Medical Records https://thejournalofmhealth.com The Essential Resource for HealthTech Innovation Wed, 10 Aug 2022 13:51:51 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.12 https://thejournalofmhealth.com/wp-content/uploads/2021/04/cropped-The-Journal-of-mHealth-LOGO-Square-v2-32x32.png Medical Records https://thejournalofmhealth.com 32 32 Does Digitisation Spell the End for Hard Copy Medical Records? https://thejournalofmhealth.com/does-digitisation-spell-the-end-for-hard-copy-medical-records/ Mon, 15 Aug 2022 06:00:00 +0000 https://thejournalofmhealth.com/?p=10946 The increased use of digital records is helping healthcare providers improve their services but caring for those old paper medical records is equally important, explains...

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The increased use of digital records is helping healthcare providers improve their services but caring for those old paper medical records is equally important, explains Simon McNairDirector of Public Sector at Iron Mountain.

The global response to the Covid-19 pandemic fast-tracked the digitisation of processes, especially those that supported remote working and those where the migration enhanced customer services. However, across the board – from retail to healthcare – this switch-up to digital platforms triggered a range of changes including the mass digitisation of legacy documentation, a conversion that underlined the value of effective records management. Good management of legacy paper records has been proven to help ensure a smooth transition to digital workflows.

Although not unique to healthcare, there is a wide range of operational benefits that encourage this sector to transition away from physical records. A reduction in on-site physical storage, which enables the better use of floor space, is clearly valuable but so are the enhanced speed of communication, improved data sharing and capacity for process automation . That’s why healthcare providers across the UK have called upon Iron Mountain’s storage and digitisation skills and experience.

A mountain of physical medical records

For example, Birmingham Children’s Hospital NHS Foundation Trust (BCH), one of the leading paediatric teaching hospitals in the UK, typically sees up to 200 patients each day. As a result, the physical records, pre-Covid, were piling up.

Sue Hobday, Head of Clinical Records and Clinical Coding at BCH, said: “If a child attends the emergency department more than once, something that often occurs, we need to access their historic files. Finding the records was time consuming and unproductive. We decided it was time to move to an electronic patient records system.”

The answer was a project that scanned around 40,000 patient records, which delivered the hoped-for performance advancements including improved information security and faster online access to patient files. The Trust now stores physical records in situ for between two and four weeks before they are scanned and filed off-site. These hard copies are fully archived for future ease of access, ensuring that their potential life-saving data is readily accessible.

Optimising change

“Although there’s an increasing move to electronic files, paper records still play a vital role and will for many years to come,” explains Brendan Sheehy, the Department of Health and Social Care’s records officer. This was underlined when England’s primary care trusts were replaced by clinical commissioning groups.

“That saw us as temporary custodian for thousands and thousands of patient records until the new organisations took responsibility,” says Sheehy. “This presented us with an ideal opportunity to consolidate our archives with a single supplier to standardise processes and gain economies of scale.”

This rationalisation and restructuring of primary care trust records has helped ensure easy access to physical records and digital patient information, as Sheehy explains: “Our records are predominantly with Iron Mountain as a single service provider and so we no longer have to search different IT systems to find what we want. It’s much simpler and more efficient.”

Having such records fully archived and digitised makes it easier to access at any point; they are more accurately classified but can also be seamlessly shared with other organisations should a data transition be needed.

A simplified approach to data retrieval

The Oxleas NHS Foundation Trust encompasses community health services, along with ownership of Queen Mary’s Hospital in Sidcup. Its ambit covers the London Boroughs of Bexley, Bromley and Greenwich; a total of 800,000 residents.

Although Queen Mary’s Hospital had stored patients’ medical history files on site, there was no purpose-built archive. Records were stored on open shelves in various locations, a far from ideal situation as they needed to be available to several organisations delivering clinical services.

“We needed to move the archive off site, improve indexation to assure records integrity, and simplify the retrieval process,” explains Julie Lucas, Information Governance Manager at Oxleas NHS Foundation Trust. Consolidating the Queen Mary’s Hospital patient files with other existing medical records would also help standardise processes and provide economies of scale.

The project involved the collection, audit and indexation of around 675,000 individual patient files, which were packed into around 30,000 storage boxes. However, consolidating patient medical records with Iron Mountain was worth the effort. It has enabled Oxleas to standardise processes, improve the quality of its records catalogue and speed-up file retrieval to improve business efficiency. Storage costs have also reduced.

“We saved around 33% across our legacy archive,” says Lucas. “We’ve been able to redeploy our archive staff and by moving files off site we’ve freed up space to be redeveloped for clinical purposes.” Overall savings are around £1.3 million per annum.

An integrated approach to digitisation

Digital patient records deliver a wide range of benefits to both clinicians and patients. However, many Trusts still have significant stores of paper records that continue to be required. A successful digital strategy must therefore seamlessly integrate the management and digitisation of paper records, now and in the future.

These examples clearly illustrate the value of an integrated approach to digitisation and the physical storage of records. Properly implemented, this methodology will help ensure that healthcare providers can successfully move to digital working while still being able to easily access information stored in physical records where required – either by retrieving hard-copy documents or by digitising those records in an integrated way. The best way to achieve this goal is by partnering with a specialist that has a proven track record of managing both physical and digital documents.

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The Role of EPR Clinical Decision Support in Tackling the Backlog https://thejournalofmhealth.com/the-role-of-epr-clinical-decision-support-in-tackling-the-backlog/ Mon, 16 May 2022 06:00:00 +0000 https://thejournalofmhealth.com/?p=10630 Digitisation of processes is common outside of healthcare, which has been slow to catch up, and suffers worrying variation in digital capability. Healthcare providers have...

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Digitisation of processes is common outside of healthcare, which has been slow to catch up, and suffers worrying variation in digital capability. Healthcare providers have a right to expect more from our technology suppliers, especially in light of new, ambitious targets being set by the government. Recently, these targets have centred around the implementation and proper utilisation of electronic patient records (EPR).

A correctly implemented EPR benefits clinicians by making them more efficient, their workflows more streamlined, and their visibility of their patients clearer. For me, a basic expectation is that clinical decision support (CDS) is also embedded into the EPR. By having this critical clinical information in the system, the right decisions can be made for the right patient at the right time. However, it is not enough to stop there. From my experience working as a doctor for many years and from my time in industry, I know that clinicians are hungry for technology to do more for them, especially as they face big challenges like the elective waiting lists. Properly implemented, intelligent CDS is one way of satisfying these needs and tackling these challenges, giving EPR a very important role in tackling the backlog.

Making the case for digital clinical decision support 

Digital CDS can improve patient safety, and boost productivity while reducing cognitive burden. Automating the process of cross-referencing national guidelines with patient data means that the right decisions can be made more quickly, and with less variation in outcomes. As a result, this also gives digital CDS a role to play in tackling the backlog. Patients can be moved around the hospital more efficiently, improving patient flow and freeing up bed capacity so more patients can be seen.

As such, I welcome the expectation that digital clinical decision support should be “the norm”. The centre has set out the “what” needs to be done. As suppliers, it’s our responsibility to execute the “how”. By embedding clinical decision support within the EPR, we can satisfy this expectation much sooner. Just as importantly, by properly embedding this functionality into the EPR, it instantly makes the technology more appealing to end users and can improve the uptake of technology overall.

But what has this got to do with the backlog? For me, when it comes to elective recovery, one of the main reasons that waiting lists are growing is not due to a lack of clinicians, but a lack of beds. On average, people are spending longer in hospital than they should, which often happens as a result of incorrect decision making. We can see this having a worrying impact in areas like A&E, where there are queues of ambulances waiting to admit patients where there is a shortage of beds. By making sure that the most effective decision is made during every clinical interaction, we can reduce the amount of time each patient spends in the hospital, make it less likely that they will need to reattend, and free up beds for new patients more quickly.

Improving the flow of patients

Digital CDS isn’t necessarily new, but neither does a standard exist, nor is it as sophisticated as it should be. Having used many different EPR systems in my time, I’m pleased to say that digital CDS is something that has long been central to the development of Sunrise. Working closely with clinicians on the design has enabled them to improve patient and clinical experience, and position us to think about the wider impacts that digital CDS can have on systemic challenges like the backlog.

Currently, in most EPRs, CDS is essentially branches of logic. Situation A will take you to intervention B or C. However, the intervention that the clinician chooses will vary from hospital to hospital, if not ward to ward. If we focused on making CDS more intelligent, enabling it to make suggestions on real patient data, then we hold the potential of reducing these kinds of variations altogether, as the suggestion is based on both information provided by guidelines, and intelligence provided by the data. This will then contribute to a better flow of patients, improving their health and enable discharge to a more appropriate care setting as soon as it is safe to do so.

In the future, I would like to see CDS capabilities enhanced with artificial intelligence. An EPR should be the single source of truth when it comes to patient data, and the possibilities are almost endless when it comes to how we make use of it. For now, we’re focusing our attention of embedding CDS in bespoke ways, so that it complements the needs of individual hospitals and departments. We’re seeing that by doing this, staff are more welcoming of the digital change, as they can see proof points that the system has been designed for them.

Naturally, the only way of being able to do this at scale is to introduce standards around digital CDS. If there are no standards in place, the way this data is used will vary and we run the risk of it causing more problems than it solves. With millions of data exchanges happening every day, it’s essential that the data being collected is of the highest quality. For me, free text is ‘dumb’ data, with very little that can be learned or replicated from it. By instigating standards, we can ensure that things like CDS are as powerful as they can be. For me, this would mean all data being inputted through drop-downs and tick boxes, with very little free text. By standardising the data that is entered, it can be more easily analysed, trends are more identifiable and more intelligent recommendations, backed up by a treasure trove of patient data, can be made.

Part of a wider system

Clinical Decision Support is not a standalone solution to the backlog. We’re all aware that there are many moving parts; clinician burnout, Covid-19 cases, health inequalities and poor population health to name a few. Rather, we need to encourage a culture that gives us the freedom to ask, ‘Can this be improved digitally?’ so we can transform as much of the system as possible. As clinicians, we need to raise our expectations on what we want from technology. As suppliers, we need to understand the problems that face the front line and build solutions that are going to help solve them.

To do that, the clinician must be at the centre of any digital change and given the flexibility to configure the solution in a way that suits them and their department.  We saw this in practice at Bolton NHS Foundation Trust when the Acute Medical team developed medical lists within their EPR. It streamlined their clinical workflows, improved patient flow, and reduced the length of stay in hospital. It’s these kinds of configurations, in combination with an intelligent CDS system, that can ease clinical burdens, free up beds, and make a real impact on the backlog.

As such, there is a great responsibility (as there should be), on suppliers to develop and implement technology that works for clinicians and benefits patients. Clinicians are burnt out. The last thing they need is a badly implemented piece of tech that is difficult to learn and doesn’t deliver the basics. That’s why we supported Medway NHS Foundation Trust to execute a pre-emptive training programme ahead of their EPR go live last year. It meant the trust was able to recognise benefits from the EPR from go-live, utilising features like digital CDS straight away.

Technology systems are there to support us, and its only right that we put high expectations on just how assistive they can be. The things we expect from our personal devices, we should be able to expect from our EPRs. My smart phone is intelligent enough to suggest different apps for me to look at depending on the time of day, why can’t my EPR do something similar? That’s my vision for the next phase of electronic CDS, an intelligent web of knowledge and insight that enables not just the right decisions, but the best decisions, in the fastest time. By streamlining and modernising simple systems like CDS, we are in a far better position to tackle key challenges like the backlog.

 

By Dr Constantin Jabarin, Locum Consultant, Gloucestershire Hospitals NHSFT & International CCIO, Altera Digital Health (previously Allscripts) 

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Building Simplicity, Trust, and Benefits into the Medical Record Consent Process https://thejournalofmhealth.com/building-simplicity-trust-and-benefits-into-the-medical-record-consent-process/ Fri, 27 Aug 2021 06:00:08 +0000 https://thejournalofmhealth.com/?p=9577 As the healthcare industry strives to make interoperability a reality, there remains a great deal of friction in getting patient data from point A to...

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As the healthcare industry strives to make interoperability a reality, there remains a great deal of friction in getting patient data from point A to point B. However, many providers are at a crossroads, as the 21st Century Cures Act intersects with HIPAA. Providers have been understandably protective of patient data to uphold mandates under HIPAA. However, the Cures Act requires providers to quickly facilitate patient data transfer requests. Clearly, maintaining HIPAA and 21st Century Cures Act, two seemingly opposing regulations, can be challenging.

A key to satisfying both regulations is implementing best practices for gaining patient consent to share their information. That said, patient consent has historically required a considerable amount of time for the organization that owns the data and for the patient. Today, we’re all familiar with digital consent forms in our day-to-day life, from downloading new apps to applying for credit cards. As providers look to implement digital patient consent, there are three areas they must keep in mind: simplicity, trust, and patient benefits.

Simplifying patient consent

An effective patient consent process would address the core requirements of identity, authentication, and informed consent while striving to be as intuitive as possible. Rather than completing different paper forms at every healthcare provider, effective patient consent should be as easy as using digital forms we complete nearly every day. The consent form should offer enough information for the patient to understand the nature of the request but not so much data that the process feels like a burden.

The consent engine should be configured so that the patient understands what’s being requested and is prompted through a set of yes/no questions to provide informed consent. Making the process simpler will drastically reduce the time necessary to gain consent, allowing the requester to complete the task for which the medical records are needed.

Engendering trust

As a society, we’ve become accustomed to clicking “I agree” without giving much thought to what we agree to and future consequences. But should blind trust be the norm? Medical records represent some of the most personal information a person can own, so it is incumbent upon providers to be completely up front about why they’re requesting the records and demonstrate that they’re using the records responsibly for their intended purpose.

The “5 Ws” are the basis of any journalism student’s education, and the concept is an excellent basis for earning patient trust when requesting medical records:

  • Who needs their records?
  • What records do you need?
  • When will you use them (and for how long)?
  • Where are they being sent?
  • Why do you need them?

Articulating the answers to these questions during the digital patient consent process will help make those patients feel more comfortable with providers sharing their data with another party.

To that end, it makes sense to explore technologies that will further build trust — perhaps even with emerging trustless technologies that can carry out a patient’s consent directives with more certainty, security, and privacy than the current human-heavy processes can. For example, with consent engine technology at the center of controlling data access, patients would be able to opt in to timeline updates that notify them of how their data is being used at any moment.

Communicating the Benefits

Beyond the 5 Ws, providers should clearly articulate how the person giving consent to their medical records will benefit from doing so. In many cases, sharing their medical records will help another provider better understand the patient’s history, improving care and outcomes.

In other instances, their data may be used for medical research, leading to breakthrough therapies or a greater understanding of combatting a condition. Or as we’ve seen throughout the pandemic, patient data can create invaluable insight necessary to improve community health. Whatever the benefits are, clear communication can further motivate a patient to offer consent.

Simplicity, trust, and benefits are necessary to facilitate the flow of medical records and are heavily intertwined. If any of the three is compromised, the entire consent ecosystem becomes vulnerable. Implementing these best practices is key to unlocking the promise of interoperability while also maintaining compliance.

About the author

Co-founder and COO of Medchart, Derrick Chow is an aerospace engineer turned consumer health entrepreneur. He is passionate about solving big system problems and envisions a future where the value and power of consumer data is distributed back into the consumer’s control. He holds a MASc in Aerospace Engineering and an MBA.

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