Back @ the EPR Arms July 2018: Quality is key

‘By ‘eck its warm Sal!  I’m glad I ditched the heels for flats I tell you. In fact, I was tempted to put me flip-flops on tuneet.’
‘Whoa Whoa. It’s not that hot tha’ knows’.
‘No –what I meant was- in Australia, they call Flip-Flops -Thongs!’
‘Oh I see. Now that could cause issues eh if I went down under for a beach holiday!’
I was pushing through a group of Yorkshire lasses having the Thong conversation at the bar who were now all guffawing. I was on my way to the table I was sharing in the very busy EPR Arms -I joined James Beattie (Information Manager) who was deep in conversation with the Medical Director – Dr Mike Ward.
‘So whoever is receiving that particular letter electronically needs to know what kind of letter it is. Who wrote it; when he or she wrote it; where to file it so others can find it; which specialty it is from and which organisation? You can’t just randomly send stuff around the NHS: that would be crazy. And they need to know it is accurate’ concluded Mike, the Trust Medical Director and Clinical Safety Officer.
‘That’s exactly what I am talking about Mike,’ said James, ‘with digital dictation we’ve set up templates for each type of letter so we can assign a document name to the document and all that other stuff you talked about: Meta Data. Every document must be understandable to whoever receives it. And that will be an increasing challenge as we widen our circulation beyond our own little part of the NHS.’
‘Yes but how do we know it is accurate? About the right patient-with the correct information?’ continued Mike.
‘Bit like a thong in Australia!’ My contribution to their serious conversation was not well received or understood.  ‘Here’s your red wine Mike and your vodka tonic James. Had a bad day lad?’ I asked  James,  handing over the drinks.
‘Bounce-backs.  Poor data.  Data quality issues.  Letters being sent out to dead patients.  Letters going back to the wrong GP.  Duplicate patients: three or four different records of the SAME patient. Letters filed in the wrong patients notes.  Incorrect date of birth. Just another bad day at the office you could say!’ he replied eagerly grasping and then gulping at his Vodka T.
‘So what do you do if you find dodgy data?’ I asked, licking the froth off the top of my Badgers Crushed Paw bitter.
‘Well – in the paper world of yesterday (and sadly quite a bit of tomorrow), if you found inaccurate data you wouldn’t simply correct it or delete it. And it’s the same with the EPR computer digital data’
‘Why not? Isn’t it dangerous to leave bad data where it is?’
‘It is but it’s not that simple is it Mike?’ said James.
‘Not that simple,’ repeated the Medical Director (and Clinical Safety Officer.) ‘For a start, YOU can’t just change any inaccuracies. You must get the person who recorded incorrect data to make the corrections or at least get the data quality team to track it down.’
‘OK I get that.’ I said ‘It’s data ownership.’
‘and accountability’ added Mike ‘and not only that,’ he continued ’you have to leave the bad data in there with its correction, but redact the patient demographic information so that you are not breaching any confidentiality.’
‘In case?’
‘In case a clinical decision had been made based on that inaccurate data.’
‘Wasn’t it easier with the paper record? If you found a letter in a casenote which was a different patient, you’d just rip it out and send it to medical records to put in the correct notes wouldn’t you?’
‘No! Actually no! You would have to leave a copy where it was found with the patient information redacted and identified as being incorrectly filed and then file the original document in the correct record also identifying it as having been filed in another’s record and the date that it has been filed. Same reason.  And – if you’ve made any orders against patients with ‘dodgy data’ or the wrong person even,  those orders have to be repeated. It’s not that simple it really isn’t! ‘
‘ Now that’s a site for sore eyes!’ Paul the young porter had joined the Thong group. They were hanging on his every word. He’s obviously just bought a new joke book. ‘Jokes about white sugar are rare. Jokes about brown sugar, Demerara’.
I zoned back in to the conversation at hand: Data quality
‘So, how on earth are you going to manage all that when all your records are on computer? That sounds like a bit of a ‘Mare’’. I summarised, half wishing I was in on the other, lighter, conversation.
‘Well,’ said Jamie,’ this is not the same in all Trusts but as I said, we have a Data Quality team. Their sole function is to ensure that the digital health records are accurate. Just because they are on computer doesn’t always mean they are correct. They still have to be looked after – managed.’
Not everyone gets that, I thought to myself. I had heard tales of Trusts shutting down Medical Records Departments as they didn’t need them any more once they’d scanned in all the paper. Used their closure as a cost saving in their business case for digitisation. No longer needed. ‘End ov!’ How wrong they were. The digital records will need to be managed: looked after. Getting rid of paper doesn’t get rid of the problem. Records still have to be managed.
‘I went in to Waterstones today and said to the assistant ‘Have you got a book on turtles?’ ‘Hardback?’ she asked. ‘Yes with a little shiney head!’ The ‘Paul the Porter Show’ was continuing at a pace. ‘Records still need to be managed’ I said out loud this time.’But exactly how big an issue is it and how do Trusts ensure their data is of good quality?’
‘I don’t really know’ said Mike in the worst Thelma Barlow impression I’ve ever heard.
‘Well – why don’t we find out?’ I asked.
‘How?’ Jamie and Mike together.
‘Let’s do a survey.’
‘Go on then!’
And so I left them at the bar and went home to create an online survey.  Let’s see exactly what the data quality issues are out there and see how Trusts are dealing with them.
And here it is- why not give it a go and/or send it on to your colleagues who may work ‘in this space’.

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