read as follows:

Lara Giddings, MHA

Minister for Health and Human Services
Thursday, 24 August 2006


The Royal Hobart Hospital has become one of the first hospitals in Australia to store patient medical records through a new computerised digital system, Health and Human Services Minister Lara Giddings announced today.

Officially launching the new Digital Medical Record (DMR) system, Ms Giddings said the new system would bring major benefits for the Royal, clinicians, nurses, other health care professionals and, most importantly, patients.

Ms Giddings said the move from a manual, paper-based way of managing many thousands of patient records to an on-screen system, was historic.

“The new Digital Medical Record system allows patient information to be scanned, stored, managed and viewed on-screen for the first time,” Ms Giddings said.

“The new digital service, which has cost just over $1 million, means that patient information will be more manageable, accessible and secure.

“And the system will allow more timely retrieval of vital information and will be more efficient.”
Ms Giddings said that health care had the dubious honour of being the world’s largest consumer of paper.

“At the RHH alone, it is estimated that the manual system of keeping patients’ medical documents has gobbled up some 5.5 kilometres of storage space,” Ms Giddings said.

“That secure storage space has been growing at around 100-300 metres per year, and is now very close to capacity.

“The new Digital Medical Record system is an exciting initiative that will prevent the Royal being swamped by paper.

“The project will free up more space at the Royal and eliminate the need to store additional patient records off-site – a very expensive option and a logistical nightmare if they need to be retrieved in a hurry.”

From the beginning of last month, all new patient information has been recorded on the Digital Medical Record, rather than being filed as paper form medical histories.

“The new system enables fast and secure multiple user access for all RHH staff involved in providing direct patient care,” Ms Giddings said.

“The DMR allows clinical information to be available on-line and wherever the patient is located, and there is instant access for those treating staff needing a patient’s medical record.

“The system has been designed from the ground up to link into existing clinical work practices.

“The system is safe and secure. There are three forms of backup including archival tape - stored off-campus in a secure facility - a backup server and a contingency system in the event of power and network loss.”

Ms Giddings said the hospital’s network was world class, and the project had enabled the establishment of state-of-the-art, secure wireless networking to almost all wards.

The hospital’s sophisticated scanning equipment is capable of scanning 60,000 pages a day.

“It puts us in a stronger position in what is becoming an increasingly technological and information driven industry.

“Going digital provides the RHH with a firm foundation on which the hospital can build towards fully electronic patient health records.

“And into the future, the advantages of the new digital system may not be confined to the Royal alone.

“The system has been developed as a single, Statewide system, but it only contains RHH patient data at present.

“However, because of its link with the Tasmania-wide patient identification system, it has the potential to act as the cornerstone of a secure, fully integrated health record for everyone.

“The possible benefits in terms of improved continuity and quality of care are immense,” Ms Giddings said.”

Oh dear, oh dear I was wrong! A close reading of the release reveals no such thing! What has been done is that the hospital has bought a large optical images scanner and all the paper that constitutes the patient medical record will be scanned into an image data base, presumably keyed on the patient’s medical record number.

Given that it would make no sense to be scanning paper records while they were in use during an hospital admission, given the impact on work processes of taking the papers away to be scanned as care was being delivered, it is clear the scanning occurs after the patient leaves the clinic or is discharged.

So what we actually have for the $1.0Million is an image archive of non-current records which can be accessed to assist current care. The key problem with this is that there are now two sources of information. Firstly the current paper record and accessible via the computer the “old patient notes”. How often these will actually be accessed is likely to be quite low – given that any current information will inevitably be transcribed into the current record for easy and quick access. The frequency with which older records are accessed after an initial review or admission is vanishing low in my experience.

Another issue with scanning the paper record is the lack of ease of access to the various components of the record when it is presented as a collection of images – even if there is some attempt to provide some structure to the record through the use of sectional tabs and the like. At the end of the day what the scanned record comprises is an image stream which must be searched largely sequentially.

Additionally, to make such an image stream at all useful, it is important to attach electronic descriptions (known as meta-data) to each image. The process of doing this requires manual human reading of the scanned image and then entry of appropriate descriptions and searching information. Clearly the amount of metadata that will be entered will be quite limited for each image given the number of images being scanned each day and the available work force to code the images. Search and retrieval of details and other useful information will thus be very limited indeed.

Purchase of this system, I understand, has been driven by the need not to accumulate more paper, given the storage constraints existing in the hospital and a desire not to spend the money that would be required on what could be termed a “real” electronic health record within a hospital information system.

This decision making is blinkered in the extreme and is to be condemned. This system is little more than an electronic document archive and offers very few, if any, of the advantages and benefits of a real integrated Hospital Information System.

There are Australian companies, such as IBA Ltd, who can offer a highly searchable, functional, workable and useable Hospital Information Systems which would offer a much greater cost / benefit ratio to the Royal Hobart Hospital than this misguided installation. Additionally there are US providers, such as Cerner, who also have installations in Australia who can also assist.

There must be a reason that virtually no significant hospital in the world, if any, have adopted a system like this as their record system. These is! It is a really, really bad idea for 2006. Indeed it was a bad idea in 1986 and every year since!

One hopes that Tasmania Health will see the error of their ways and resolve to provide proper electronic health records to their clinician sooner rather than later, rather than extending this inappropriate technology further into the Tasmanian Hospital System.


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