Question about patient Id system used in hospitals and clinics

carlowplayer

Say for example I go to a hospital for surgery here in Ireland and waterford hospital and I am given a patient I'd will that is number stay the same if say I go for completly different stay in hospital again years later in St James hospital or indeed any other hospital in the world Or even an std clinic. How does the patient id system work

L1011

There is, as yet, no sharing of patient IDs across the entire country. There were plans to ensure that hospital groups used the same but last time I was exposed to the raw data (late 2013) they weren't even close to it.

Dingle_berry

When you are admitted to hospital the Patient Administration Ststem (PAS) generates a Medical Record Number (MRN) that is unique to you. This number generally doubles as your chart number too.
Most hospitals don't share PAS and rarely share charts so the same patient would have two different numbers. Even in hospitals that do share a PAS (eg waterford, kilkenny, Wexford and clonmel) the same patient could have several MRNs, one associated with their GP (for lab work), one with a waterford consultant and one with kilkenny etc.
In public sexual health clinics patients information is anonymised. They have seperate charts with only the patients initials on them.

This is far from ideal. There is a move towards a national laboratory information system (LIMS) now that would require national patient identifiers so maybe that will drive the change.

carlowplayer

Dingle_berry wrote: »

When you are admitted to hospital the Patient Administration Ststem (PAS) generates a Medical Record Number (MRN) that is unique to you. This number generally doubles as your chart number too.
Most hospitals don't share PAS and rarely share charts so the same patient would have two different numbers. Even in hospitals that do share a PAS (eg waterford, kilkenny, Wexford and clonmel) the same patient could have several MRNs, one associated with their GP (for lab work), one with a waterford consultant and one with kilkenny etc.
In public sexual health clinics patients information is anonymised. They have seperate charts with only the patients initials on them.

This is far from ideal. There is a move towards a national laboratory information system (LIMS) now that would require national patient identifiers so maybe that will drive the change.

Let me guess this information ie ID and medical info wouldn't be shared with hospitals in other countries at all

Abby19

carlowplayer wrote: »

Let me guess this information ie ID and medical info wouldn't be shared with hospitals in other countries at all

As an intern I can tell you that this information is readily shared between hospitals and various healthcare providers, but you have to identify yourself (I usually state my name, that I am an intern in X hospital working for Dr/Mr/Ms Y in Z speciality) and clearly identify the patient, usually using their DOB and address. I rang another hospital 3 times today about a particular patient. I regularly ring GPs to get more info on patients if they are poor historians. For ID related queries I have had to fax the patient's consent to release the information. Information has been got from overseas GPs and hospitals (cos they don't use our MRNs either).

Most hospitals here still have paper charts so you may have to file your request through medical records.

Yes it can be frustrating and let's face it, not the best use of time, but we don't reinvent the wheel every time someone comes in, especially if they have a long and complicated medical history in another facility.

Top tip - every time you go into hospital/OPD clinic, bring either a complete list of all your medications, however many you take and how many times a day. Saves the intern/ward pharmacist chasing it up with your GP/Pharmacy and reduces medication errors.

Dingle_berry

carlowplayer wrote: »

Let me guess this information ie ID and medical info wouldn't be shared with hospitals in other countries at all

The MRN would only be useful to people looking for that specific chart, ie people in the hospital.
Medical information would be shared if appropriate (patient consent, correct identifying details etc) Even radiology films, pathology samples etc are shared. Just not the actual charts, only what information is requested.

Vorsprung

Dingle_berry wrote: »

This is far from ideal. There is a move towards a national laboratory information system (LIMS) now that would require national patient identifiers so maybe that will drive the change.

Any movement on this does anyone know?

Dingle_berry

Vorsprung wrote: »

Any movement on this does anyone know?

Not that I've heard but bloodtrack is probably stealing its thunder for the foreseeable future.

Breezer

Beaumont is still seemingly rocking its 3 (or was it 4?) numbers per patient. Some of which are referred to by two different names. Good luck getting that one streamlined in a hurry.

Corruptedmorals

3 or 4...how would they file the charts? Sounds like a nightmare. Unless it's way the Hermitage does it which is having a number generated for each stay/claim etc but it all comes under the one MRN.

I spend too much time requesting blood results and scan reports, I'd love if that was centralised.

Dingle_berry

It's common for patients to have several charts and/or MRNs within a group of hospitals. You could be born in Kilkenny, go to college in waterford, have an accident in Wexford, then move to Clonmel where you have a baby. Similar for CUH, Tralee, etc.
Also each time a GP sends in a request with demographic details that don't match the historic ones a new MRN must be generated. Unless the GP confirms that they are the same patient.
So when you ask for a patients history it is worth checking for other charts/MRNs.

Corruptedmorals wrote: »

I spend too much time requesting blood results and scan reports, I'd love if that was centralised.

Most labs have a software system for making results available to the requesting clinician I thought?
Pathology and radiology are two seperate departments, seperate databases and admin staff too. It would be like asking for the paeds ward to be centralised with CCU or something

dreamers75

HSE hospitals have possibly the worst document management systems in the history of document management. One hospital threw all their MRs into a prefab and i mean literally threw them in, they use the terminal digit system which is archaic but the staff/union wont allow training to a more umm system from this century.

Some hospitals have teams of staff who have to locate these files from the "pile in the prefab" in one hospital it was a team of 17 but in fairness it was a big pile.

What they should do is an online portal for new patients and should be digital only (Dr/nurse use Ipad/Tablet only), what they did was split the hospitals into 4 territories and went to tender for options, they all picked different ones . These will come online in the year 3000 but all of the companies who won the tenders will be paid and it will be very expensive and none of the issues they have will be addressed.

Corruptedmorals

Dingle_berry wrote: »

Most labs have a software system for making results available to the requesting clinician I thought?
Pathology and radiology are two seperate departments, seperate databases and admin staff too. It would be like asking for the paeds ward to be centralised with CCU or something

I'm a secretary, I have to request results from other HSE hospitals. Also internally we only have access to bloods, all radiology reports and everything else have to be requested through the department. In this day and age it feels archaic. Even the system when I worked in a private hospital where the digital record was cohesive with all of the patient's results together would be amazing by contrast. As for databases though-there could be one for bloods and one for radiology reports-NIMIS already does radiology films for HSE hospitals, something like that.

I don't see much of an issue with terminal digit chart filing though. Once the filing system is organised and the charts are tracked, it works fine and it's too much money to digitise records.

hardCopy

The patient's PPSN would seem a logical unique identifier to use, I did I hear a rumor though that it would be unworkable due to data protection concerns.

echo beach

hardCopy wrote: »

The patient's PPSN would seem a logical unique identifier to use, I did I hear a rumor though that it would be unworkable due to data protection concerns.

Logical but as you say there are data protection problems. When data, like a PPSN, is collected it can only be used for the purpose for which it is collected.
The PPSN is issued for tax and social welfare purposes but somehow the HSE use it all the time. It is on medical cards and DPS cards and is used in vaccination records and for smear testing and breastcheck.

Breezer

Corruptedmorals wrote: »

3 or 4...how would they file the charts? Sounds like a nightmare. Unless it's way the Hermitage does it which is having a number generated for each stay/claim etc but it all comes under the one MRN.

I spend too much time requesting blood results and scan reports, I'd love if that was centralised.

Yeah something like that. 'Episode number' every time you're admitted or a GP requests bloods. 'MRN' for the chart. Some other number for the blood bank. Radiology uses one of these, can't remember which one, and there's something called a 'history number' which is the same as one of the above, but has a different name just to keep things interesting.

End result: if as a GP I ring up to get blood results for a patient I'm asked for an episode number, which of course I don't know. I'm then transferred to some admin office who takes patient details and the date the bloods were done and translates that into an episode number. Then I get transferred back to the lab and they can use the number to give me results. If bloods were taken on two occasions I can end up doing it twice. On one occasion bloods were taken at some point prior to or after an OPD, requested by the hospital, but I needed them for something a while later. I ended up writing to the consultant to get them. Nightmare for all concerned.

Dingle_berry

Breezer wrote: »

Yeah something like that. 'Episode number' every time you're admitted or a GP requests bloods. 'MRN' for the chart. Some other number for the blood bank. Radiology uses one of these, can't remember which one, and there's something called a 'history number' which is the same as one of the above, but has a different name just to keep things interesting.

End result: if as a GP I ring up to get blood results for a patient I'm asked for an episode number, which of course I don't know. I'm then transferred to some admin office who takes patient details and the date the bloods were done and translates that into an episode number. Then I get transferred back to the lab and they can use the number to give me results. If bloods were taken on two occasions I can end up doing it twice. On one occasion bloods were taken at some point prior to or after an OPD, requested by the hospital, but I needed them for something a while later. I ended up writing to the consultant to get them. Nightmare for all concerned.

May I ask if that is an Irish lab (using episode numbers)? What format do these numbers take? 04BB321?
The lab surely has some way of tying all of a patients results together. An MRN is the easiest way.

Breezer

Dingle_berry wrote: »

May I ask if that is an Irish lab (using episode numbers)? What format do these numbers take? 04BB321?
The lab surely has some way of tying all of a patients results together. An MRN is the easiest way.

Beaumont. No idea what format they take, it's a relatively long number. From the time I worked there, I remember all the numbers got printed on stickers for the chart, so they must tie together somewhere. But for practical purposes i.e. ordering tests or chasing them up, you need specific numbers, and there doesn't seem to be any way for the individual systems to cross-reference them. My impression was that the system was built bit by bit as the hospital developed over the years, and now needs a complete overhaul, but this would take time and money which if it's to go anywhere probably needs to go into things that will have a more direct impact on patient care.