Recently Wales Audit Office’s IM&T Audit Manager, Paul Cunningham, spoke to the British Computer Society at Aberystwyth University, about a WAO review of NHS data quality in a lecture entitled ‘Health data, what could possibly go wrong?’
In the second part of his blog, Paul gave us a flavour of what the talk was about. You can read part one here and also view the presentation for a short time via http://bit.ly/bcsmidwales-healthdata (English only)
Our health itself is a complex thing and we may need to visit specialists in different hospitals around Wales. Add to that the many NHS reorganisations which have taken place and you have the complexity and duplication of data we now see.
NHS Staff do their very best in trying circumstances and we have some anecdotal evidence that hospitals may routinely forward summary notes when they know one of their patients is about to visit another hospital, but unexpected transfers may not always be recorded and it is unlikely that all detailed notes are shared in this way.
We can see patterns in the data that indicate all these factors, but it all adds up to the conclusion that merging records, which in theory sounds relatively easy to do with a simple spreadsheet, is in practice a non-trivial task involving physically finding and reviewing all the many shelf miles of paper records.
Untangling the web
So how do we deal with this problem? Our review found areas of good practice around Wales and we made a point of sharing these in the form of WAO recommendations. But you saw how fast complexity rises with numbers even with a simple game like rock-paper scissors. Add to that, the large number of systems in use around Wales, the number of patients and you quickly surpass the conceptual limit of the human mind.
In the fullness of time, the actual underlying medical notes and records will have to become electronic. Doing that for all new records would be hard enough, but matching, copying and encoding all existing paper records is almost unimaginable in scale. Until then, electronic medical records are really just a summary of, and a pointer to, the paper files. So NHS Wales is trying a different approach, involving a Wales-wide index of all patients (identified from the local patient data) which points back to the many original computer records and their corresponding paper counterparts.
Allied to this will be a web site portal which can bring all of these records onto a single screen for viewing (under proper confidentiality controls, of course) by the appropriate hospital staff.
The audience for my talk was an eclectic mix of computer science students (possibly including some future auditors?); experienced academics; health workers and BCS members; so, not surprisingly, they offered some interesting suggestions which might well form the basis of future work. These included wider studies of NHS data processing as well as a revisit of this issue to see how the new approach fares. So watch this space for further developments!
About the Author
Paul Cunningham is the Wales Audit Office’s IM&T Audit Manager and has many years’ experience working across all sectors of the WAO’s business, including NHS, local and national government clients. Prior to joining WAO, he lectured extensively in IT, computer science and business studies as well as providing consultancy for private industry. He is married, with three children – the youngest, Ashley, being the mathematical mind that created the complex game described above. He also has two granddaughters who live nearby in the Rhondda Valley.