The Electronic Casenote (eCn) by Murray Glaister

eCn, the new electronic casenote system, went live in the Mental Health Service on 1st December 2012.  This will be rolled out over the coming months and years to replace all the existing paper casenotes within secondary care across the region.

 The system has evolved several times in the five months since it went live. Feedback from users has helped to push the development in the areas that are needed most.

 The clinicians and support staff who now use the system on a day to day basis have provided all the development requests, reporting, suggestions, comments and criticism.  These are the people who help us most, they take the time to understand and work with us in eHealth to really start making it happen.

 My key message in this blog is to thank those involved so far for their time, understanding, criticism (where necessary) and support.

 So what is the casenote?

 Firstly, it is the place where all the information about patients is stored from treatment episodes and things that have happened to them over the course of interactions with any NHS services.  This information needs to be kept for future reference, to document what has happened and as a legal record of the treatment that has been provided to date, although much of it is probably never looked at again.

 We have started legacy scanning in several areas and our approach is to ‘scan as is’. The scanning team are NOT checking through the notes to make sure it is ordered and perfect before scanning commences. If records are in the wrong order in the existing paper casenote then the scanning team will replicate that wrong order in the legacy scan.

 We will also scan the volumes as they are.  If a patient has multiple volumes they will have multiple legacy scans. Similarly if they have visited several service areas they will have several legacy scans.  The exception to this will be the removal of some lab results which are routinely viewed via the Lab Web Browser and SCI store.

Secondly, but probably more importantly, the casenote is there to support clinical care. This involves easily accessing the relevant information.  The key to this is good and consistent document identification and classification. However, lessons learned from the earlier eMRec pilot and other national experience indicated that there was an even bigger danger in trying to classify documents in too much detail.

 Fortunately, there was a Scottish Group looking at producing national document classifications so we took their output and made Doc Type one of the four core components assigned to each piece of information (along with CHI number, date/time and Specialty).  It is not perfect and will evolve over time but it gives us something to start with.  Having the eCn filter results by Specialty, date/time or document group will allow a clinician to focus on individual documents as required or allow a wider, more holistic view, if necessary.

 Lastly, the broad use of casenotes is not about the storage of information, it is a document that is used as a prompt or a mechanism for a piece of work.

 The casenote appearing in an outpatient clinic means the clinician has to create a note, either directly by writing or via dictation.   The casenote on a desk is the prompt to review, write an inpatient summary discharge letter, return for dictation, filing etc.

 So this workflow or prompting needs to be thought through, understood and replaced in some way shape or form. There has already been some work carried out by health records looking at the Outpatient clinics in DGRI that we will soon be discussing with a wider audience.

 A final point of clarification, is that eCasenote will replace all paper casenotes , the legacy archive, the piles of notes found in the medical records store or in offices across the region as well as the stacks of paper that are transported daily around the organisation.

 In many instances, and for many people, the easiest way to record information is still to record it on paper. Outpatient Clinics may have blank pre indexed sheets to write on but these will be captured immediately after the clinic.

 Similarly, for inpatients in Midpark, notes are still collected during the stay, grouped together, separated and coded into main document category groups by the ward clerks before being sent for scanning.  Although we are starting to change that process.

 The first stage of the project is about gathering these paper records together as effectively as possible to help move towards going paperlite (reducing the dependence on paper, particularly in storage terms) which is different from paperless (removing paper altogether).

 Some consultants in Mental Health are now typing notes directly into eCn, with others testing and using laptops to access information off site.

 However, and this goes back to an earlier point, we are looking at changing systems that people have been working on and improving since 1948. In many ways the eCn will mean starting again, and it will be evolved and developed over time, with help from the front line staff, into the basis of a system we will use for the next 65 years.

 Murray Glaister is an eHealth Project Manager and would be happy to discuss the eCn with individuals or teams if they wish further information. He can be contacted via switchboard.

 Next week’s blog will be by Dr Ewan Bell Consultant Biochemist and Clinical Director for Diagnostics.

 

 

5 thoughts on “The Electronic Casenote (eCn) by Murray Glaister

  1. The most important thing to do when the electronic record arrives is to remove ALL paper available to clinicians. We ran a duplicate system in the surgery for around 2 years and that is exactly what it did – duplicate the work. You pick a date and at that time ALL entries are only made on the e-record. No paper notes, no sticky labels. We were very nervous and planned to have the old notes available on the desk for 3 months but ditched them after 4 weeks.

    • thanks that’s usefuly viewpoint. The plan is that when we go electronic the paper storage will go. We are still thinking about allowing clinicians to capture notes on paper and scanning it in rather than have to key into the eCn system, but already we are seeing a movement within mental health to direct input into the note. Thanks again

      M

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