Recordkeeping in times of change and financial constraint august 2013
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Jane Smith & Matthew DoddsSouthern DHB
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Like sands
through the
hourglass, the
se are the
HistoryRecords
Roles
Recommendations
Results?
The Present SituationStorage
Daily Dramas
$$$$$$
Policy vs. Reality
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Prior to February 2007 the Otago and Southland DHBs were separate entities:
Clinical Records Service sat within the Information GroupNo Corporate Records Structure or Service
Clinical Records Service sat within the Patient Services -Surgical DivisionBusiness Records Archiving System well established
February 2007 - The SouthernAlliance (OSDHB) was formed between the 2 DHBs
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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
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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
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Older records stored in “concrete bunker”/boiler room
Current records stored in overcrowded room behind main administrative office
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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)
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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
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VS.
Southland Dunedin
Windows Natural light Modern building Ventilation
No Windows (Obviously) Very old building Inadequate ventilation Risks (unsafe environment)
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VS.
Southland Dunedin
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2000 -2007
Feb. 2007 –
Apr. 2010
May 2010 -Present
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Best of both? Yes, where appropriate
Incorporating differences in locationLiving 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
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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
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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
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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
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After the Christchurch Earthquakes, some
potentially unsafe buildings on the
Southland campus were demolished
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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.
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Staff Comments - Verbatim
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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…
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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
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Incident/Near Miss/ Issue identified
Investigation
Root Cause Analysis
Recommendation / Business Case
submitted
Consultation & Delays
NOTHING!
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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”
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Relates to Records?
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Shortland Street
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DAYS OF OUR LIVES
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Manager’s Responsibilities – Achieved
Records Manager’s Responsibilities – Achieved
Staff Responsibilities – Achieved
Does this make us “effective” when the issues remain the same
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No (extra) funding
Low risk & priority
But…
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Miracles (On Christmas Eve / Recoveries from Illness) are a soap opera cliché… but in real life…
Fully electronic records
$$$$
Safe & Healthy environment
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Self-Assessment (82 pages)
257 separate documents as evidence
Corporate Records Coordinator time, fixed term
Inexperienced auditor
Lack of depth
Outcome =
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Records
Everything
Else
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South Island direction DHB agenda High Staff Turnover
Experienced staff moving on New HazardsPolicies, Legislation, Standards
etc.
Electronic Records DHB Funding
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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
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HealthConnect South
SI New PAS
Shared Health Records – primary, secondary, tertiary (electronic not paper)
Cloud storage – management of this
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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
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Virtual Tour
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“You’re not in Guatemala now, Dr. Ropata”
Then
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Now
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Then…andNow
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Then
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Virtual Tour
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Virtual Tour
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Virtual Tour
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Virtual Tour
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Virtual Tour
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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
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This story has all the makings of a soap opera, but in fact, it’s our story and truth is stranger than fiction.
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