Recordkeeping in times of change and financial constraint  august 2013
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Recordkeeping in times of change and financial constraint august 2013



Delivered at the Dunedin Recordkeeping Symposium held by Archives NZ on 29th August 2013.

Delivered at the Dunedin Recordkeeping Symposium held by Archives NZ on 29th August 2013.



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  • Topic – titleLighthearted view of our storyPast and present dramas, a myriad of challenges, die-hard characters.Focus on clinical records, as what we know, and overview of all issues over the last 12 years.
  • Not an inspirational/ motivational presentationAn honest account of our story, which may have some parallels to your organisation?
  • Otago – and had done for a number of yearsSouthern Alliance – created a new set of challenges
  • CR supervisorCRCRegional/District managerCorporate Systems Manager/PRA Board chairSouthland – Frances etc.MH records – Otago/SouthlandClinical Records teamsSatellite record areas
  • Yes, the merger occurred, but essentially this occurred in name only – a new logo, on
  • Timeline of storage issuesCrown – Wakari – Crown2008 Southland to Crown2010 Wakari to CrownDumping ground at WakariLow risk , low priority, lack of decisions and interest – lip serviceNot included in decisions, not invited to consult, no place in MSP – no structure/inclusion of records storage – everyone just sees Electronic Records as the answer, without understanding the need to Electronic records – interfaces to PAS, equipment, efficiency, accessibility and reliability of systemsHybrid systems – different processes in different departments – trying to align or streamline these is impossible as the clinicians do wildly different thingsSouthland and Otago still have completely separate clinical systemsFinancial constraints re external storageCost centre pays for external storage, no global budget for recordkeeping/storage.Corrective Actions – audits, accreditations, certification – sort out storageNo global Recordkeeping framework
  • Detail recommendations – satellite, storage Dunedin, crown, electronic vs paper, convergence of patient management systems, audit corrective actions
  • Records tell our story, past present futureOur future is today, tomorrow, but it goes on and on like a soap operaRecords should be treated as an asset
  • Not included in many decisions, until something goes wrong, and then “Oh, I didn’t realise”… Not even entering people’s minds
  • Sound of muffled conversation
  • No interest or solutions for what exists, only going forward
  • Was expecting an analysis of hard-hitting directives so could be used as ammunition for improvement and the need to changeHigh expectations, was expecting a serious in-depth look, pinning hopes on it
  • Legislation, policies, procedures, guides, …
  • Support from individuals, but unfortunately individuals can’t change the culture of the organisationAny real changes require dollars, and buy in from staff
  • NHIT BoardSI AllianceShared care record – 5 DHBs & PHOs, GPs & other healthcare providers5 years awayReally sexy & interesting, but lack of awareness that “old” hard-copy records still need to be managed.
  • Over the last 12 years, nothing changedNo framework around concept, who manages it?
  • Good service
  • Numbers at CrownNumbers everywhere else – Dunedin, Lakes, Invercargill, Wakari, Linear meterageNumbers of records turned over each month
  • Active patient records – around the district, living documents,

Recordkeeping in times of change and financial constraint  august 2013 Recordkeeping in times of change and financial constraint august 2013 Presentation Transcript

  • Jane Smith & Matthew Dodds Southern DHB
  • Like sands through the hourglass, the se are the History Records Roles Recommendations Results? The Present Situation Storage Daily Dramas $$$$$$ Policy vs. Reality
  • Prior to February 2007 the Otago and Southland DHBs were separate entities: Clinical Records Service sat within the Information Group No Corporate Records Structure or Service Clinical Records Service sat within the Patient Services - Surgical Division Business Records Archiving System well established February 2007 - The SouthernAlliance (OSDHB) was formed between the 2 DHBs
  • Pre-NHI records (including closed hospitals - Gore Hospital, Dee St. Maternity, Lumsden & some Lakes Hospital records) dating back to the 1960s stored in: No particular order The old “dining room” of the old hospital and several rooms in the old nurses home Active records stored in the same areas Two years of current records in the main Clinical Records office No off-site storage
  • Patient records dating back to 1957 being reviewed on the Dunedin Hospital site Pre-1957 records stored at Wakari Hospital Many other records also stored at Wakari: Cherry Farm (including many integrated Seacliff records), Vincent (Cromwell), Balclutha, Dunstan, Tapanui, Owaka, Roxburgh records
  • Older records stored in “concrete bunker”/boiler room Current records stored in overcrowded room behind main administrative office
  • Otago DHB • Team Leader Clinical Records & Coding – new role (2001) • Supervisor • No Corporate Records team Southland DHB • Manager Clinical Records & Coding / Privacy Officer • Changed to Team Leader (2006) • No Corporate Records Team • Inactive Business Records processes developed by Librarian Southern Alliance • Regional Manager Clinical Records & Coding (2007) • Team Leaders in Otago & Southland • Supervisor – Otago • No Corporate Records Team Southern DHB • Manager Clinical Records & Coding • Team Leaders • Supervisor - Otago • Corporate Records Coordinator – Otago Phase One – Fixed Term (2011)
  • 24/7 service 365 days/year Does not process public enquiries Includes Arranged Admissions 23 staff including: 1 casual staff 1 FTE Coding Assistant 0800-1700 weekdays 0800-1630 weekends and statutory holiday Does process public enquiries: record viewing, ACC requests & invoicing Includes Privacy business 13 staff including: 3 casual staff 0.5 FTE Coding Assistant
  • VS. Southland Dunedin  Windows  Natural light  Modern building  Ventilation  No Windows (Obviously)  Very old building  Inadequate ventilation  Risks (unsafe environment)
  • VS. Southland Dunedin
  • 2000 - 2007 Feb. 2007 – Apr. 2010 May 2010 - Present
  • Best of both? Yes, where appropriate Incorporating differences in location Living with differences if outcome/service is the same Records content/structure completely different Pre-merger processes in other departments haven’t changed “If it ain’t broke” – don’t fix it… Different business processes are ok… if they work Administrative nightmare No overarching RK framework
  • Dunedin Site •Patient records from 1957 – 2002 on-site •83 satellite patient record locations •Random silos of information not linked or integrated to the main clinical record •No global management of business records Southland Site •No Southland records off-site •Established archiving processes for inactive business records •Clinical Records in old Children’s Ward •A myriad of old satellite records stored underneath X-ray in basement area •Dee St. Maternity, Bellevue & Gore Hospital records stored in basement Crown •Some business records, some clinical records stored at Crown by the ODHB •Old Oamaru Hospital Records (1999) Wakari •Pre-1957 patient records (100 linear metres of 1920 -1946) in old “boiler room” – in rusty filing cabinets due to leaks •Old OAHB (excluding Oamaru) records •Cherry Farm records •Poorly managed miscellaneous records in basement for old hospital building 1990s - 2002
  • Dunedin Site •Deceased clinical records to Crown (2002) •Deceased clinical records back from Crown in 2004-2005 •Electronic records storage introduced (labs & radiology) (2002) Southland Site •New Southland Hospital opened October 2004 •Clinical Records re-located to main corridor in new building •Electronic records storage introduced (labs & radiology) •Inactive records & some active records transferred to Crown Crown •Contract initiated in 2002 with ODHB Clinical Records •Some satellite record areas established records storage with Crown •Pre-1946 records from Wakari stored at Crown •Deceased Dunedin clinical records sent back to Crown (2008) Wakari • Regional Archivist invited to assess pre- 1957 patient records (2002) • After refit “File Storage area” became “Dumping Ground” for all and sundry (2005) • Archives NZ completed an appraisal of pre- 1946 (approx 42,000 records) records deeming them to be of “historic value” and stated the DHB to “be the only board to hold general patient files pre-1940” Lakes •Inactive patient records stored in concrete “bunker” in basement •Inactive records transferred to Crown in 2008 •Active records stored in main building 2002 - 2008
  • Dunedin Site • Fixed Term Corporate Records Coordinator (Otago) established (2011) Southland Site •Earthquakes in Christchurch prompted evaluation of old buildings leading to evacuation and demolition of buildings used for records storage •Other Southland cost centres storing records at Crown •Some inactive patient and business records stored in Supply building Crown •Huge number of active Southland clinical records transferred to Crown which prompted a 6 day a week retrieval service Wakari • Realignment of half of the building to rehab equipment store and carpenter’s workshop • Records storage areas full and unmanaged • In June 2013, approval given to check through Cherry Farm (including Seacliff) records. This process has commenced. • Old Neurosurgery Unit records have been stored in this area since 2000 Regional Archives •1920 – 1946 patient records transferred from Crown to Regional Archives Dunedin Office (2010) 2009 - 2013
  • After the Christchurch Earthquakes, some potentially unsafe buildings on the Southland campus were demolished
  • 2002-2004 • Generator noise • Temperature fluctuation • Diesel fumes • Paint fumes • Disgusting smells • Insufficient lighting • Dust • Water leaks • Silverfish • Lack of ventilation • Unauthorised persons • Identified as fire risk • Tree roots growing through the lower basement floor • Lack of storage space meaning some records on floor and others piled high close to fire sprinklers 2005-2007 • All of the preceding issues and… • June 2005 • Full Shelves • Lack of resources • 3 double shelves of active clinical records shelves moved to make way for 5 applications staff members – compounding storage issues • Volumes room movable shelves overloaded • Muffin Break dishwasher powder burns hole in carpet in main office • Blocked drains damage PC • Defrosted freezer causes leak in main office • Fire alarm issues • Stairs closed off, Psych lift issues 2008-2010 • All of the preceding issues and… • Intercom not working • Rodents, wasps and bees 2010-2012 • All of the preceding issues and… • Construction work on the Ground floor causing multiple issues including leaks, mould, salt efflorescence, falling debris from ceiling, brick dust • August 2012 – Fire Department deemed the basement storage area unfit for records storage requiring a sprinkler upgrade – no action to date.
  • Staff Comments - Verbatim
  • Every time the organization has been audited since 2002, clinical records storage in Dunedin has been identified as requiring corrective action (EQuIP4 Standard 2.3.1) The result being…
  • Relocate Dunedin Clinical Records with many different options Presentations, proposals to Executive Management Storage issues continually raised at DHB forums with Occ. Health, Quality Committees Requested to be included in Master Site Planning Corrective Action plans as identified by accreditation surveyors External Storage for Southland, Lakes and Otago records (back and forth) Satellite Records to be created electronically only (2009) Electronic Reporting / Paperless Results Plans for convergence of patient administration systems and clinical intranets/workstations Reorganisation/Rethink of storage options on Dunedin Hospital site Integration of all health records Corporate Records Management
  • Incident/Near Miss/ Issue identified Investigation Root Cause Analysis Recommendation / Business Case submitted Consultation & Delays NOTHING!
  • No executive sponsorship for records management Records storage issues and risk management automatically rubber-stamped “low risk” & low priority Reactive rather than proactive management due to constraints – “Fire-fighting”
  • Relates to Records?
  • Shortland Street
  •  Manager’s Responsibilities – Achieved  Records Manager’s Responsibilities – Achieved  Staff Responsibilities – Achieved  Does this make us “effective” when the issues remain the same
  • No (extra) funding Low risk & priority But…
  • Miracles (On Christmas Eve / Recoveries from Illness) are a soap opera cliché… but in real life… Fully electronic records $$$$ Safe & Healthy environment
  • Self-Assessment (82 pages) 257 separate documents as evidence Corporate Records Coordinator time, fixed term Inexperienced auditor Lack of depth Outcome =
  • Records Everything Else
  • South Island direction DHB agenda High Staff Turnover Experienced staff moving on New Hazards Policies, Legislation, Standards etc. Electronic Records DHB Funding
  • Clinical Records Department location Continual leaks, construction issues, other location dramas Priorities & where recordkeeping fits into these Lack of on-site storage for all records
  • HealthConnect South SI New PAS Shared Health Records – primary, secondary, tertiary (electronic not paper) Cloud storage – management of this
  • Concept sounds good To make it work – we need to fix current issues and move on Storage – on-site & external Retention Resources/Roles Appropriate funding Sponsorship, buy-in and participation Realistic timeframes
  • Virtual Tour
  • “You’re not in Guatemala now, Dr. Ropata” Then
  • Now
  • Then… and Now
  • Then
  • Virtual Tour
  • Virtual Tour
  • Virtual Tour
  • Virtual Tour
  • Virtual Tour
  • Otago Active MAIN CR - 284,000 Mental Health Records – 80,000 Southland & Lakes Southland Active CR - 121,672 Lakes - 5,500 Mental Health Active – 15,712 Crown Otago – 28,962 (Deceased) Southland – 127,809 Other Wakari Storage – 80,000 approx. Satellite Record Locations 83 – Otago 12 - Southland
  • This story has all the makings of a soap opera, but in fact, it’s our story and truth is stranger than fiction.