what's the point of paper format hospital patient records?

stezie

OK.. I'm waiting in a hospital emergency department waiting area for 6 hours.. (different topic)

I notice nurses are carrying around mountains of patient records on trolleys..

Its not the 1800's anymore..

Why can't electronic methods not be utilized now a day..

Surely that data in a paper record cant be used on a computer system for proactive treatment. Alarms, notifications, reminders etc.. Do people exist in the background to copy that paper record to a database?

Why does every doctor, nurse, consultant on the hospital journey need to ask the same "tell me what happened " storey and take the same notes.. it's in the computer? Well it should be..

Sorry for bored hospital waiting room rant...

I just feel that there is so many areas for efficiency improvements.. little ones, but many..

Victor

Because it is difficult to view multiple pages of documents simultaneously on a computer.

It's harder for Russian hackers to encrypt paper documents.

Jim2007

Thankfully they keep both as do most European states. These days it the fall back position in case systems go down or are wiped by hackers. This happened fairly recently in a few states in the US where court records were wiped out and they had to revert to the physical records maintained by the judges and court clerks.

Geuze

We don't have Electronic Health Records (EHR).

There is a plan to slowly implement it, starting with ePrescribing.

I think a law was passed to allow for health identifiers.

thereiver

Its hard to hack into patient records if they are in paper document form I think they are still updating a digital patient record system .

SuperBowserWorld

It also happens here when HSE was hacked for a ransom.

It's kinda ridiculous though from a hacking point of view. How sensitive is most people's health data ?

Also, it is possible that each patient (or a family) has their own private key to encrypt/decrypt sensitive data when they/family member is in the hospital or if a doctor requests it.

Also, it should be possible that anyone can share anonymously their health data globally so that large sets of extremely useful data is available for research.

Fallout2022

They gauze wounds with these same paper records. Nothing's wasted.

Peregrinus

Why does every doctor, nurse, consultant on the hospital journey need to ask the same "tell me what happened " storey and take the same notes.. it's in the computer? Well it should be..

That's an intentional policy , and it happens even when the records (paper or electronic) are right there in front of the doctor. It has two functions.

First, the medic wants to see that the story you tell is the same as the story in the records. A regular and occasionally disastrous problem in medical practice is treating one patient based on what's in the records of another patient, because the wrong record has been handed out or called up. The medic needs to confirm that the record in front of them is your record.

Secondly, in many cases the medic wants to hear the history from you. There may be details which have not made it into the records, or you may mention something that has happened, or has intensified, or whatever, since the record was created. The records are important, but they're not the best information avaiable; they are someone else's record of their interpretation of what you said on a previous occasion. What you say now, in person, trumps that.

mountai

I remember the days when Revenue.com was computerised , CJ Haughey made it a priority that this should happen . It modernised the system , bringing everyone under the rules and the punishment for not obeying the rules were severe ,and did the State a great service . No worries about Hacking in those times . I would imagine that information gathered by hackers in the field of finance would be more valuable than health information , so if the same protection used by Revenue , was used by the Health service , would there be a problem?. Go to any Private Hospital , and see their system , paper is only used in Toilets .

Hamsterchops

https://www.boards.ie/discussion/2058371430/whats-the-point-of-paper-format-hospital-patient-records

I'm with you 100%"on this, and I know exactly where you're coming from. Back in the early 90s I was tasked with making a manufacturing company paperless, and within eighteen months it was achieved.

But not before we had many a battle with the old guard who loved their four part carbon copies and their intrays. The mindset had to be changed, weaning the old timers off their intrays and onto their computer terminals. People still had the option to press the print button and the Oki printer would oblige, but the default became paperless by 1995.

Not in this country, I hasten to add.

juno10353

https://www.boards.ie/discussion/comment/122670546#Comment_122670546

Only vary basic info on computer eg name address next of kin, date of birth and file no.

Paper files opened on visit to ER etc and forwarded to whereever is doing followup. After a period of time after last appointment files are sent off site. Totally inefficient.

irishgeo

The new childrens hospital is the pilot site for the new electronic health file.

https://www.childrenshealthireland.ie/about-us/new-childrens-hospital/ourchildrenshospital/project-ogham/

OscarMIlde

https://www.boards.ie/discussion/comment/122670627#Comment_122670627

I'll add to that and say that hospitals only have the notes they have recorded themselves or those that have been sent on. They will often be completely unaware of any diagnoses/testing etc.that has been done in another hospital, particularly if previous hospitals were in a different hospital group. I've lost count of the times in my lab we get a request for test x on a patient only to check and they had the same test previously while in a different hospital and second hospital completely unaware of both test and result.

I would advise everyone to keep important medical documents in a file and bring photocopies to hospital appointments.

There are moves towards universal shared hospital systems but we are along way away from it. We don't even have a universal patient number, such as an NHS number, in Ireland. Each hospital provides it's own MRN number, sometimes several, to the same patient, which makes it difficult to identify patients if additional info like home address is not provided.

Squeeonline

In august the company I work for was hit with the crowdstrike outage. I couldn't work for half a day, whatever. The important thing is production in the factory had paper backups of documentation and could continue. Half a day loss there would cost millions and have knockon effects for months.

GAAcailin

https://www.boards.ie/discussion/comment/122670581#Comment_122670581

Regarding the sensitivity of people's medical data; I would have thought that who cares if people see my records. But from talking to my SIL who is a social worker in a deprived area, when the HSE system was hacked it would have caused major problems if records were leaked; She had many interviews recorded with potential child neglect / abuse cases. IN many instances it would be someone reporting maybe a family member re suspected abuse.

GAAcailin

Agree with this; I had a lot of medical intervention this year, tests, surgery, follow on treatment etc. Each consultant I met would ask 'tell me about your journey so far' - the notes would be in front of them.

Had to wonder about how this filters back to your GP; I hadn't been referred by my GP and happened to be in with him the other day - he knew nothing about what I had been through. Only when I mentioned it in passing he looked puzzled and started opening up letters/ correspondence that had been attached to my chart (probably from admin staff)!

breezy1985

https://www.boards.ie/discussion/comment/122670686#Comment_122670686

It's not just basic info. Previous scans, bloods etc. are all on the computer too.

But yes the sending them between hospitals and storage is inefficient.

beachhead

https://www.boards.ie/discussion/2058371430/whats-the-point-of-paper-format-hospital-patient-records

Having electronic records will certainly help the HSE to monetise patients records as the NHS in the UK has done.

SuperBowserWorld

https://www.boards.ie/discussion/comment/122670719#Comment_122670719

Oh no, they are going to put the data on Ogham stones.

josip

https://www.boards.ie/discussion/comment/122670657#Comment_122670657

Did you intentionally use " did the State a great service " expression there?

https://www.youtube.com/watch?v=pGEQtBID-HA&t=89s

Cluedo Monopoly

The risk with paper, and we have seen it happen, is that medical notes can be added/altered to cover up for negligence.

Escapees

To me, the reason for so much paperwork in hospitals is simply that 1) the medical/healthcare sector is very rigid and slow to change, 2) the HSE lack IT staff competence (I've heard some stories!!), and 3) any move to a paperless system would mean a lot of unionised admin staff would become redundant.

On this last point, in my latest dealings with the HSE, I receive appointment notifications in the post which are printed in colour (mainly to facilitate an ever-changing HSE letterhead design!), but... while the actual appointment date and time are automatically printed on the letters, these details are then manually highlighted by an admin staff with a highlighter marker. Just changing the format of the text in the appointment letter template so that it has a bright background fill colour would eliminate the questionable need for any admin staff to be manually highlighting the appointment times on all outgoings letters! Furthermore, this would then mean that the letters could be automatically enveloped by machine etc. and thus eliminate another manual admin task!

There is just so much inefficiency in the HSE like the above example. But unfortunately the unions will always take arms against and prevent any improvements or technology advancements...

RiderOnTheStorm

there was research done into what was needed to get all healthcare IT systems onto the same level / talk to each other and the result was "its too difficult difficult / too expensive / too many systems" . It is just gotten so complicated at this stage. Not only do you have different hospitals on different versions of software, and then the pharmacy , GPs , dentist , home-care , paliative care , etc all on different systems. You have different departments within the same hospital running different software, eg patient records run on different system to x-ray which is different to theatre lists , etc. Its not the answer that people want to get, but it is a spiderweb of patchy systems, each one doing 90% of what it should most of the time, but they dont share info.

I remember when I was in college in late 80's we were told that the paperless office was coming in. It never did. Computer systems came in, but the paper stayed too. So now staff have 2 systems to record / recall info.

There is also a definite reluctance to let go of systems that are familiar , even if they are not up to the purpose anymore. And an element of safety in paper. Its the 21st century now, but you would be surprised (maybe not) how often IT systems / broadband / electricity goes down, and the show must go on. Its a bit like the physical blocks that they put aeroplane flight name on in airtraffic control, and then they stack them up and move them around as the planes come & go. Not perfect, but hard to go wrong, and easy to look at and see whats going on.

AndrewJRenko

https://www.boards.ie/discussion/comment/122670719#Comment_122670719

HSE have been working on Electronic Health Records for close to ten years now. The first 'digital baby', born with an EHR from birth, must have started school by now.
On the vague possibility that anyone is actually interested in the facts of what's happening, there's lots of information in the public domain, starting at

https://www.ehealthireland.ie/technology-and-transformation-functions/standards-and-shared-care-records-sscr/shared-care-record/electronic-health-record-ehr/

The bad news is that if you want to speed up the roll out, you're going to have to increase spending on those dreaded 'HSE administrators' that people spend their days on Boards giving out about, as they are the people who build, support and manage these systems

BrianD3

As usual with the health service, problems are due to vested interests, big egos, greed, silo mentality, not coming out of my budget mentality, terrible communication, little fiefdoms, resistance to and fear of change. People want to do things the way they've always done them (sometimes without telling anyone how they do it) even if those ways don't work well for patients. As time goes on, problems become embedded, systemic and structural and it gets more and more difficult to bite the bullet.

Even in the year 2024, there are still people in the public service and professions who cant/won't use a computer, some see operating a computer as low brow "technician" or "typist" work. Plenty of staff are also institutionalised and apathetic. Enter the public service straight from school and stay there until retirement. Lifers, in other words.

When half hearted attempts at computerising records are made, things can get worse. You might get 20 different versions of the same excel spreadsheet floating around in emails and on network drives with nobody having a clue which is the correct or up to date version. Best of luck getting anyone in authority to recognise that this is a Bad Thing. Shur, their pension will be paid no matter what happens - so why bother doing anything about anything.

Ella108

A lot of paper work is tedious, unnecessary only because to prevent errors or scams. Same like house keys or car keys. If whole world was honest, it would all work efficiently. Also not to forget GDPR is important, patient data, and so on, and has to be handled with caution.

Like others here already mentioned , electronic records are super efficient, saves times, labor, etc but lot of old methods are still in place because a number of reasons it could also included they are either not IT trained, or IT support is not in place. Notes making is simpler on papers for some who are not IT proficient, one example.

This is one big reason, for long waits.

Markus Antonius

https://www.boards.ie/discussion/comment/122670525#Comment_122670525

https://www.boards.ie/discussion/comment/122670546#Comment_122670546

Nonsense comments. We were very clearly wiped out by hackers a few years back when they brought down all our systems and stole all our data. We have a paper based records system but the internal systems to allow the health system to function are computerised.

We literally have the worst of both worlds…

Strumms

a lot of crucial industries like transportation, aviation, construction…. keep hard copy records in tandem with electronic records.

Started using handheld PDAs in a job and about a year later the manager… “ ok, we can still use the PDAs to do our work but we need to go back printing the work reports / records too and filing them for x months…”

This was apparently at the behest of the industry regulator who wanted / needed everything backed up in a secondary manner….in case whatever server or cloud was hacked , compromised or corrupted….don’t know if that actually happened somewhere else or was just a proactive thought on their behalf but it made sense. Even is it was an extra 20 minutes of printing & filing at the back end of a shift for us.

dxhound2005

https://www.boards.ie/discussion/comment/122671656#Comment_122671656

You must have worked with them for a long time to find out so much information.

Mucco

Digitisation is being mandated by Europe now. Read up on the European Health Data Space. It means your records will be available to doctors in other EU countries to treat you when on holiday. Also handy for treatment at home in different places.

Escapees

Ah, but the unions will resist and slow any digitisation efforts. I was visiting someone recently at a hospital and had to ring a staff member via their mobile in order to gain access to the ward. Why? Because the unions have instructed the nursing station to no longer answer the entrance bell/intercom. Absolute madness. The unions are essentially preventing patient visits and the staff are having to give out their mobile numbers to try to accommodate visitors, whilst still complying with union orders.

silliussoddius

https://www.boards.ie/discussion/comment/122670939#Comment_122670939

Don't be so bloody sarcastic, they are using the latest and greatest available technology.

Pauliedragon

I remember a couple of years ago I had a bad dose of shingles. Long story short I had several follow up appointments for an eye exam. Every time I had my appointment I had to sign in to A&E wait to get my files and carry them to the ophtamoligy department myself.

Del2005

https://www.boards.ie/discussion/comment/122671093#Comment_122671093

It's even easier with digital records.

irishgeo

https://www.boards.ie/discussion/comment/122673349#Comment_122673349

Its not because a system like that should only allow you to update but never delete anything in a record.

radiotrickster

A paper record can't be hacked. If a system is hacked and suddenly a company has access to every person diagnosed with a certain condition, they can try to sway people away from Western medicine through targeted ads online and phone calls, or even push certain medications on people.

Imagine being diagnosed with cancer and the ads on your phone are naming your hospital or even your doctor as untrustworthy, and recommending you drink their herbal tea as treatment instead? There are people who don't have the media literacy skills to even identify ads online, never mind which ones to trust.

Escapees

Ummm... Sure, paper records can't be hacked, but they can get destroyed in a fire or flood etc. The reality is that the benefits of digitisation (in terms of quality of service) far exceeds the associated risks. It's a bit analogous to keeping savings virtually in the bank versus in cash notes under your mattress. There are risks with both, but most would agree that the banks are the safer bet.

BrianD3

https://www.boards.ie/discussion/comment/122680447#Comment_122680447

+1, except paper records can be "hacked", it has already happened. The people responsible weren't genius Russian criminals but urban explorers

https://www.independent.ie/irish-news/hse-facing-inquiry-into-two-leaks-of-patient-data/a1892203190.html

Also, urban explorers accessed paper records in St Loman's in Mullingar, the HSE said that this wasn't a GDPR breach because the records related to dead people. So that's grand then.

AndrewJRenko

https://www.boards.ie/discussion/comment/122673174#Comment_122673174

What hospital was this in please?

GAAcailin

A massive advantage of digital records is the ability to summarise and report on medical conditions for patients. Any Healthcare IT system should have powerful MI Reporting. I am always interested in the system my GP looks at when I visit; he seems to have different tabs and the ability to open up communication from Consultants from scanned documents. Had bloods done recently and he was able to compare to last years results instantly. A good medical software package isn't just a set of word documents uploaded