2. Like sands
through the
hourglass, the
se are the
History
Records
Roles
Recommendations
Results?
The Present Situation
Storage
Daily Dramas
$$$$$$
Policy vs. Reality
3. Prior to February 2007 the Otago and Southland DHBs
were separate entities:
Clinical Records Service sat within the Information Group
No Corporate Records Structure or Service
Clinical Records Service sat within the Patient Services -
Surgical Division
Business Records Archiving System well established
February 2007 - The SouthernAlliance (OSDHB) was
formed between the 2 DHBs
4. 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
5. 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
6. Older records stored in “concrete
bunker”/boiler room
Current records stored in overcrowded room
behind main administrative office
7. 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)
8. 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
9.
10. VS.
Southland Dunedin
Windows
Natural light
Modern building
Ventilation
No Windows (Obviously)
Very old building
Inadequate ventilation
Risks (unsafe environment)
15. Best of both? Yes, where appropriate
Incorporating differences in location
Living 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
16. 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
17. 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
18. 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
19. After the Christchurch Earthquakes, some
potentially unsafe buildings on the
Southland campus were demolished
20. 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.
22. 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…
23. 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
26. 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”
35. Manager’s Responsibilities – Achieved
Records Manager’s Responsibilities – Achieved
Staff Responsibilities – Achieved
Does this make us “effective” when the issues
remain the same
38. Miracles (On
Christmas Eve /
Recoveries from
Illness) are a soap
opera cliché… but
in real life…
Fully electronic
records
$$$$
Safe & Healthy
environment
39.
40. Self-Assessment (82 pages)
257 separate documents as evidence
Corporate Records Coordinator time, fixed term
Inexperienced auditor
Lack of depth
Outcome =
43. South Island direction DHB agenda High Staff Turnover
Experienced staff moving on New Hazards
Policies, Legislation, Standards
etc.
Electronic Records DHB Funding
44. 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
45. HealthConnect South
SI New PAS
Shared Health Records – primary, secondary,
tertiary (electronic not paper)
Cloud storage – management of this
46. 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
88. 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
89.
90. This story has all the makings of a soap opera,
but in fact, it’s our story and truth is stranger
than fiction.
Notas del editor
Topic – titleLighthearted view of our storyPast and present dramas, a myriad of challenges, die-hard characters.Focus on clinical records, as what we know, and overview of all issues over the last 12 years.
Not an inspirational/ motivational presentationAn honest account of our story, which may have some parallels to your organisation?
Otago – and had done for a number of yearsSouthern Alliance – created a new set of challenges
CR supervisorCRCRegional/District managerCorporate Systems Manager/PRA Board chairSouthland – Frances etc.MH records – Otago/SouthlandClinical Records teamsSatellite record areas
Yes, the merger occurred, but essentially this occurred in name only – a new logo, on
Timeline of storage issuesCrown – Wakari – Crown2008 Southland to Crown2010 Wakari to CrownDumping ground at WakariLow risk , low priority, lack of decisions and interest – lip serviceNot included in decisions, not invited to consult, no place in MSP – no structure/inclusion of records storage – everyone just sees Electronic Records as the answer, without understanding the need to Electronic records – interfaces to PAS, equipment, efficiency, accessibility and reliability of systemsHybrid systems – different processes in different departments – trying to align or streamline these is impossible as the clinicians do wildly different thingsSouthland and Otago still have completely separate clinical systemsFinancial constraints re external storageCost centre pays for external storage, no global budget for recordkeeping/storage.Corrective Actions – audits, accreditations, certification – sort out storageNo global Recordkeeping framework
Detail recommendations – satellite, storage Dunedin, crown, electronic vs paper, convergence of patient management systems, audit corrective actions
Records tell our story, past present futureOur future is today, tomorrow, but it goes on and on like a soap operaRecords should be treated as an asset
Not included in many decisions, until something goes wrong, and then “Oh, I didn’t realise”… Not even entering people’s minds
Sound of muffled conversation
No interest or solutions for what exists, only going forward
Was expecting an analysis of hard-hitting directives so could be used as ammunition for improvement and the need to changeHigh expectations, was expecting a serious in-depth look, pinning hopes on it
Legislation, policies, procedures, guides, …
Support from individuals, but unfortunately individuals can’t change the culture of the organisationAny real changes require dollars, and buy in from staff
NHIT BoardSI AllianceShared care record – 5 DHBs & PHOs, GPs & other healthcare providers5 years awayReally sexy & interesting, but lack of awareness that “old” hard-copy records still need to be managed.
Over the last 12 years, nothing changedNo framework around concept, who manages it?
Good service
Numbers at CrownNumbers everywhere else – Dunedin, Lakes, Invercargill, Wakari, Linear meterageNumbers of records turned over each month
Active patient records – around the district, living documents,