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ACC flowchart
- 1. Office Administrator Mental Health (OAMH) Email ACCRequest Received ACC Requests follow on effects of request ACC2368 Checked for correct DHB, names, dates etc. OAMH ACC6300 Checked for signature & release OAMH Electronic file opened& email, ACC 2386 & ACC6300 copied in with file extensions & NHI - OAMH iPMS checked to confirm Attendances of client, Services used, Referrals & Paper Documentation OAMH HCC checked for notes OAMH Concerto checked for ED discharges, GP Letters, Psych Reports or any other paperwork relevant to MH OAMH Depending on date request from ACC, Paper notes are requested via email to Service Manager & Administrator to recall notes OAMH (Te Rawhiti, Tiaho Mai, Whirinaki, Awhinatea, The Cottage, Faleola Etc.) Notes not on site are recalled from external stores Branch Administrator Notes are received, disassembled to be scanned or photocopied and sent to OAMH. Branch Administrator will reassemble and request pick up by external stores Email to external Stores to deliver Email to external Stores to pick up Branch Administrator will email scanned notes or post photocopied notes to OAMH OAMH will scan photocopied notes in to client electronic file will or place scanned notes in to client electronic file ACC MH spread sheet register to be filled in OAMH OAMH email for review by Clinical Quality Coordinator Clinical Quality Coordinator emails ACC & cc OAMH OAMH adds the Clinical Quality coordinators email to the electronic file ACC MH spread sheet register to be completed by OAMH One client request for notes back to 1996 only. ISSUE If the client has been in the service prior to 1998 the patient documents may not be electronically recorded ISSUE ACC or the client may request that only certain areas of information be released resulting in manual word processing manipulation by OAMH May require break glass OAMH Every pertaining document for perusal is PDF file and stored electronically for review. Every email pertaining to the client is added to the electronic file. Every client is stored with the document description, reverse date &NHI. Should the client have used more than one service, we can only release that which pertains to CMDHB. The client may have had several separate episodes within the service. These have to be individually PDF, named, dated & NHI’d If ACC request DOB , there may be Kingseat notes. This now goes to the MH Act Administrator who will physically search the files and if not there will request from archive. If there are notes in the archive, the MHAA will have to be pick them up. This requires booking a car and taking the MHAA off site to pick up, scan & return ISSUES BOTTLENECKS TIME OFF SITE EXTERNAL STAFF REQUIRED TO COMPLETE 1 Office Administrator 4 days @ 20 hrs. per week Depending on the amount of information requested by ACC the branch administrator may need to call upon other staff to disassemble notes, photocopy or scan and reassemble the files EXTERNAL SERVICE (paid for by CMDHB) On Line Security On Line Security Open Programmes required to be searched Clinical Quality Coordinator for review Other staff seconded due to volume size Mental Health Act Administrator If ACC request DOB or 1st presentation we have to research what the 1st presentation may have been as it may be PRIOR to electronic notes There is only one Mental Health Act Administrator for CMDHB. Court is held Tuesdays & Fridays. Section hearings from the court are of the highest priority 1 volume may contain between 2 & on average 75 pages, double sided (4 to 150 copies or scans per volume) from DOB may be between 1 & 15 volumes or 4 pages to 2250 pages. This particular client is a good example for us to have presented electronic notes due to the request start date of 1996. Approximately a total of 25 ED discharges,2 GP letters & 66 pages of electronic notes that have to be perused by the OAMH and peer reviewed by the Clinical Quality Coordinator to ensure that it is pertinent to the ACC request. Had ACC requested DOB or 1st presentation, we would have requested the paper file which is currently 2 volumes containing 85 pages (170 scanned or photocopied) in volume one and 78 pages (156 scanned or photocopied) in volume 2 of CLINCAL NOTES only. A total of approximately 420+ pages (including electronic) that have to be perused by the OAMH and peer reviewed by the Clinical Quality Coordinator to ensure that it is pertinent to the ACC request. This does not include any paper assessment, clinical letters or discharge summaries as requested by ACC. ISSUES When we receive a request that indicates DOB or 1ST PRESENTATION we are unable to determine 1st presentation due to the fact that the client may have been in care of a mental health facility prior to electronic records. As a result, in the past we have searched to determine if the client (has only presented electronically and the request is from DOB we check to confirm) has a prior history pre electronic records. We currently have no resources to do that. This is why we are asking the ACC manager to discuss with their client when and where their client thinks they may have been attending. Asking that we identify a particular incident without dates means we have to review all the notes. We currently have no resources to do that. All client requests are actioned by OAMH, even when the client has been inappropriately requested. That is not noted until this stage of work ACC Requests Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Total Requests 148 9 11 9 7 7 7 8 9 13 9 1 12 12 10 24 Inappropriate 33 1 3 1 1 1 3 4 4 3 1 0 3 1 2 5 Percentage Inappropriate 22% 11% 27% 11% 14% 14% 43% 50% 44% 23% 11% 0% 25% 8% 20% 21% From DOB or 1st presentation (unknow n) 79 9 10 7 2 6 5 4 8 9 1 0 4 4 1 9 Percentage of requests from DOB 53% 100% 91% 78% 29% 86% 71% 50% 89% 69% 11% 0% 33% 33% 10% 38% Legend Key Refer Issues Hi Tina I thought I would let you know the magnitude of administration time it will take to fulfil this request. Below you have asked for six volumes of files, (clinical notes) to be copied, and forwarded to you so you can scan and forward on, you verbally mentioned this needed to be done with in a five day period. From previous experience I estimate it will take approximately 45mins to 1.5 hours for each file with no interruptions and providing there are no issues with the photocopier. Constant use of paper files over the years have caused a lot of wear and tear to their contents, especially clinical notes, thus requiring repair work, and sellotape was commonly used to repair the pages, but unknowingly, this caused a lot of paper jams especially when needing to use double sided functionality in addition the clinical notes themselves were never perfectly flat with a lot of folds, tears etc also the amount of paper needing to be used, I estimate could reach in excess of 400 + (double sided) and double this if we have to copy one side for scanning. From personal experience I have seen photocopy machine feeders/rollers experience on going issues after this type of excessive copying. Unfortunately I myself cannot put aside this amount of time to do this, and will require this to be shared amongst my ward clerks, but at the moment I have one member of staff on annual leave and one staff supporting the MHA role, and the remaining staff are filling the gaps in my roster. IMPACT 5 Days