Back @ the EPR Arms: September 2017 Finding stuff and understanding it once you have

Another night in the EPR Arms. The sky achieving a darker, dusky hue when another Hugh walked in through the main door.

Back @ the EPR Arms: February 2017 Daisy's Record

When do I stop saying ‘Happy New Year’ I asked Frank in the pub the other night.

‘Well, to be fair I think you’re milking it a bit now were in February’ he said with his usual frankness. Well it would be wouldn’t it?

‘Speaking of milking it, how’s your cows getting on?’ he asked.

‘Two pints of Badgers Crushed Paw bitter please landlord,’ I shouted in the direction of Bill the ever-busy barman/landlord/chef.

‘Daisy’

‘Daisy?’

‘Yes. Daisy the cow and Jasper the dog’.

‘Is this the start of one of your jokes? A cow and a dog walked into a bar’

‘By ‘eck you’ve lost it big time. Cheers’ he said taking one of the pints from me and heading to a table in the corner. Bustling busy Thursday. Nearly weekend. Nearly. ‘ I saw you do a presentation once about Daisy the cow and Jasper the dog’.

‘OK and now I’m back in the room’ I said, now confident that I hadn’t slipped into a paralell universe’.

‘ A presentation. That was years and years ago.’ I continued pulling the buffet towards me. (Buffet is a Yorkshire stool and is NOT food related.)

‘I know, but it left an impression. Not sure if that was a good or bad one but remind me and I will tell you’.

‘Well ,’ I said licking the froth from the side of the glass. Not a good habit but waste not want not (as they say in Yorkshire.) Frank adds ‘many a mickle meks a muckle’ as the say in either Scotland or Jamaica (depends on where you search on Google for proverb meanings! )

‘Well – it was based on a conversation I had with a farmer - in here actually Frank. And he was called Frank, Frank. Coincidence or what. Back in 2005. Wow! Eleven years ago. Gosh! Anyway, he told me his tale. This tale to be frank:

“In the old days, I used to get up at 4.30am and bring all the cows in from the fields and milk them at 5.30am and then again at tea time.”

“I bet that was hard chasing them all.”

“Well no actually. They want to be milked, ‘cos they get full and uncomfortable don’t they? Their udders is busting and swollen. So now’s I’ve got this fancy milking parlour, they come and get milked whenever they want. 24/7”

“How?”

“Well, I’ve chipped them all: a little tag on their ear. They know that when they enter the parlour they’ll be fed, so they approach the unit and the unit knows who it is by their chip. It releases the right amount of feed and checks if they’ve already been milked. They know the teat configuration and size (‘cos all cows udders are different), and the teats config has been measured by laser and stored in the unit. It then sterilises the teats. Attaches the milking cup thingy-bobs and milks each teat one by one.”

“One by one?” I asked.

“Yip. Instead of sticking a four teat vacuum thingy-bob on and sucking till all milk has come out, it measures milk flow and conductivity for each individual teat, and stops when the flow stops.”

“Conductivity?”

“Yip. Clever innit? The ‘lectricity flow across the milk is affected by things like infection.”

“Infection?”

“Yip. It plots graphs of the milk flow and conductivity of each teat. You can see which teat is infected and it sends me a text message on my mobile. And I’m still in bed!’

‘No way!’ I said.

‘Way!’ he replied.

“And wait for it, and this is the best bit, I end up with an electronic record of Daisys health and stuff.’

‘Health and stuff?’ I asked incredulously.

‘Yip. I have a record of Daisy’s milk yield, weight, food eaten, so I can work out if there’s a problem. I’ve even got her wearing a pedometer so I know how far she’s walked.”

“So why is this the best bit?” I asked.

“Because you’ve been going on for years about your electronic health record, your EPR and how that record should be a by-product and not simply the objective.”

I was impressed he’d latched onto my mantra – oft repeated, mostly by me! “Yes. Support clinicians in what they do and what they’ve done is automatically captured” I repeated mainly for Frank’s benefit.

“It’s the same with Daisy. My aim wasn’t to produce a record of Daisy’s health or milking history. I just wanted to get her milked efficiently. The computer is supporting the milking process and offering decision support and guidance: not too much food today. One of the teats is poorly etc. But you end up with all of it recorded electronically.”

‘Wow!’ So you’ve got an EPR equivalent?

‘Yes sir. Instead of having lab test requesting or your electronic prescribing, I’ve got milking. My milking is supported with technology. The computer directs me to capture the correct information that I need, it offers me guidance and support and it gives me, in return two things.’

‘TWO things?’

‘Yip. An electronic record AND a lie-in!’

Back to today:

‘You see Frank, some folk in our NHS lose track of what EPR is all about. Some think going paperless is the objective but it’s not. Supporting our busy doctors and nurses with computers simply improves their effectiveness and ensures all the right clinical data is captured by them during that episode and makes that available to others to impove their interractions with the patient. The fact that we need less paper is simply a by-product of using these epr type systems to support them in what they do.

‘So those Trusts that are responding to Jeremy Hunt’s vision by scanning their paper casenotes are barking up the wrong tree?’

‘Not necessarily, scanning the old legacy paper has a place in this emerging electronic record. But simply ‘going paperless’ by scanning does not give you the real clinical benefits of a proper epr system.’ I detected that I was losing Frank - he was eyeing up the Guest cask ale hand-pulled pumps and twitching nervously.

‘Frank! Frank. Let me explain: We could take the paper drug charts from the ward and either get someone to scan them every night or type in the drugs/dose etc for each patient on that patient’s EPR. That would give us an electronic record of what drugs had been prescribed and which were administered and by whom and when’.

‘Isn’t that what you want?’ asked Frank frankly losing interest by the minute.

In part yes, but we actually want these clever EPR systems to influence what drugs are being prescribed. We want decision support at the point of care. It’s all very well knowing later that what killed the patients was a dose six times higher than normal. We want to know that while the drug is being prescribed and certainly before it is being given.

‘And you end up with an electronic record of what was prescribed and administered?’

‘Yes- we end up with Daisy’s record!’

So that was where you got your presentation from? And what about Jaspers record?’ asked Frank being Frank again.

‘Jasper is another story for another night. Same again? Your shout!’

Back @ the EPR Arms: June 2017 Cyber Cyber Cyber

Soggy spring is transitioning into soggy June via soggy May.

May called an election. Shocked us all. We all shocked (collectively) her.

Drama and sadness: London then Manchester and London again.

Back @ the EPR Arms: December 2016 Christmas

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

 

Back @ the EPR Arms: May 2017 A troubled mind

‘Ay Up lad!’ said Fred as he let me go first to open the door of the EPR Arms, ‘You’ll have tae gee yit a whallop! All tha’ sun then’t rain then’t sun. Swelled it annit!’. 

You don’t need to go abroad to hear another language. I pushed the door and it didn’t budge.

 

‘A bigger whallop than that yer Jessie!’

 

I kicked the bottom of the door and simultanously pushed with my shoulder.

‘Tha’s better lad!’

 

And I was in.

Back @ the EPR Arms: October 2016 Wachter

Digitising the NHS.

Another busy night in the EPR Arms. Not quite autumnal but going that way. Nights getting shorter but  leaves refusing to leave their tree. TV Sofa ads promising delivery before Xmas. You get the drift - but not for a few months yet - not cold enough.

James Beattie, is the new Information Manager across the road at the local Trust and he’s just popped in after work for a 'snifter' before going home to his hot-pot and red cabbage. He had found Rupert, Surgical Directorate Manager, just getting them in for me and him, so he cleverly slipped into his slip-stream and sneaked a pint of Badgers off him.

"Ay Up! James,’ I said acknowledging the recent addition to the round, then back to Rupert,  ‘I am not saying it’s better Per Se Rupert,' I continued, taking my pint of Badgers from his outstretched hand, 'I am just saying that is the way of the world. You just can't stop modernisation just as you can't stop globalisation and mobilisation and any other 'ation' you care to mention. Digitisation is happening whether you like it or not'

'John Lennon!' said Tim - the hospital electrician sitting on a bar stool who had swivelled round to join in. 

'Eh?'

"I've had enough of reading things by neurotic, psychotic, pig-headed politicians' said Tim by way of explanation.

'It's nothing like!' said Rupert and I in unison.

‘Wrong song! ' Apologised Tim, 'everybody’s talking about revolution, evolution, flagellation, regulation, integration, meditation, United Nations.'

'That's better and thanks for your input Sparky. Haven’t you a fuse to go to?’

Rupert now directed his comments to James while his eye searched for somewhere to sit, ‘I was just saying James, this rush to digitise the clinical record is causing real issues with my docs and nurses. I mean real issues.’

‘In what way Rupert?’ asked James. 

‘Well for a start the number of separate clinical systems and their passwords. Nightmare. And there’s still lots of sharing passwords - on wards and in clinics. I see it every day in my Directorate'

'Is that still happening Rupert?’ I asked, assuming this had all been put to bed years ago. ’Doesn't everyone know passwords are to be kept private?'

'Yes perhaps they do, but the clinical systems that these busy doctors and nurses are using are the problem.' James replied

'How?'

'I'll tell you how!' said a very grumpy and tired looking Junior Doctor – bursting through the door and wiping the rain from her wax Barbour jacket. Just off-duty from A&E, it was Dawn by name and grumpy by nature. 'I'll tell you what! ‘Gin & Tonic Simon' she bellows across to one of her 'Caz' mates who’d just arrived at the bar. 'Simon, this guy wants to know what I think about 'computers'.' She spat out the word with enough venom to make all of us take three steps backwards. 'I'll tell you what. The Trust has made moves towards some almost integrated electronic patient record systems or EPR as they call them. That sounds like I am logging on to one system doesn’t it. One EPR. Wrong. Wrong. Oh how so flippin’ wrong. It actually means us busy clinicians accessing three or four different systems. Don't you think we've got enough to do without having to mess about with computers? Don't you?'

'I've watched Casualty on the telly on a Saturday night and Charlie is never busy. He just spends his time checking the ceiling tiles are still in place’ I said sidling over to a free table to bagsy and at a safe distance from Dawn.

'Don't believe all you see on telly Sweet Cheeks' replied Dawn. 'Not all systems are linked - most of them we have to log in separately: That means remembering - Log in Names. Passwords. Four different log-in names and four different passwords for the four different systems. I can't remember them all so I just write them down on a post-it note on the monitor'

Rupert looked at James across the table.

Dawn continues, 'so imagine you are on a busy ward or in a busy clinic or in A&E and you've logged in to your 'EPR' and you get called away to look at another patient in another cubicle. Someone takes your place at the PC and needs to urgently order some tests or prescribe a drug. It is very, very tempting for them to just carry on with the EPR logged in to YOUR log-in details. Saves time.

James jumped in at this point. 'OK Dawn – we appreciate that. But don’t you realise that’ll mean that anything done on that machine will be done against YOUR name?’

‘Exactly! If I don’t log out, because I’ve got called away urgently, then anyone can do whatever they want in MY NAME’

James continues, ‘But in court you will have no defence. If someone 'takes over' your PC and then prescribes a drug incorrectly - then what defence do you have? The overdose was prescribed by you as far as the court is concerned.'

"OK. OK said Rupert, ‘the basic issue here is why do folk not log out?' he directed the question at Dawn who by now had finished her first G&T and was waggling her glass at the bar for a refill. ’Simon! Another!’  Wow she MUST have had a bad day!

'I'll tell you what: Time. It takes SOOO long for a PC/workstation to fire up and allows a new user to log in with their own details.'

'But that is changing isn't it?'

‘Yes but will it change in my lifetime? They have been promising an all singing all dancing EPR for decades. Decades.’

Rupert begins to waken up to the theme. ‘You know, I'm beginning to think this electronic record just isn’t worth it. Just keep paper. It works fine.’

'What you guys talking about?' said Simon another of the JD’s from Cas, struggling with two beers (for him) and a large G&T (for Dawn) and a bag of scratchings clamped in the corner of his mouth (hopefully for us all.).

"Rupert was just saying that all this palaver with electronic records, he wants to go back to the tried and trusted paper casenote.

'Can't do - no turning back the clock' said Simon tearing open his scratchings and offering them to all on the table.

'But there was nowt wrong with how it was. I think we should go back' said Rupert.

'And I want to be twelve stone with brown hair' I said. 'It ain't gonna happen'.

Simon continues, 'And anyway, the NHS has changed. Moved on. It's no longer the place where you can have a leisurely tonsillectomy with a ten day length of stay. It's all different. All changed. More care in the Community. Changed. For all we hate these flipping computers, we need them. But we need them to be right.'

'And how do we do that?’ asked James.

‘Wachter’ said Simon.

‘Bless you!’ I replied.

‘No – Professor Wachter. He has written a brilliant pragmatic guide to IT in the NHS which came out last month (and a summary is available here on the NHS Digital website with an even more concise summary here on the IHRIM website).

He continues, ‘Professor Wachter reckons, and I quote ’The goal is not digitisation for digitisation sake, but rather to improve the way care is delivered in the NHS, in part by using digital tools.’

 

‘And that is exactly what the NHS EPR Programme concluded in 1998’ I added. ‘We seem to have lost our corporate memory.’

‘In what way?’ asked Simon.

‘Have a look at the final reports from the EPR Programme. It concluded that it wasn’t about creating an electronic record in hospitals Per Se, it was about supporting the clinical care processes with technology and the record will be a natural by-product. Use decision support tools where appropriate with the aim of improving clinical care. It seems that the NHS is on the road to getting rid of paper, but this is the end product not the goal in itself.’

‘Yes’ added Simon, ‘a senseless drive to scan paper without putting it in the right context for the clinicians is asking for trouble. Simply scanning paper into a single PDF file is asking for trouble. Expecting busy doctors to have to log on to four or more different systems is plainly asking for trouble. And if we aren’t ready for it then putting in a half-baked solution is just…..’

‘Asking for trouble?’ finished Rupert.

‘Exactly’ we all said almost together.

’And the time to do it is when all the appropriate infrastructure is in place, and we have all this logging-in nonsense resolved and enough hardware to stop us queuing for a free PC’ added Simon.

‘Yes actually that is a very fair point Simon’ I said, ‘I was in Malaga airport last month. Worked brilliantly – on-line booking; turned up at the airport and plane left on time, suitcases delivered to the right country BUT the queue at Passport Control was a nightmare’.

‘In what way?’ asked Rupert.

I continued, ‘They are going over to this digital/retinal scan/finger-printy model. Brilliant concept. But there is not the infrastructure yet for it to work. They only had two digital/retinal scan/finger-printy workstations!  TWO and a man in a box for Luddites who preferred the old way. The queues were almost back to the plane. In the end, the man in the box just waved everybody past him grumpily. They are not ready yet. You only get one chance – make sure the timing is right. Make sure you have the right technology in place, otherwise there will be trouble.’ I finished with a flourish.

Speaking of trouble, Dawn was well through her second G&T and detected a summing up of the discussion so she stopped drinking to add her twopence worth. ‘The techies have got to really understand how we clinicians work. We can’t have separate systems with separate passwords. That is crazy. We’ve got to have a quicker way of logging in and out. A Proximity card tap. I’m in. Tap I’m out. Simples.’

‘Is that all?’ asked Rupert.

‘No – it has GOT to be fast and well designed. I just haven’t got time to look for ‘stuff’ in three hundred scanned pages of rubbish. I need to see it in a well-designed place. Zap Zap Zap and Zing. Got it. If I can’t find it I’ll miss it. That could be dangerous. With the paper record, at least there was an understanding that not everything was necessarily there but you could easily flick through and find enough to crack on. But with these computers, we ASSUME everything is there. It may well be, but unless we can get into it quickly and find it, we’re up a creek without a paddle.’

‘Anything else?’ enquired Rupert, ‘Before we go?’

‘Yes – computers can be brilliant. They can help guide busy clinicians through decision support. Just because someone has said we have to be paperless in 2018 – no! -  2020 - no!  2023, doesn’t just mean simply scanning the paper casenotes. Oh no! We have to use technology to get all the above clinical benefits. To change the way that we deliver clinical care. Make it easier and also safer.

At that point everyone decided to move out into the wind and rain without a paddle or umbrella, at the end of another hard day at work and harder evening in the EPR Arms.

How is your Trust designing your electronic records?

Are they involving the doctors and nurses?

Are they involving you, in Medical Records?

How are they scanning the paper record? Is it being structured in an easy to access way or is it simply a single big fat file?

And why does Charlie Fairhurst keep looking at the ceiling?

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