Inaccurate and incomplete records at the Royal Free Hampstead

Anyone listening to the NPfIT minister Simon Burns on the BBC R4 “Today” programme last week could have been forgiven for believing that the Royal Free Hampstead NHS Trust has remarkably accurate, easy-to-use and pervasive electronic...

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Anyone listening to the NPfIT minister Simon Burns on the BBC R4 “Today” programme last week could have been forgiven for believing that the Royal Free Hampstead NHS Trust has remarkably accurate, easy-to-use and pervasive electronic records.

Burns said of the future of the NPfIT, in the context of a report of the National Audit Office on detailed care records systems: 

“The Department of Health and the Cabinet Office are going to look at this to see how we can move forward in a way that is not going to waste taxpayers’ money but will achieve having an IT system for modernised NHS that actually does serve patients, and doctors and nurses who treat them, so that it is effective and delivers.

“For those who doubt that can happen, if you look at the Royal Free Hospital [Hampstead]  about three years ago they had installed by BT the system the government wanted and it was chaotic.

“They have now worked on that, adapted it, and it is now working to a way the Royal Free thinks is fantastic because it is improving patient care and it is part of a modernised process that they welcome and have embraced with vigour.”

Today the Care Quality Commission publishes the results of its unannounced visits to various hospitals, including the Royal Free Hampstead, in March 2011. The Commission’s report is called “Dignity and nutrition for older people - review of compliance”.  

During their visit, the Commission’s representatives checked how well hospital staff were entering timely and accurate information into the patient records. These were some of the Commission’s comments:

“Overall we found patients records not filled out on two wards. The ‘Patient’s plan’ which is the patients care plan was not completed in the records on more than one occasion…Of the records we reviewed food charts and fluid charts were often inaccurate, not completed and not up-to-date… The admission/discharge inpatient record has sections to document patients’ needs. For example we saw that there are sections on preferred name; next of kin and their contact details; whether or not the patient has glasses/hearing aid; and do not attempt cardiopulmonary resuscitation statuses. However these sections were not always completed.” 

Possibly this was the tip of the iceberg at the Royal Free, because the Commission was looking only at “dignity and nutrition” for older people. Possibly the Royal Free is still using paper and electronic records.  Possibly the Royal Free’s staff find the systems or forms difficult to use.

But if you’d taken Burns’ comments to the BBC at face value, you might have thought that the Royal Free had one of the UK’s most effective patient record systems.  A hospital can have the best electronic record systems available but if they are difficult to use, or staff do not use them, or they enter information that’s inaccurate or incomplete, what’s the point?   

And isn’t it time for NPfIT ministers to set a precedent by giving out information about the national programme that is accurate, in context, impartial and tells people what is actually going on?

The Informatics Directorate at the Department of Health would probably wave aside these criticisms. Its officials would say they can help provide the systems needed by doctors and nurses but they cannot force them to use them properly. 

But that's what NHS Connecting for Health said of smartcards being shared among NHS staff and clinicians, and inaccurate information from GP records going onto into the Summary Care Records: it’s not our fault. 

For patients and taxpayers it is no comfort to know that it’s not the fault of the DH or NHS CfH when patient record systems at the heart of an £11bn programme are ineffective or unusable. 

When hospitals commission and install their own systems - not those procured centrally - they have the motivation and control to make them work effectively.

Now read: Royal Free boss lambasts e-records system after hospital lost £10m

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