Missing Medical Notes
Discussion
I had to visit my local MIU a few days ago after standing on a piece of wood which had a protruding nail.
No problem with the treatment that I received but something rather concerning came to light.
I have lived in the same town for over 30 years and have been with the same medical practice for the whole of that period. The Practice recently merged with another practice which operates out of the same building. MIU is in a different building about 20 metres away.
The Nurse who treated me told me that I did not exist on their
computer system.
She wrote me a note to take to practice reception asap.
It stated
'Please can you update the Patients NHS Spine Clinical Notes as we have no records for him.'
A bit concerning if I had an accident elsewhere and was unconscious.
Has anyone else had a similar experience? The Receptionist that I spoke to could not understand how this could have happened.
No problem with the treatment that I received but something rather concerning came to light.
I have lived in the same town for over 30 years and have been with the same medical practice for the whole of that period. The Practice recently merged with another practice which operates out of the same building. MIU is in a different building about 20 metres away.
The Nurse who treated me told me that I did not exist on their
computer system.
She wrote me a note to take to practice reception asap.
It stated
'Please can you update the Patients NHS Spine Clinical Notes as we have no records for him.'
A bit concerning if I had an accident elsewhere and was unconscious.
Has anyone else had a similar experience? The Receptionist that I spoke to could not understand how this could have happened.
Considering there are over 44,000 healthcare IT systems in 26,000 organisations it's unsurprising data gets lost:
https://digital.nhs.uk/services/care-identity-serv...
It's an inexcusable shambles.
https://digital.nhs.uk/services/care-identity-serv...
It's an inexcusable shambles.
Riley Blue said:
Considering there are over 44,000 healthcare IT systems in 26,000 organisations it's unsurprising data gets lost:
https://digital.nhs.uk/services/care-identity-serv...
It's an inexcusable shambles.
Well that's something I didn't know. As you say, hardly surprising.https://digital.nhs.uk/services/care-identity-serv...
It's an inexcusable shambles.
Recently I needed to ask for a copy of my full medical record. I got back nearly 300 pages of pdf hosted via some sort of secure platform where you can read/download it. I was amazed with scanned records going back to the early 80s!
Over the past few years I've been impressed by the development of the NHS App and also the MyChart/MyMFT App that gives near instant test results as soon as they're completed along with Consultant's letters etc.
Clearly in some NHS Trusts it works, but not a uniform picture across the country.
Over the past few years I've been impressed by the development of the NHS App and also the MyChart/MyMFT App that gives near instant test results as soon as they're completed along with Consultant's letters etc.
Clearly in some NHS Trusts it works, but not a uniform picture across the country.
Primary and secondary care are notoriously bad at sharing information. The MIU data may be on a different platform.
You can ask for a subject access request for your patient data, however, I suspect all you really want is for your information to be joined up and accessible.
I would be persistent though - as losing patient information is not good / not legal / poor record keeping.
You can ask for a subject access request for your patient data, however, I suspect all you really want is for your information to be joined up and accessible.
I would be persistent though - as losing patient information is not good / not legal / poor record keeping.
ISTM that it's more a case of NHS systems not talking to each other. Your records are presumably with the GP but invisible to the staff you saw.
Don't underestimate just how s
te and shambolic NHS IT can be. When I was logging in to look at and make entries in my patients' records I had separate systems for
Each system had a separate username and password and expiry periods - couldn't jump between systems so to adequately assess and record something about a patient I had to open all of these separate systems. Woe betide me if I left my desk to actually see a patient because it all locked up, if another member of staff hadn't logged themselves in, I had to log in to all of the information systems again.
I joked, not innaccurately, that I was being paid tens of thousands a year just to log in and out of information systems.
Our own Trust was particularly shambolic as rather than purchase an established information system it went down the penny pinching route and entered into an arrangement with a developer to essentially beta test a non established system. It persisted with this for about a decade before abandoning it and then failed to learn the lesson and got into bed with another developer for the next system. The old record system was locked after a few months and access to patients' historical records from the new system was akin to trying to find a book in a library through the keyhole let alone read what is in the book.
Apart from not commuting, freedom from IT misery is one of the greatest benefits of retirement.
Don't underestimate just how s
te and shambolic NHS IT can be. When I was logging in to look at and make entries in my patients' records I had separate systems for- Trust records where I made my own entries and could read colleagues (in the same organisation's) entries
- Drug prescription system
- Adjacent trust for pathology (blood tests mainly) records through rotating residents who kept their log in details whilst seconded to us. I got access as a part of a pilot scheme but other consultants didn't.
- Another system for radiology records which I couldn't access but residents who had kept their passwords could get in
- No access to records for adjacent Trust
- No access to GP records other than a sort of 'front door' summary.
- No access to social care records. Not even being able to identify whether patient known to social services. This required a phone call to someone who could access the record.
Each system had a separate username and password and expiry periods - couldn't jump between systems so to adequately assess and record something about a patient I had to open all of these separate systems. Woe betide me if I left my desk to actually see a patient because it all locked up, if another member of staff hadn't logged themselves in, I had to log in to all of the information systems again.
I joked, not innaccurately, that I was being paid tens of thousands a year just to log in and out of information systems.
Our own Trust was particularly shambolic as rather than purchase an established information system it went down the penny pinching route and entered into an arrangement with a developer to essentially beta test a non established system. It persisted with this for about a decade before abandoning it and then failed to learn the lesson and got into bed with another developer for the next system. The old record system was locked after a few months and access to patients' historical records from the new system was akin to trying to find a book in a library through the keyhole let alone read what is in the book.
Apart from not commuting, freedom from IT misery is one of the greatest benefits of retirement.
Edited by oddman on Sunday 14th September 08:40
We are just finishing implementing the EPR systems in hospitals across the country.
Electronic Patient Record.
Not just the notes, but all the other stuff too. Drug records, medical imaging xrays. Operation records etc.
Guess how many different EPRs softwares there are in use. (all talking difference languages)?
https://6b.health/insight/list-of-eprs-in-nhs-trus...
Answer ; a lot.
When do bits of software talk to each other? Answer: never.
But the last time the NHS tried a single bit of software for everything, they spent £13 billion on it, and then cancelled it.
Yes £13billion wasted.
If you thought it was easy to have "Medical Notes" all in one place and download able, then think again.
Probably another £20billion spend
Electronic Patient Record.
Not just the notes, but all the other stuff too. Drug records, medical imaging xrays. Operation records etc.
Guess how many different EPRs softwares there are in use. (all talking difference languages)?
https://6b.health/insight/list-of-eprs-in-nhs-trus...
Answer ; a lot.
When do bits of software talk to each other? Answer: never.
But the last time the NHS tried a single bit of software for everything, they spent £13 billion on it, and then cancelled it.
Yes £13billion wasted.
If you thought it was easy to have "Medical Notes" all in one place and download able, then think again.
Probably another £20billion spend
Also to say from personal experience, if you come in unconscious from a wreck on a motorway or from the bottom of your stairs,
we have a plan.
But if you have a serious (anaphylaxis, not itchy rash) reaction to something, maybe wear a bracelet or the thing on your phone for medical alerts....
I have treated unconscious people who don't even have a name, sometime for 24-36 hrs.
John Doe on ITU on day 2.
we have a plan.
But if you have a serious (anaphylaxis, not itchy rash) reaction to something, maybe wear a bracelet or the thing on your phone for medical alerts....
I have treated unconscious people who don't even have a name, sometime for 24-36 hrs.
John Doe on ITU on day 2.
Zingari said:
Recently I needed to ask for a copy of my full medical record. I got back nearly 300 pages of pdf hosted via some sort of secure platform where you can read/download it. I was amazed with scanned records going back to the early 80s!
Over the past few years I've been impressed by the development of the NHS App and also the MyChart/MyMFT App that gives near instant test results as soon as they're completed along with Consultant's letters etc.
Clearly in some NHS Trusts it works, but not a uniform picture across the country.
The cost of implementing Epic in Manchester really has been (and still is) epic!!Over the past few years I've been impressed by the development of the NHS App and also the MyChart/MyMFT App that gives near instant test results as soon as they're completed along with Consultant's letters etc.
Clearly in some NHS Trusts it works, but not a uniform picture across the country.
People moan about the NHS spending £££££ on management, some of the costs for the US based electronic health records is on a different level.
Epic however still doesn't integrate with GP system and NHS spine is a different matter, so its still essentially just acute care record.
https://www.hsj.co.uk/technology-and-innovation/45...
A large Trust I work with, have a warehouse approximately 2600 sq M for their Central Record store, which is off site from the Hospital. Most of that floor space is for the records, which stored in roller shelves, ala these:
https://storageaspects.co.uk/product/pharmaceutica...
Records a stored 7 shelves high, don't know how many rows where there, but it was a lot! I was amazed the volume of records are there. I have photos but can't really post them, but just found when the facility was built nearly 20 years ago, and at the time it had up to 1m individual patient records and 1.5 miles of shelving, so probably a lot more now. It is a big job to digitise this (duh!), which is due in start in a year or two, allegedly.
From memory they have to hold the records for 10 years (after death of a person?), and the people that do the filing start as a Band 2.
https://storageaspects.co.uk/product/pharmaceutica...
Records a stored 7 shelves high, don't know how many rows where there, but it was a lot! I was amazed the volume of records are there. I have photos but can't really post them, but just found when the facility was built nearly 20 years ago, and at the time it had up to 1m individual patient records and 1.5 miles of shelving, so probably a lot more now. It is a big job to digitise this (duh!), which is due in start in a year or two, allegedly.
From memory they have to hold the records for 10 years (after death of a person?), and the people that do the filing start as a Band 2.
Our new EPR is not going to digitise old records en masse (what with the Sun only having a certain amount of fuel and Bezos having all the cash)
But will digitise said legacy records on request.
Weirdly this used to be fast - ish. You asked a porter to go to Records and he came back with the paper file about 3hrs later. You read it with your fingers helping your eyes.
I think the new tech will be slower/worse/more expensive/open to digital attack /need 4hrs of online learning/ impenetrable to the senior staff / abandoned by the very firm that sold it after 7 yrs / etc
Copy and paste that sentance to any other place you see fit
But will digitise said legacy records on request.
Weirdly this used to be fast - ish. You asked a porter to go to Records and he came back with the paper file about 3hrs later. You read it with your fingers helping your eyes.
I think the new tech will be slower/worse/more expensive/open to digital attack /need 4hrs of online learning/ impenetrable to the senior staff / abandoned by the very firm that sold it after 7 yrs / etc
Copy and paste that sentance to any other place you see fit
I refer to NHS IT as Nst.
It's a huge mess. I'm a GP, and in Scotland, so a bit different to England and Wales and that's also part of the problem. I have patients who have moved across border and a couple of years down the line I still don't have their previous GP notes. All the paper records were "back-scanned" a couple of years ago so older GP records for each patient are now in a single non-searchable pdf i.e if I want to read back to review some information from 10, 20, 30 years ago I have to click through page by page.
And to do the normal day job I have to log on to 6 different bits of software, all with differing password requirements and different intervals for changing.
t.It's a huge mess. I'm a GP, and in Scotland, so a bit different to England and Wales and that's also part of the problem. I have patients who have moved across border and a couple of years down the line I still don't have their previous GP notes. All the paper records were "back-scanned" a couple of years ago so older GP records for each patient are now in a single non-searchable pdf i.e if I want to read back to review some information from 10, 20, 30 years ago I have to click through page by page.
And to do the normal day job I have to log on to 6 different bits of software, all with differing password requirements and different intervals for changing.
The_Doc said:
Weirdly this used to be fast - ish. You asked a porter to go to Records and he came back with the paper file about 3hrs later. You read it with your fingers helping your eyes.
I think the new tech will be slower/worse/more expensive/open to digital attack /need 4hrs of online learning/ impenetrable to the senior staff / abandoned by the very firm that sold it after 7 yrs / etc
Quite, and if I missed a vital piece of information in a paper record, I would be culpable but would feel this was somewhat justified.I think the new tech will be slower/worse/more expensive/open to digital attack /need 4hrs of online learning/ impenetrable to the senior staff / abandoned by the very firm that sold it after 7 yrs / etc
With electronic records I could be held responsible for a poor decision because I missed a needle of information in a field of haystacks.
If the NHS was in charge of test cricket it would be sending its opening batsmen out with a butcher's apron and paper hat for protection and a table tennis bat to face a fast bowler.
The_Doc said:
I think the new tech will be slower/worse/more expensive/open to digital attack /need 4hrs of online learning/ impenetrable to the senior staff / abandoned by the very firm that sold it after 7 yrs / etc
However if you walked into a bank now and asked to see your bank statements, how reassured would you be if they than disappeared into the back and started riffling through archives of paper. You than ask about the deposit you made a week ago, they cannot find it as the bit of paper has now gone missing, but you have a carbon paper copy so you show them.....that than triggers more frantic paper searching etc. You can also forget about login into the banking app to look at recent transactions, the most you can do remotely is to phone up the branch and hope you can speak to the same guy that served you and remember when they put your paper records of your account.Its actually staggering just how much is still done on paper in the NHS, considering the stakes involved, illegible handwriting, misfiled notes, wrong ID sticker, the amount of medical error/misses that's potentially sitting in paper records is unknown to anyone. There is a huge amount of potential for digital transformation in clinical care, but you do need digital records first and foremost, not necessary human typed - ambient Ai dictation, even theatre tracking tools are all things ready for implementation. Personally I think the biggest benefit of digital records is for patients, as digital records allow for everyone to see what's been discussed, and whats planned, where people on the waiting list.......It's a level of transparency with NHS processes that current patients simply cannot get access to purely because how analogue processes are.
Edited by gangzoom on Monday 15th September 12:48
oddman said:
Quite, and if I missed a vital piece of information in a paper record, I would be culpable but would feel this was somewhat justified.
With electronic records I could be held responsible for a poor decision because I missed a needle of information in a field of haystacks.
How do you know now on paper you actually have all the most up-to-date records for a patient? With electronic records I could be held responsible for a poor decision because I missed a needle of information in a field of haystacks.
If the patient doesn't mention it, or forgets to mention it, how would you know if they have been admitted to ED last night with anaphylaxis to the drug you are about to prescribe in clinic?
gangzoom said:
oddman said:
Quite, and if I missed a vital piece of information in a paper record, I would be culpable but would feel this was somewhat justified.
With electronic records I could be held responsible for a poor decision because I missed a needle of information in a field of haystacks.
How do you know now on paper you actually have all the most up-to-date records for a patient? With electronic records I could be held responsible for a poor decision because I missed a needle of information in a field of haystacks.
If the patient doesn't mention it, or forgets to mention it, how would you know if they have been admitted to ED last night with anaphylaxis to the drug you are about to prescribe in clinic?
Gassing Station | Health Matters | Top of Page | What's New | My Stuff