CPR for paper records creates Creame

Auckland District Health Board’s Creame (clinical record access made easy) project involves milking data from paper-based patient records and presenting it in electronic form.

It also involves adding new electronic data to create computerised patient records, or CPR for short.

It’s almost fully deployed at the Starship childrens’ hospital and the DHB’s other sites, at Grafton, Green Lane and National Womens’ hospitals, are part-way towards deployment.

Creame project implementation director Linda Fletcher, speaking at an electronic health records conference in Auckland last month, said the decision was made to progress from paper records to computerised ones, rather than fully electronic ones, for reasons of timeliness.

Full electronic records are “a longer-term strategy”, for which the CPR has provided a platform, she says.

“If you look at health organisations internationally that have electronic patient records, scanning has been part of it.”

The CPR strategy was embarked on when it was decided that manually shifting the mountains of paper records at different Auckland DHB sites such as Greenlane and Grafton was impractical.

When the DHB’s new hospital at Grafton opens in October, it is expected that 4000 records a day will go back and forth between Grafton and Green Lane, which will be an outpatient and day surgery site only.

Rather than face the prospect of using trucks to transfer paper records, the DHB undertook to scan the paper records and store them electronically — the CPR part — and add feed-ins of new data, such as lab results and emergency department discharge summaries.

“The lab interface went live on June 19, which means we don’t have to scan in lab results any more.”

Instead, the results are added automatically to patients’ records once they become available online.

Challenges presented during the project included lack of standardisation for paper records across the different DHB sites and a non-destruction policy regarding records, which means there are a million stored at ADHB sites and another million at offsite storage facilities.

Software from Australian document management specialist Tower Technology was used to integrate the different strands of data input when the paper records were scanned.

Auckland’s system is based on an update of an implementation first done at Canberra hospital seven years ago.

Once the computerised record is created, additional information can be added via email. Access to records is authorised according to user status and staff at the DHB are divided into records user groups, with different levels and types of access according to the group they belong to.

There is an audit trail that logs every user, a contrast to the paper records, where there is no log of who has viewed them. The records are stored on magnetic disk and backup and disaster recovery copies are stored on optical disk.

“We have three copies of the information,” Fletcher says.

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