A Christmas Record
Approaching the EPR Arms on a starry, starry (twinkly, frosty) night.
’ ……and a partridge in a pear…’
The door opened and shut again. I walked closer.
‘……...five gold rings, Four calling….’
Shut again. Lots of comings and goings tonight. Open………
’and a partridge in a pear tree’.
I held the door opened and this time heard all the remaining days of the twelve days of Christmas.
I could smell mulled wine and mulled cider. I could see a plate of warm mince pies sitting on the bar- a bar done up with Holly and Mistletoe - ancient traditions of what has over centuries become our Christmas celebration: a mix of religious and pagan symbols.
‘Here we are again. Another expensive waste of money! Christmas-Pah!’ Spat Jamie Beattie, the Information Manager, mostly into his beer which he swigged to swallow the rather dry mince pies.
‘Been at the humbugs again eh? ‘I asked. ‘and if you hate Xmas that much, why come to the EPR Arms on Carols Night?’
‘Cos its Thursday and I always pop in after work on a Thursday. It’s a tradition.’
‘And so is Christmas. A mixed up tradition but enjoyable for all that.’
‘And why are these called Mincemeat pies? I mean – they’ve been nowhere near a cow!’
‘Well, they really were meat initially:[i] – lamb I think – very thinly sliced up.’ I stopped to shout my order in the direction of the bar. ‘Pint of Badgers Bill when you’re ready. None of that mulled muck for me!’ and then continued with Jamie, ‘then cinnamon, cloves and nutmeg were added to preserve the meat. Meat was replaced more recently by beef suet.’
‘Well – how strange. Nice but strange’. He said taking another freebie off the pile.
I continued. ‘So OK it’s Thursday and you’re thirsty but what else are you doing here at this time? I mean, you normally only stay for a quick slurp don’t you?’
‘I’ve had a really bad day. I can’t begin to bore you with the details but…’ I sensed he was about to do just that so I went to collect my beer from the bar in case I died of thirst waiting for his punch line. Returning to his table, I threw bags of scatchings and nuts at him in an attempt to cheer him up, without much suceess.
‘OK’, supplies delivered. ‘I’m ready for your grumpy story. Shoot!’
At that moment, Loz walked through the door and grabbing a free mulled wine and mincepie from the bar, joined us.
‘Nightmare. Bloody nightmare and just before Christmas at that. I mean – it couldn’t come at a worse time, could it Jamie?’
She sipped her mulled drink – nay – gulped it and stood up to get another. Mulled anything anyone?’ she asked ambitiously. With these freebies feeding half the bar, I don’t think Bill had thought through his latest marketting strategy!
‘Nay Lass but grab us a couple of they mince pies wilt?’
On her return, Jamie started giving us the gory detail of his week. It was all about giving patients access to their record.
‘So what’s your beef Jamie? Do you not think they should ask for access?’ I asked naivly.
‘No of course they should have access. It’s just that we’re in a mess at the moment. If this was twenty years ago, we would have simply got out the paper casenote and gone through it to identify the parts that are NOT to be seen.’
‘Could not be seen? Why? What parts can’t be seen then?’
‘Well – for a start, any information belonging to a third party.’
‘Third Party?’ I repeated sounding like a bit of a parrot.
‘Yes any information written about another family member, or another person who has offered information in confidence.’
‘OK I get that. There may be stuff in there they shouldn’t see!’
‘Yes like another patient’s records!’ said Los with a smirk;
‘Another patient’s re….’
‘It happens. Missfiles!’ said Los who continued. ‘We also do not withhold information written by another NHS organisation – we see this as continuing care and we are processing the data. But some Trusts have to get consent from clinicians from another Trust who have written the information in the record.’
‘No way!’ I exclaimed
‘Way!’ replied Los. ‘This adds loads of time to the request being managed. And we only have 40 days to get it all sorted. 40 Days!’
‘The Holly & the Ivy, when they were both full grown.’……. whispered around us.
‘I never realised it was so…..so ……’
‘Thrutchy? Thrutchy? Well it is! And to make matters worse, we don’t just have one place to look but loads of different clinical systems and paper. AND PAPERS NOT JUST IN ONE PLACE’ stressed a stressed Loz.
‘Paperless by 2018?’ I reminded them of Jeremy Hunts ‘promise’.
‘Snow was falling. Snow on snow. Snow on Snow. In the Bleak Midwinter…..’
‘Not gonna happen in our Trust that’s for sure.’ Said Jamie.
‘So’ I continued like a terrier in this Terrier town, ‘what do you have to do when someone asks for their record?’
‘Well then, first thing we do is send them a form to complete. We have to ask for some form of ID when they send it back. We also need to take into account if they are Next of Kin (and we need proof!), or if they are separated parents wanting access to their child’s record. In which case we need evidence of parental responsibility.
‘Wow! I didn’t realise it was so – so –‘
‘Well – yes and…..’
‘Yes. I mean it was so much easier when everything was on paper. And will be so much easier when everything is on computer. But at the moment….’ said Jamie.
‘It’s a mess. I’ve spent five days this week on these requests. I’ve got other work to do,’ said Loz. An already busy Medical Records Manager (with a different job title these days and a number of additional duties bolted on). Her name badge is now so big she has to walk sideways through her office door! She continued, ‘I copy some bits that are on paper. I download onto encrypted DVD any electronic data and sometimes I invite them in to have a look through their digital record.’
‘Yes but don’t you get paid for it Jamie don’t you?’ I asked, remembering reading something in my local daily rag.
‘Yes – we can. At the moment! We ask for money up front and don’t disclose the record until we have it. If it is just electronic information then we can only charge £10. If it is paper records we can and do charge £50 whether it is a request from patients or solicitors.
With deceased records we can charge an administration fee of £10 and then we charge 30p per double sided sheet of paper – some of these can add up to over £200 so we check with them first before we do the work to disclose. It’s a real challenge.’
‘What if they can’t afford it?’ I ask being devil’s advocate.
Jamie again: ‘We have the discretion to waive charges – deceased babies for example. We also do reduced rates for those on low incomes (but then we need proof – and that takes time to sort out.).’
‘Well I am flabbergasted. In fact my flabber has never been so gasted. What an administrative nightmare. Still at least you have a Xmas break to get on top of it till New Year!’ I gently propose, trying to bring us back to some sort of festive mood.
‘New Year! New Year? It gets worse. It’s going to get worse not better!’
I must admit, this wasn’t making me feel all cuddly and Xmassy. ‘Why will it get worse?’
‘GDPR! ‘said Jamie.
I wasn’t sure how a Railway Company could make it worse.
‘General Data Protection Regulation. New rules about data protection being implemented in 2018 across all of Europe. Including new rules about access and control of records.’
‘And how will accessing records be affected?’
‘Well, the issue is that we cannot make a charge under the new GDPR[ii]’
‘What – all that work you have to do you won’t get paid for?’
‘Correct – for example even in our relatively small Trust, our Disclosure Office has had a regular income in the region of £70k – this loss will now have to be found from other budgets.And we still have to do all this work and soon in 30 instead of 40 days.’
‘That is absoluety crazy. Crazy!’ I summarise.
Loz completes the misery with ‘and the reduction in disclosure time has reduced to 30 days from 40 days. But there is some good news.’
‘Good News? What’s that then?’
‘There’s free mulled wine and mince pies all night. I’m having another.’
Well – I suppose that IS good news – if you like your drink mulled!
Merry Christmas to you all and a Happy New Year.