Digitisation & Integration of Healthcare Records, why do we lag so far behind?

How did we end up being back of the class when it comes to an integrated healthcare records system in Ireland? How did we fail to implement APIs to interlink hospital and doctor records? 

In 2017 I was once nearly a victim of lack of such a system. During an admission to a public hospital for emergency abdominal surgery it was noted I had a lesion at the base of my lung that to the respiratory consultant looked like cancer. It wasn’t, but was the calcified remains of a subdiaphragmatic abscess caused by a previous bowel leakage, as noted at a private hospital where I had undergone surgery. The public hospital had already pencilled me in for urgent removal of a lung lobe as the lesion appeared identical to mesothelioma. In order to save myself from the fate of unnecessary lung removal I needed to drive over to the private hospital and sign a form to release my medical records. I’m sure this type of thing happens to others day in day out, but it felt unreal at the time and caused a vast amount of stress. 

What exactly stopped us from getting to where consultants, GPs, patients and other healthcare professionals are unable to communicate through a common portal? The tech has been here long ago. For anyone with any familiarity at all with Linux directory and file permissions, this sort of thing could be applied to healthcare record permissions in the form of Healthcare

Professional Groups, and Patient Group. Eg Pharmacy Group would have permissions to view key information & current treatments, and to record medicines dispensed. 

Yes it would be complicated to set up, but there are already APIs which could be utilised and others which could be tailored. Security & as safe as possible back-ups would be vital considerations, with basic medical professional ledgers kept as to basic updates. Eg “Rosemary Murphy: underwent spine MRI 30/11/2021 no lesion noted”, so there would be a very small paper trail in the event of a systems failure. 

A lot of person-power would be needed in the digitisation process, a lot of trusted persons sitting at screens for a couple of years to even begin to catch up. I worked on digitisation projects where a lot of staff working 7 days, on overtime, did an amazingly fast and efficient job of reinstating lost data after a fire destroyed the server which was not remotely backed up. It would take the political will and investment. I believe the new Children’s Hospital will be paperless. No reason why everywhere should not be, except finding enough trusted people for data handling would be a challenge, after all we are dealing with very sensitive personal medical records. 

https://techarchives.irish/irelands-first-computers-1956-69/david-kennedy/

From the 1960s this guy developed an IT system for Aer Lingus operations, first program was in FORTRAN created by John Byrne of TCD who happened to be a relative of mine. David Kennedy created an Aer Lingus subsidiary, Cara, which sold software to other aviation entities.

We need people like him to analyse and implement what is needed in our healthcare systems.

BattleCorp

It's being looked at now but it wasn't a priority for years. Lack of joined up thinking. The HSE is run on spreadsheets which is akin to working on an abacus nowadays.

nothing

Did a stint as a student at a hospital (back when they used take on secondary students for summers), the computer based system was awful, and learned that basically every individual hospital had paid for/developed their own system and there was pretty much no compatability from one hospital to another. That blew my mind 20 years ago at the lack of foresight, the waste of resources, and sheer idiocy. I suspect nothing has changed.

GreeBo

Its kinda linked to the national identity stuff.

To properly implement such a system you first need a unique way to identify each person.

Then all systems need to be computerised and use this unique identifier.

Then the systems need to be linked.

But people start to talk about big brother and GDPR nonsense.

Its really easy to hide stuff when everything is unconnected and on paper as it takes manual effort to find things, but once things are connected you can throw hardware at it and it will spit out things that warrant further investigation. Certain people dont like that.

shesty

There appears to be some reluctance to allow attempts to introduce digital records to get up and running.

https://www.irishtimes.com/health/2023/01/25/digitisation-of-health-service-is-being-impeded-by-bad-actors-former-department-head-says/

Given that some hospitals have managed to implement digital records, I wonder is it certain individuals in certain hospitals causing the problems.If so they should really be called out for it, or penalised in some way.Blocking simple progress like this, which our system badly needs and is in everyone's interests for the most part, is not excusable.

It’s down right dangerous in today’s context of hi tech medicine not to have it backed-up by an integrated hi tech system. Yes, I imagine certain people want things to be relatively in searchable, and certainly not by another doctor in another hospital. But a permissions system would assist there, however I don’t imagine a medical consultant would like his/her access being controlled by a sys admin typing sudo su 🤣.

L1011

Hospitals 'owned' by many disparate bodies between voluntary boards, religious orders and various bits of the HSE; GPs and pharmacies all private contractors and the GMS contract being absolutely antique; regionalised IT budgets in the HSE prevent national planning (and yet the early NEHB and SEHB drives to digitise ahead of the rest of the country got centrally sat on after the HSE was formed); rudderless management running to fix the latest scandal and either unable, unwilling or not allowed to fix structural issues; the surreal situation that Healthlink (the messaging and referral interlink system) was formerly a private company.

Pick one. Or pick all, they're all valid reasons why stuff has barely advanced in 25 years compared to what the NEHB could do then.

L1011

https://www.boards.ie/discussion/comment/120179401#Comment_120179401

FORTRAN was not created at Trinity if that was what you were truing to suggest?

Aer Lingus are suffering hugely by still using the now comically antiquated ASTRAL system from the 1960s, so you really picked a terrible example here.

Overheal

https://www.boards.ie/discussion/comment/120179401#Comment_120179401

Aer Lingus doesn't run a hospital and they barely run an airline. I can think of better ways to operate an emergency medical facility

https://www.boards.ie/discussion/comment/120179679#Comment_120179679

I am giving an example from the pioneering 1960s, not the current incarnation of Aer Lingus. If one well able guy could accomplish such a thing back then surely a person of similar calibre could head a team that could knit together health service informatics. The ground has already been well prepared by the pioneers. More a question of politics these days.

https://www.boards.ie/discussion/comment/120179672#Comment_120179672

Where did I say FORTRAN was created at TCD? Their article tells of how it was used in the creating of scripts for implementing of early Aer Lingus algorithms.

L1011

https://www.boards.ie/discussion/comment/120180011#Comment_120180011

the words "FORTRAN created by" rather suggested that.

Someone who designed a system in the 60s is exceedingly unlikely to be in any state to even consult on a design for something in the modern era - they likely retired 20+ years ago.

And their modern equivalents will already have been involved in the various reports over the year - its the managements refusal to fund and implement that is the issue; not the skills available.

https://www.boards.ie/discussion/comment/120180023#Comment_120180023

For goodness sake my point is being missed… of course we can’t have a 1960s system to operate health records. What I’m getting these times is a lot of hand wringing and an “it can’t be done now” take. We build on the pioneers’ work, we have people as talented, but we don’t yet have the will to forge ahead.

I never suggested that the original 100 year olds, if they are still alive, should be in charge of it all now 🙄

I worked in the public libraries services, which were individually operated by the various local authorities. Each system was a different package. Eventually we integrated all the different systems under a package called Sierra from a California based company, with no real-time support given the time difference. We didn’t quite like the system for quite some time, there were huge hiccups, but eventually the staff got the system to work together as one. It was a rather painful process but we got there and now the system is one and can be accessed from a couple of options including the API BorrowBox. Now we are talking customer, items and transaction database, not healthcare. But with a similar effort the disparate healthcare systems (or non systems) could be integrated.

kirk.

Is hospital systems rocket science ?

I wouldn't have thought so

macraignil

Not sure who we are being compared with to say we are lagging behind on digitisation but I have heard that the logic for keeping printed patient charts in the past was that the printed version was seen as a backup store of information on a patient that would still be usable in an emergency situation when computer based systems are not accessible. When I was told this I had the image of a hospital working in a power cut but it's not that long ago that there was an encryption virus introduced to the HSE computer systems and going into work I was faced with a machine on the desk where I work with a sign posted on it from the hospital IT team saying that in no circumstances were any of the hospital computers to be switched on or used. All the computers were later replaced and I imagine all the old machines became scrap as there could be no guarantee that the old PCs did not keep some of the damaging software they were infected with.

I can see improvements have been made with patient information being accessible online when proper access permissions are granted but there is often information in printed charts that has never been put on a digital system and some that were on IT systems that are no longer active and printouts from them in the patient's paper chart is all that is left to say a particular test for example was carried out at some point in the past. At times there can be some of the records from other hospitals for that patient if they had been requested but it would be unusual for this work to be taken on and there simply is not the spare capacity in hospital administration staff to do this for anything more than a small portion of patients. Its only a few weeks ago I heard some radio presenter ranting about how the health service needed more doctors and nurses and less administration staff. I'm not sure how they came to get this information that the health service was so weighted against doctors and nurses but they seemd fairly confident with their claims that more expenditure on administration in the health service was not what their listeners wanted to hear.

To improve the integration and digitisation of health records would require a lot of work and employing lots of accurate diligent workers to insure no mistakes were made in getting the information on every health service patient records from multiple sources 100% correct. It would also require a system that is completely secure from unwanted external access to confidential records and a durability in the system that would mean all the work would not need to be repeated again when it was realised that a more up to date IT system should be employed. There are already IT systems used in patient administration and sharing of information on patients but this is very different from having a digital only record for patients. Developing this concept could see a large portion of the health sevice budget going to build a system that might end up failing and the risk of getting such a system wrong are huge for anyone who decided to implement it. I could go in to further detail on some of the complications that could arise particularly for more complex patients and ones who have a longer and more detailed medical history but to keep my post to a reasonable lenght I would just like to say that I would be very concerned about patient health care records going completely digital and think there are potentially very serious consequences if this was not handled well.

kirk.

What's the norm elsewhere

AndrewJRenko

Just on the off chance that anyone is actually interested in the scope and complexity of the challenges facing the HSE around digitalisation, this would be a good starting point.

https://ehealthireland.ie/ehealth-functions/

The idea that Linux directory and file permissions would form some kind of basis for Electronic Health Records is crass in the extreme.

It’s a bit like saying bricks are the solution to our homelessness crisis.

Nermal

https://www.boards.ie/discussion/comment/120179649#Comment_120179649

The mix of public & private we have is the perfect recipie for preventing things like this.

With more public ownership standards and interfaces could be mandated, and institutions that don't bother doing anything could be threatened or even defunded.

With more private ownership you'd see incompatible networks developing but the pace of change would be much, much faster.

We've ended up with the worst aspects of both: there's no external or internal incentive to change at all.

maninasia

https://www.boards.ie/discussion/comment/120180785#Comment_120180785

Public and private insututions can be integrated much easier under a universal insurance healthcare system, there every individual has a unique health insurance chipped card which is used to access the data from hospital/GPs side when you visit and plug into payment and hospital reservation systems.

All the hospitals and GPs will be forced to conform to the universal health insurance standards otherwise they won't get paid (public or private) as universal insurance is patient centric, the money follows the individual patient who becomes more like a customer. Countries such as Taiwan have had such a system for over 20 years.

Make it about access to patient fees and they will confirm quickly.

In the off chance we actually manage to create such a complex system, the data would inevitably be breached. How would you feel about everyone knowing your health status? I frankly don't care but it is something to consider.

timmyntc

https://www.boards.ie/discussion/comment/120180828#Comment_120180828

If things like banking can be done totally digitally and work, surely medical records can.

Again, this isnt rocket science.

You could have a centralised highly regulated point of storage, and individual hospitals/GP practices can make requests for records from that, with their own credentials. They would not be kept in sync or stored locally, only request a patients records as you need them. I'm sure there are ways to idiot proof the whole thing also to protect against end-user ransomware, such as 2FA for any requesters.

This is a very solvable problem, that has been solved in numerous ways all over the world. There is no excuse for reliance totally on paper records in this day and age.

timmyntc

Revenue have a totally digital record of your income, taxes paid, tax credits, employment history, debts owed, etc etc.

Yet they have no issue with this either. There really is no excuse for not having the healthcare system digitised

macraignil

https://www.boards.ie/discussion/comment/120181042#Comment_120181042

"This is a very solvable problem, that has been solved in numerous ways all over the world. There is no excuse for reliance totally on paper records in this day and age."

As someone working in a HSE hospital there is not total reliance on paper records. There are IT systems with patient information available for a number of years and these systems can be accessed through the internet. The paper records do often contain additional information that is not available on the online IT systems but this is often older and less relevant to the current patient treatment.

micosoft

https://www.boards.ie/discussion/comment/120180175#Comment_120180175

It's not rocket science, it's much much harder. Both Microsoft and Google have written of over $10 billion between the two of them attempting to solve the patient record problem. Microsoft is closing its HealthVault patient-records service on November 20 | ZDNET

One of the challenges in this country is folk assuming things are easy/cheap/quick in domains they know nothing about but happy to explain why their own relatively simple job is super complex.

AndrewJRenko

https://www.boards.ie/discussion/comment/120180817#Comment_120180817

Are we back in 2012? FG came to power in 2011, leading a Government with a strong majority, with a clear policy for Universal Health Insurance as one of the pillars of their campaign. Their Labour partners were broadly supportive. When the rubber hit the road, they couldn’t make it work. The Irish market is too small to support competing UHI insurers.

Taiwan has 23 million people. We have 5 million. It’s a big difference.

AndrewJRenko

https://www.boards.ie/discussion/comment/120181042#Comment_120181042

On the broader question, the reason why we don’t have full digitisation of health records is because we haven’t resourced and paid for this. We only started putting any serious resources into this about six or eight years ago. The existing team have made very considerable progress, on things like electronic prescriptions, electronic referrals, electronic health records (EHRs) across maternity hospitals and more, as detailed on the site linked above. They have nothing near enough staff, and the staff that they have are frequently poached by private sector consultancies, and then sold back to the HSE at treble the daily cost.

They’ve also been slightly distracted for a couple of years with Covid, having delivered key systems in record times, including the vaccination booking systems and the online Covid cert. The Covid app developed by the HSE was picked up by several other countries too.

If you want the best of digital systems, you have to pay for them.

Charles Babbage

https://www.boards.ie/discussion/comment/120179672#Comment_120179672

The poster made no suggestion about FORTRAN being created at TCD, only that someone in TCD used it.

Aer Lingus may have fallen behind in the 60 years since, but that in no way devalues the usefulness of their early work.

The lack of a computer record is shocking. Across Europe there surely are examples of systems that can be modified for Irish needs, issues likes different ownership of hospitals etc exist elsewhere. There may be isolated progress, but this needs to be fully integrated.

zg3409

Chronic underfunding is a big issue. Also all regional health boards have old legacy incompatible systems. We are also a relatively small country with separate procurement systems.

The technology is only a tiny part of the problem, there is various regional/local agreements on pay, structures, systems, procedures, processes, paper based, undocumented etc.

Then add in unions that want extra money for everything. Typically Ireland has a bad track record at major projects even "straight forward " in comparison to health things like public pay systems.

There is also pushback on data security concerns, paper records at say your local doctor are unlikely to be leaked on a national scale unlike what happens in ransomware cases. In the USA it's common for entire databases of all patients history to be leaked or even deliberately shared with health insurance companies for risk assessing patients.

If everything was in one database today there might be some unintended consequences such as health insurances micro profiling every citizen and adjusting premiums or denying cover or paying out claims. In the USA it's the wild west.

We should try to have at least a way of sharing documents and scans electronically, too many taxis being sent with files between hospitals.

AndrewJRenko

https://www.boards.ie/discussion/comment/120181407#Comment_120181407

Can you identify any examples of unions wanting extra money for anything related to digitisation in healthcare?

micosoft

https://www.boards.ie/discussion/comment/120180667#Comment_120180667

Indeed. A lot of "techie" answers that are very low level "install software, ???, Success".

The challenge we have here is a massive transformation programme where the bulk of the transformation (Costs/Effort) is in the way people work and the elimination of certain roles and creation of new roles with radically different skillsets (i.e. not a transfer or reallocation of people) all while keeping a struggling health system going. It's 10% technology problem 90% people.

This is really hard and the biggest challenge is a highly unionised workforce along with the exceptional power of the consultants along with a mandarin class of administrators all conspiring to resist change because it's not in the personal interests of a significant enough minority of healthcare workers to accept change. Unfortunately the solution will require significant industrial unrest to "break apart" the HSE so it can be reassembled as an effective organisation.

micosoft

https://www.boards.ie/discussion/comment/120181042#Comment_120181042

The head of Barclays Bank said Banks were IT companies with a banking licence. Many international banks spent billions consistently over decades to get where they are with much simpler employee relations and a much simpler dataset. Not a great example at all.

Geuze

https://www.boards.ie/discussion/comment/120181424#Comment_120181424

Here is an example from the LA:

https://www.rte.ie/news/ireland/2023/0129/1352533-wrc-council-inspector/

AndrewJRenko

https://www.boards.ie/discussion/comment/120181802#Comment_120181802

1) Not in healthcare

2) Not a “union wanting money” but one individual employee wanting money.

3) She lost her case.

Clutching at straws?

GreeBo

https://www.boards.ie/discussion/comment/120181042#Comment_120181042

Banking is orders of magnitude a simpler space to work in than healthcare.

https://www.boards.ie/discussion/comment/120181802#Comment_120181802

She would not have wanted to have worked in my place.

To have everything on the one single database may not be the answer at all, it would require a hell of a lot more than that. But the set of healthcare databases should be queryable by means of permissions (I used the simple Linux permissions purely as an example of how a more complex API could potentially be developed) so that at least, eg, the public hospital could have got access to my scan report that time from the private hospital and not start scheduling me for urgent lung surgery. They depended on my driving over to that hospital to initiate the process. It was clumsy, stressful and unnecessary.

In Ireland we have a deeply ingrained “can’t do” attitude, which is at the root of it all. We do have to look out for unintended consequences, but these are not insurmountable. In such a system, patients should have the ability to grant or deny certain permissions in the first place.

NewClareman

https://www.boards.ie/discussion/comment/120181255#Comment_120181255

I am not convinced that finance is the main obstacle to implementing this more quickly. As an example there are many roles dependent on the existing paper based records system. Targeting areas such as these, where substantial cost savings should be possible, should help partially self finance much of the implementation.

Im also not convinced that agreement has been reached to implement a standardised approach across all public hospitals that would allow packaged, off the shelf, solutions be used. I suspect that there are multiple vendors with such systems that could deploy them cost efficiently. Maybe I'm wrong but my experience in other industries was that managers held on to their unique processes, with bespoke supporting systems, for dear life.

Having said all this, I'm really impressed with all the work done to date, particularly the published architecture. I hope it can be progressed more expeditiously and help transform us into a modern health system.

When the library authorities were starting to integrate it started slowly enough. It began with the small step of making all catalogued library materials throughout the country at least visible on a common portal. It was at least somewhat helpful in that you could see what was available and where it was located. A couple of years later we had a fully integrated, fully interactive system, due in no small measure by tremendous efforts of the staff. But there again information science was at the core of our operations.

https://digital-strategy.ec.europa.eu/en/policies/electronic-health-records

EU wide proposal to integrate healthcare records across member states. Already happening across Finland and Estonia.

Calahonda52

Post 31 on the money, especially the US problem where whole cohorts of folk are now being denied insurance due to access to medical records.

as for the union issue

see this

https://www.google.com/url?q=https://www.rte.ie/news/ireland/2023/0129/1352533-wrc-council-inspector/&source=gmail&ust=1675193623802000&usg=AOvVaw2WDUchn_YILMnyVxKesz-A

A Fórsa representative told the WRC hearing that the employer "showed no duty of care to the worker" and highlighted that "she should have been referred to occupational health as a result of the stress caused to her by these proposed changes".

I was in a public service location lately and there were 3 staff knitting. They refused to take on alternative work at the same desk unless they got extra pay: on full pay and are running a website where the output is being sold.

NewClareman

https://www.boards.ie/discussion/comment/120181492#Comment_120181492

Yeah, I hadn't seen your response when I replied above.

A while ago, now, I was deeply involved in an IT modernisation program, which was to drive organisational change. Similar issues arose, but not to anything like the scale of the HSE. Every manager had unique processes that were essential to business success. There were business analysts and process specialists coming out our ears, all on an expensive day rate. Their job was to document and specify these essential processes, for subsequent implementation.

It was never completed, despite many millions being spent on vendors and consultants. Instead, stripped down simplified processes were developed, that could be supported by off the shelf systems. I don't think there's the political appetite in government to support such an approach in the HSE. As you say, too many vested interests that they are afraid to tackle. It's far easier to throw yet more money to give the illusion of real progress.

macraignil

https://www.boards.ie/discussion/comment/120182105#Comment_120182105

"information science was at the core of our operations."

I'm taking it from this statement that you were part of the efforts to integrate library authorities so well done with the advances you have made there. Your first post mentions being penciled in for surgery due to the appearance of a lesion on a scan and that going to get your records from a private hospital that had additional information saved you from undergoing this surgery to remove a lung. I am sorry you had this stressful experience but it is very common particularly in the case of time sensitive interventions for procedures to be booked well in advance due to waiting lists even if there was only a chance that this intervention was to go ahead. I'm not working in respiratory health but I would be very surprised to see someone getting a lung removed based on one image and in most similar circumstances I have seen recorded a biopsy is taken initially to confirm with a histopathologist that the consultant's suspicion based on the image was correct. There are also patient paper records showing public hospital administration contacting other hospitals to get patient treatment details sent onto them in case they were relevant to future treatment but I don't know why this was left to you to do yourself in your own medical experience that you have highlighted.

Just to help me compare your success with what is required to be done with the health service, how many active library users are there in the country and how many library book listings needed to be integrated?

NewClareman

https://www.boards.ie/discussion/comment/120182428#Comment_120182428

Maybe I'm missing something, but I don't see the relevance of the number of users as an indicator of complexity. Yes, if the idea is to integrate existing systems, that would be a nightmare. However, I would have thought that a solution could be developed for one class of function, say radiology, proved; and then rolled out to similar functions countrywide.

Going further, I cannot imagine that there is anything so unique about Irish public healthcare that requires entirely new IT solutions. I'm sure that there are vendors that could provide substantially off the shelf solutions, that have already been proven elsewhere. Some may even be prepared to implement for free, if given an agreed percentage of cost savings. It then comes down to the political will to impose change, where it cannot otherwise be agreed.

timmyntc

https://www.boards.ie/discussion/comment/120181871#Comment_120181871

What extra difficulty does a shared database of patient records pose for healthcare workers?

They already keep patient records, in many cases they even have their own digitised record systems. The change is to have a centralised repository of patient records where medical practitioners can quickly & securely request or edit said records.

And the idea that banking is simpler than healthcare? Nonsense. In banking IT systems, there are far more actors in play, far more data by volume & frequency of updates, and a far greater consequences if something is cocked up.

https://www.boards.ie/discussion/comment/120182428#Comment_120182428

My situation was complex, but to explain it better I underwent a full colectomy and follow up surgeries & procedures to treat complications at the private hospital. This was following decades of ulcerative colitis A year later I developed a sudden strangulation of a parastomal hernia, taken by ambulance to public hospital where I underwent surgery. After discharge from hospital I arrived home to a letter in my porch advising me to attendance the hospital’s early lung cancer clinic some days later. I was stunned as I had no respiratory symptoms.

Once there the respiratory consultant had a nurse in with her, her hand on my should as she explained there was no easy way to do the pleural biopsy bar opening up part of my chest, which may be quickly followed up by lung removal if cancer were found. She said lesion looked identical to mesothelioma and only hope was to gave this procedure extremely quickly, and that I was pencilled in next week for it, date given to be there and then. She asked me were there any possible records of previous scans/reports anywhere else to check against before proceeding further, and that tone was of the essence. I ended up driving over to the fairly nearby private hospital to ask for release of documents, which felt bizarre at the time. An ability to directly access my record would have saved the whole situation, starting with the urgent call to the early cancer clinic.

Re library records I would have to go back and research that, I am now retired from service, but there were hundreds of thousands of catalogued materials, and of course thousands of users. There was a huge transaction rate.

The integration was overseen by a management who didn’t actually use the system and had limited IT knowledge. The actual implementation was mostly done was trained Grade 3 staff who were working from notes and making non-stop bug reports. The bug reports were largely dealt with by Grade 4 staff and the overall excellent Sys Admin Librarian who was Grade 6, but most Grade 6 & 7 had difficulty even turning on their own computers. Spreadsheet creation etc was always delegated to lower grades who had been sent for training to the Institute of Public Administration. One particularly talented person of entry rank, who had done a mammoth share of patching the system, was subsequently by-passed for promotion.

https://www.askaboutireland.ie/libraries/public-libraries/fast-facts-and-figures/

Some Public Libraries Ireland stats

https://www.borrowbox.com/

The API which is used to access library service sponsored eBooks for free.

https://www.librariesireland.ie/

The portal for the now integrated library services in Ireland.

The process of integration was very stressful, especially when we first went live on 2nd January in the noughties with a system which was originally not fit for purpose until the staff on the ground who worked various shifts covering 9am-8.15pm and Saturdays, made it so. Senior management worked 9-5, Mon-Fri and were very far removed from the systems as it progressed. A willing staff can make it all come together.

macraignil

https://www.boards.ie/discussion/comment/120182643#Comment_120182643

With increased numbers there will be increased incidence of more difficult to integrate cases with some patients having multiple volumes of printed chart medical records and these are often the ones with the more difficult to deal with conditions. There are already IT systems accessible remotely for different classes of function but only some of them are cross linked between hospitals. With one that I am familiar with that gives lab results to a hospital group you have numbers of cases that are more complex with some results not showing up on a simple search by patient ID number and surname as they have more than one ID number assigned to them from tests done at different sites or even the same site after their number was changed for hospital administrative changes that I have never got fully explained to me. It is possible to see this in some patient printed charts where they will have one number in their older records but a different one in more recent records. Its my view that if you are dealing with a bigger number of records then the task does get more complex simply because there are more of the irregular cases that take extra work to figure out how to integrate correctly.