Jane Smith & Matthew DoddsSouthern DHB

Like sands

through the

hourglass, the

se are the

HistoryRecords

Roles

Recommendations

Results?

The Present SituationStorage

Daily Dramas

$$$$$$

Policy vs. Reality

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

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

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

Older records stored in “concrete bunker”/boiler room

Current records stored in overcrowded room behind main administrative office

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)

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

VS.

Southland Dunedin

Windows Natural light Modern building Ventilation

No Windows (Obviously) Very old building Inadequate ventilation Risks (unsafe environment)

VS.

Southland Dunedin

2000 -2007

Feb. 2007 –

Apr. 2010

May 2010 -Present

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

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

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

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

After the Christchurch Earthquakes, some

potentially unsafe buildings on the

Southland campus were demolished

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.

Staff Comments - Verbatim

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…

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

Incident/Near Miss/ Issue identified

Investigation

Root Cause Analysis

Recommendation / Business Case

submitted

Consultation & Delays

NOTHING!

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”

Relates to Records?

Shortland Street

DAYS OF OUR LIVES

Manager’s Responsibilities – Achieved

Records Manager’s Responsibilities – Achieved

Staff Responsibilities – Achieved

Does this make us “effective” when the issues remain the same

No (extra) funding

Low risk & priority

But…

Miracles (On Christmas Eve / Recoveries from Illness) are a soap opera cliché… but in real life…

Fully electronic records

$$$$

Safe & Healthy environment

Self-Assessment (82 pages)

257 separate documents as evidence

Corporate Records Coordinator time, fixed term

Inexperienced auditor

Lack of depth

Outcome =

Records

Everything

Else

South Island direction DHB agenda High Staff Turnover

Experienced staff moving on New HazardsPolicies, Legislation, Standards

etc.

Electronic Records DHB Funding

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

HealthConnect South

SI New PAS

Shared Health Records – primary, secondary, tertiary (electronic not paper)

Cloud storage – management of this

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

Virtual Tour

“You’re not in Guatemala now, Dr. Ropata”

Then

Now

Then…andNow

Then

Virtual Tour

Virtual Tour

Virtual Tour

Virtual Tour

Virtual Tour

http://www.crownrms.com/newzealand

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

This story has all the makings of a soap opera, but in fact, it’s our story and truth is stranger than fiction.