Issue 3 : Records Management

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The Problem

1. Define in 10-20 words.

“Records Management” refers to the problems that stem from using paper records.

[Chung's Comment]

The problems lie in the lack of dialogue between ER and other departments regarding the exchange of patient records.

2. Research: What information were you able to find on the web or from readings?

Hospitals deal with large volumes of data. Storing, organizing, and retrieving this data creates major issues. Several studies have been conducted to determine the optimal solutions for managing hospital records.

A study in 2000 conducted by Pia Elberg at Aalborg University, Denmark, discusses the benefits of implementing an electronic records database. The study concluded that hospital have the potential to be more efficient with electronic databases but it requires the hospital staff to change their way of conducting business. The study is titled How can electronic patient records help innovate health care? [1]

Another article by Dr. Todd Taylor, at Arizona College of Osteopathic Medicine, discusses the issues of information management in the ED. Taylor writes: “If you cannot measure it, you cannot manage it”—trite, but true. Such is the state of many emergency departments (ED)—unmanageable because of a lack of valid measurable metrics of patient care. Even worse, often the information that is available is inaccurate, too little, and too late to affect patient care on a real time basis. Such are the challenges for ED managers in the current health care environment. It seems that technology would be a natural tool." [2]

3. How can the problem be measured?

Some possible metrics include:

Number of files and space needed to store files

Nurse flow charts (daily patterns - how often nurses have to refer to a patients charts)

Number of issues caused by loss of files

Cost of paper based system vs. electronic system

Time study - how long does it take to retrieve files?

Wait time - paper based systems vs. electronic systems

Patient satisfaction surveys (Press Ganey)

[Chung's Comment] The metrics could include:

1) the amount of data exchange (hourly, daily, monthly) between departments.

2) the amount of data exchange (hourly, daily, monthly) directly related to patient records.

3) The exchange time/cost difference per patient record between paper-based and electronic systems.

COMMENTS: Ackerman I think I've missed the point entirely. Let's say you have an electronic information system... you still have "records management" problems. The problem is that on the clinical side (including pharmacy) as well as the business side, we need a lot of information. We need it accurately, and we need it now. Many patients cannot, for a wide variety of reasons give me useful information. Sometimes I can figure it out from other sources.

Emory, Crawford Long, and Grady (yes Grady) have electronic medical records (more or less). Yet we still have paper charts that are kept in parallel. Why? well... some have to do with certain documentation requirements such as having actual signatures for consent to treatment and consents for procedures. Ambulances usually hand us the "run sheet". Patients from nursing homes sometimes come with a stack of paper (usually missing the information I actually need) that might contain medical history or other information. When we get a call regarding an "expected patient" or transfer usually this is transcribed on paper. Plus computer systems crash. I find increasingly with our electronic medical record I have too much information about irrelevant things and what I care about is buried in the mess and it doesn't matter if it is on a piece of paper or stored in bits and bytes. If I don't have the information then I can't take as good care of the patient. A medication that the patient is on or an allergy that I don't know about can cause a fatal error, and often at a time when I can't afford to take a long time searching and (unfortunately) I may be the only part of the time who would recognize the bit of information as being important...

Medical informatics has been around as a field for nearly 40 years and the big problem of "records management" remains unsolved. Focus on something in particular that has specific metrics. As an example - Patients from nursing homes are brought to the ER with incomplete medical histories and are frequently unable to provide this information. A measure could then be percentage of nursing home patients with current medications/allergies/recent vital signs (from the home, not EMS), documented baseline functional status, living will or DNR status...

Press Ganey is a terrible measure for this group of problems. Staff job satisfaction surveys might be better.

[Chung's Comment]

1) The current system needs to be modified because the workflow itself is not working efficiently in terms of time and cost.

2) Indentifying the nature of tasks in the current workflow is the first step to understand the process.

3) Re-defining the scope and relations of tasks is urgent.

4) All measurement of data exchange of workflow should be on a quantified basis.

5) Proposed workflow could be based on a comparative study.

6) Levels of complexity of tasks in different phases need to be examined in a careful way.