This weeks #Otalk is on the topic of “Occupational Therapy and Digital Care Records – Help or Hinderance?” and will be hosted by Paul Sugarhood (@PaulSugarhood).
Here is what Paul had to say…
I am an occupational therapist currently working in education and research at London South Bank University, having spent many years in clinical practice in the NHS in east London. One topic that colleagues often talked (perhaps complained?) about was clinical documentation: the amount of time it takes, various mixes of paper and digital records, and wondering whether much of what was documented was ever used for anything.
Digital care records (DCRs) have been positioned as essential in promoting quality, safety, standardization and integration of care, and reducing duplication, inefficiency and fragmentation (Department of Health, 2008, 2012). The National Information Board (NIB) is the senior advisory group charged with developing strategy and priorities for data and technology across the health and social care system. It has set the specific target that “all patient and care records will be digital, real-time and interoperable by 2020” (NIB, 2014).
This target is repeated in the Sustainability and Transformation Plans that aim to deliver the Five Year Forward View (NHS England, 2016). According to the quick guide for digital, success in 2020 will be demonstrated when:
“Patient information is recorded once, digitally, at or close to the point of care…Information is digital (paper-free) and flows between primary, secondary and social care providers seamlessly…Patient information at the point of care is available digitally (irrespective of where it was recorded), on a secure, timely and accessible basis…[and] Transfers, referrals, bookings, orders, results, alerts, notices and clinical communications are passed digitally between organisations” (NHS England, 2016).
This ambitious vision is matched in occupational therapy in the publication Managing information: a 10-year strategic vision for occupational therapy informatics (COT, 2014). The vision emphasises the fundamental importance of DCRs as the underpinning of most information flows for service users. Recommendations are made for development of DCRs so they facilitate integrated and seamless recording of referrals, assessments, care planning, interventions, outcomes and discharges (COT, 2014).
However, there are indications of a significant gap between vision/policy and the real world of occupational therapy practice. A UK-wide survey identified that nearly half of occupational therapists do not have access to DCRs, and nearly one third have no regular access to computers at work (National Allied Health Professionals Informatics Strategy Taskforce 2014, cited in COT, 2015). Occupational therapists complain of duplication of effort and inaccessible data within and across organisations: “The…example given, in which a member of staff was rushing around recording information in multiple systems, is no doubt something which will resonate with many occupational therapists” (COTIM, 2016).
A systematic review by Greenhalgh et al. (2009) concluded “that even though secondary work (audit, research, billing) may be made more efficient [by DCRs], primary clinical work may be made less efficient.” I have attended multidisciplinary team meetings where we needed to log onto three different systems to access client records: the GP with the primary care system, the community health staff with a (different) community system, and the social worker with the Local Authority system. Even then, we did not have access to what happened at the local hospital, which used yet another system. The same client’s information recorded in 4 different DCRs!
Suggested discussion questions and talking points for this tweet chat are:
- How do you use digital care records, and to what purposes?
- Do digital care records reduce duplication and inefficiency? How?
- What are the impacts of digital care records on communication and collaboration between health and social care professionals?
- Do digital care records promote safety and standardization? How?
- Are your work practices shaped by digital care records, or are you able to shape the records to match your practices?
- How do you work around digital care records if/when they do not support your practice?
COT (2014) Managing information: a 10-year strategic vision for occupational therapy informatics. London: COT.
COT (2015) Managing information: implementation plan 2015-2025. London: COT.
COTIM (2016) Newsletter. Issue 205, 22 November 2016. Available at: https://www.cot.co.uk/ehealth-information-management/cotim-newsletter [Accessed 6 January 2017].
Department of Health (2008) The NHS informatics review report. London: Stationery Office.
Department of Health (2012) Digital strategy: leading the culture change in health and care. London: Stationery Office.
Greenhalgh, T., Potts, H., Wong, G., Bark, P., Swinglehurst, D. (2009) Tensions and paradoxes in electronic patient record research: a systematic review using the meta-narrative method. The Milbank Quarterly 87 (4), pp. 729-88.
National Information Board (2014) Personalised health and care 2020: using data and technology to transform outcomes for patients and citizens. London: Stationery Office.
NHS England (2016) Sustainability and transformation plans. Available at: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/ [Accessed 6 January 2017].
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