I walked - nay slid, through the rain that had frozen to snow which in turn had warmed to slush as I turned the corner which would deliver me into the arms of the EPR.
As I took that corner, I could distinctly hear the seasonal tones of well played brass. A sound that tells me the shopping days to Xmas were reducing at a pace. I detected some wassailing1 too from the hospital choir. Once a year, all is forgotten with all tensions being put on hold. Whether a porter, cleaner, manager, nurse, doctor, OT, Physio, Radiology or Admin matters not a jot because they are all singing from the same carol sheet. Austerity paused. Brexit put on hold - for one night only!
1 The tradition of wassailing (alt sp wasselling) falls into two distinct categories: The house-visiting wassail and the orchard-visiting wassail. The house-visiting wassail is the practice of people going door-to-door, singing and offering a drink from the wassail bowl in exchange for gifts.
The Sally Army band always does this NHS gig and together with the hospital choir they start off in Outpatients foyer then meander along the corridors, pausing outside the wards, and finally playing and singing outside A&E before crossing the road to ‘do the street’.
Each and every pub and shop is targetted and in every pub, the well-oiled festive revellers dig deep. No doubt feeling that they are playing a part of a real live Christmas Carol. Imaging little Tiny Tim’s face when Scrooge appears with the goose held firmly in his ink-stained wrinkley hands - a goose bought with their donations. Life’s sadly not quite like that, but these charitable endeavors certainly bring smiles to everyone’s faces, as they remember there is always someone worse off than them.
I see the band and choir getting ready to cross the road, so I speed up just a bit to get in before they do. Bill is back behind the bar again after Trev, who had been acting as locum while he took his pre-Christmas hols.
‘Hows things Bill? Busy?’
‘Steady away Lad. Steady away’. (That’s Yorkshire for ‘yes it’s OK. Not too busy but people keep coming and going at regular intervals imbibing in my lovely alcoholic beverages. Thanks for asking.)
’So, have you had a good break?’
‘Yes just six weeks in the sun. And what a time to do it eh? Just as the weather goes all ‘Pete Tong’ over here!’
‘You can say that again. A pint of your best Badgers please before the Sally Army gets here’.
‘Oh yes – it’s that time again isn’t it. Do you know it doesn’t seem like a year since I was trying to get those pine needles out of the carpet! Plastic this year. Plastic I say!’
‘Good King Wenslas looked out on the feast of Stephen’ came floating through the cracks in the door a minute or two before the Sally Army and choir made their entrance.
‘Thanks Bill’ I said quickly taking my pint and looking around for a free chair. It was a busy night down at the EPR Arms. Folk staying behind after work for a quickie before venturing home. There was a group in the corner from across the road with a couple of spare chairs going begging. I remember them from another night in the bar - Medical Records I think, with a hint of coding.
‘Loz! I said 'How are you doing?’ I said pulling up the spare chair.
‘Fine. Fine. Even better now ‘cos I’ve done for Xmas. Two full weeks off. Wa-hey! Do you know the others? Michelle the coder with Jane and James. Same business-coding.’
‘Hi there. Merry Xmas! Busy time isn’t it with work and then all that shopping and kids getting excited and stuff’ I said to no-one in particular but Michelle grabbed it.
‘Actually I love this time of the year. It’s the only time I can get my kids to behave! ‘If you want something from Father Christmas then make your bed. Eat your tea. Sit quietly.’ The list goes on and on.’
‘Or threaten them with Santa’s Radar!’ added James.
‘What?’ we all asked.
‘My uncle tells his young children that the house alarms motion detectors in each room,you know, the thing that goes red if you walk passed it, well - he says that’s Santa’s radar and he is keeping an eye on all children to make sure they are behaving!’
‘That is SOOOO cruel’ was the collective response.
‘Come to think of it, he’s the same Uncle who tells his kids that Ice Cream vans only play that tinny music when they’ve run out of ice cream. Bit of a miser my Uncle’
‘And you remember Louisa from Records?’ continues Loz seamlessly.
‘Hi there Louisa. Isn’t this nice? All cozy and warm and seasonal. Roaring fire. Love it! Love it! And now the Sally Army and hospital choir to finish it off. What more could you hope for?’ I asked (I thought) rhetorically.
‘A job - that’s what!’ said Louisa.
‘But you’ve got a job haven’t you?’
‘Yes but my job is in medical records. You know? Where the PAPER records are. And guess what - they are getting rid of the paper record!’
‘Not till 2018’ said James.
‘2020 now’ added Jane.
‘I’d heard it was 2022’ contradicted Loz.
‘Actually 2023 is the latest’ I added my threepence worth.’ So things are not as immediate as you think Louisa’.
The First Noel, the angels did say, was to certain poor shepherds in fields where they lay’.
I need to nip this one in the bud or all the seasonal bonhomie will be out the door. ‘Well, for a start it will take a while yet. As you said yourself, it’s like chasing a rainbow: as soon as you get close to your crock of gold, it moves on. And so the date for going paperless is constantly shifting. And anyway, whatever happens, records still need to be managed. Getting rid of paper does not get rid of the need to manage the records. An electronic record is still a health record - just in a different format, so all the good practice still needs to apply. It won’t ‘just happen!’’
‘In what way?’ Louisa asks.
‘Right - Well. Access to the record. Who is going to manage that? Who knows (and understands) the rules about access to records? You do –that’s who. And who knows what bits you can show and which you can’t? And who has a legitimate right of access and who doesn’t? And what you actually are allowed to share? And how you record the complicated stuff like gender re-assignment and visitors to the NHS? And who knows how long to keep them?’
‘Keep them forever innit’ said the young Mark I hadn’t seen in the corner. One of the IM&T Department’s support team ’When Man first landed on the moon they had less computing power and storage memory than I had in my last but one mobile- iPhone 5. Storage isn’t an issue any more. We can store electronic records for ever. No more culling. No more destroying. End ov’
‘AH yes Mark but are you ALLOWED to keep them forever? Don’t you know about the Data Protection Act?’
‘Erhm…well erhm’
‘Just because you can technically and physically store them forever doesn’t mean you should.’ continued Louisa.
‘But if you can, then why wouldn’t you?’ said Michelle Coder, joining in. ‘If we want to understand the complete patients holistic lifetime clinical journey, surely we should be able to access ALL their record from birth onwards’.
‘Yes but again, it all has to be done within the law. If it’s illegal to store everything forever then it’s illegal to store everything forever’.
‘In which case the law is wrong!’ added Mark.
No one actually argued with that.
You see, that little interraction demonstrated the ongoing need to have people that understand records and their management. And don’t get me going on the actual structure of these electronic records!
‘You should be in there in the middle of whatever is going to replace your paper Louisa. You should be providing that expertise. Don’t just leave it to the teckies. They’ll just scan everything into a single massive PDF file. Most of them don’t actually understand record management. You do!’ I aimed that at Louisa or anyone else who was listening.
‘OK OK a fair point. Perhaps the pictures not as bleak as I thought’said Louisa.
………‘Snow was falling snow on snow, snow on snow’……..
‘It will be if you let it be’ I added. ‘And you Coders,’ I said swivelling on my stool to James, Jane and Michelle, ‘what does the future hold for you? You’re not going to be doing clinical coding in ten years’ time are you? Where are you going?’
‘Coding Auditor I reckon.’ said James.
‘Coding teacher’ said Jane.
‘Actually I don’t know,’ said Michelle. ‘I might actually do something completely different. Something in this new world of electronic records. I might do one of them there Informatics exams. New career might be my way forward. I don’t want to wait till I’m pushed out.’
‘Good plan,’ I said, ‘Why not. Get on the front foot.’
As the band and choir crept out to the dying strains of ‘In the Bleak Mid-Winter,’ a tired and damp looking elderly chap with a ruddy face, bushy beard and a red coat with well-worn leather boots came over to bagsy the spare stool (or buffet as they call them in Yorkshire – which might be confusing when someone shouts ‘the buffet’s ready’).
‘It’s pronounced Buff-it NOT Buff-ay’ said a Yorkshire translator usefully.
‘Mind if I join you? I’ve just finished my shift’ said the man in red.
‘Be our guest’ said Loz, ‘Shift where? Making childrens toys in Lapland by any chance?’
‘Toys? Lapland? No – at t’post office. I work forT’ Royal Mail. A postie. Have done man and boy. Rain or shine. Forty years. As I wuz comin’ in I heard you talking about losing your job. You know, I’ve been terrified of losing mine ever since that T’interweb started up. I mean, who needs a foot-slogging Postie when you’ve got email and text and WhatsApp and Face-off and LinkedUp and Snapface and all them stuff? ’
‘Good point’ says Mark, ‘and almost right! So how come you’re so tired and still working?’
‘Cos actually because 16 billion letters still get posted every year. Granted it’s down from our peak of 20 billion in 2004, but now they’ve added parcels to us round. What I lost in letters I med up for with all those packages from Amazon and ‘Not on th’ igh Street and ….It’s all gone mad.’
Louisa started to reminisce about the old days: ‘I remember when I used to order things from the paper or magazine. Titbits or Womans Own or something like. There would be a £5.99 delivery charge for something that cost a tenner and it would take 28 days to get to you. 28 days I tell you!’
‘Like those two footed slippers?’ joined in Louisa smirking. ‘I was almost tempted to try those.’
‘No – I never actually bought one of those. But now you can even get stuff delivered same day – same day!’ said Jane. ‘I mean – where’s the fun in that? I used to enjoy waiting for the delivery but now, I see what I fancy and click, it’s ordered and ding-dong, it’s arrived. No time to change me mind or what!’
‘We still and always will need ‘stuff’’ joined in James.
‘So in these last 15 years my job’s changed.’ said Mr Postie.
Yes, I thought. All our jobs have changed. When I first started work in the laboratories in the NHS, we used to do pregnancy test by concentrating the patient’s urine and injecting it into mice for four consecutive days. Every NHS hospital had an animal house. Nowadays you just need to lean on the chemist window and they can tell you the time and place you actually conceived. OK maybe not the place! Laboratories are now a very very different place to what they were, but they still need staff, albeit for roles that no longer involve fluffy/furry creatures...
‘I think the management of records will continue to be critical in the future and the IM&T guys don’t ‘own’ this role. Records, be they electronic or on paper, must be actively managed. It will not just ‘happen’ and for this to be achieved, the NHS needs staff with those record management skills. So Loz, don’t worry. It will take years and years and there’s always a place for you in the same way there will always be a role for you Mr Postman’
‘Ay – ‘appen. But if not, I reckon I could always get a job as Santa meself eh?’
And with a Ho Ho Ho he shuffled towards the door swinging his now empty sack behind him ‘And a very Merry Christmas to you all!’
As one we raised our glasses and clinked where we could and echoed
‘Merry Christmas to you all.’
And as he opened the door to slide his way down the road, the disappearing brass and choir sounds of Christmas were drowned out as Noddy Holder took over on the JukeBox with a less subtle IT’S CHRISTMASSSSSSSSSSSSS !
And so to you, readers of this EPR Arms column/blog and members of IHRIM, you too have a very Merry Christmas and a prosperous New Year. And look to the future now – it’s only just begun