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End of the paper trail: moving towards a paperless ward round

  • Jake Harvey (a1), Max Pickard (a2) and Mohammed Nunhuck (a3)
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The use of electronic notes is fast becoming the ideal towards which the modern National Health Service (NHS) strives. Electronic note-keeping and records have many advantages. Legibility ceases to be problematic, information can more readily be shared among professionals (who may be considerably separated geographically), information is far less likely to be misplaced and bulky notes do not have to be stored and transported.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Baggaley, M., Inglis, G. & Malizia, A. (2005) The writing is on the wall: use of an LCD projector to aid communication at the ward round. Psychiatric Bulletin, 29, 180181.
Department of Health (1997) The Caldicott Report. Department of Health.
Department of Health (2006) NHS Records Management: Code of Practice. Department of Health.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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End of the paper trail: moving towards a paperless ward round

  • Jake Harvey (a1), Max Pickard (a2) and Mohammed Nunhuck (a3)
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eLetters

Electronic case records -A useful resource -lessons learnt

MahadevaPrasad Jasti, Specialist Registrar in Child and Adolescent Psychiatry
03 March 2008

I read with interest the article by the authors Harvey, Pickard and Nunhuck's useful report on the use of electronic case notes. It was indeedmy experience too, having worked in an Inpatient adolescent unit, where wehad the access and resources for electronic case records, not only to help with our ward round which our team secretary dutifully and with a smile( not an easy task when more than 12 people talking at times) undertook the mammoth task. This task of notes during ward round was previously the duty of the junior doctors. We also had all entries rangingfrom patient reviews, important meetingsincluding CPA meetings, incidents on the ward ,nursing notes and handover meetings from nursing staff on the electronic case notes, which meant I could review the complete notes from the click of a button, in my office. The use of electronic case records as outlined in their report has a distinguished number of advantages. Apart from those highlighted, it also helps from a medico legal perspective that records cannot be changed after entry. It provides a transparent system for patients and their users.As outlined in their report, the development of a template is crucial to the success, as poorlydesigned templates serve no more than typed notes.

I also would like to highlight that there are also some problems, which need to be addressed when using electronic case records. The practical problems start to arise when the team secretary is on leave or unable to do the ward round. It creates lot of problems starting from understanding, the setting up of system and logins as they are mostly password protected for confidentiality and this may increases the length of time of the meting. One of the responsibilities as a junior doctor was to be able to understand the importance of note keeping, legible entries and also making sure that entries from ward rounds were clear and correct.Using this system of electronic case records takes away another important and valuable skill. Probably the best way is to help junior doctors also acquire computing skills along with their generic skills, which will be invaluable in the years to come rather than to resist change to an electronic system. My other concern is when the computer systems give up we may not be able to enter important information for sometime . The main need to move from paper to computer records is to decrease the use of paper but we are currently far from achieving this, as there is a clear role for paper records for more than one reason, for example A second opinion doctor needs to review case notes which he/she cannot access with our protected computer systems. It would be fair to say that though the electronic case records have advantages it would still not stop the cutting of trees for paper.
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Conflict of interest: None Declared

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Advances in technology

Vijay Natarajan, Staff Grade ,MRCPsych
15 February 2008

It’s great to be able to access multidisciplinary information about your patient while you are sitting in your office. No more phone calls to the ward or different people. One can log on to the system and put a small note after the clinic or home visit and the detailed letter does not needto be typed urgently.

Yes, a lot of people are slow in typing and hold poor knowledge aboutcomputers but one has to move with the new technology. The NHS has created facilities to get European Computer Driving License training for free in certain trusts.

One has to show motivation and take out time to hone these skills. Once learnt, a whole new world opens in front of you. Probably some time should be allocated to junior doctors to develop these skills. It may seempointless and a waste of NHS resources but in the long run it will improve efficiency.
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A Ghost by the name of Technology

Dr Vishweshwari Bhadravathi, Specialist Registrar in Child and Adolescent Psychiatry, Birmingham Childrens Hospital
04 February 2008

Further to Harvey, Pickard and Nunhuck's useful report which exemplifies an encouraging process, I would like to highlight a few important issues, some of which compliment and others pose a challenge to this paper-free concept that all of us looking forward to.

Whilst most of us are used to Information Technology, in one form or other, not everyone is catching up at the same speed. The expectation of logging information on to the computer involves someone typing during the meetings against the clock which not everyone present in the meeting wouldfeel comfortable/confident about.

In an already under-resourced NHS, it might be an unrealistic expectation to have secretarial support for this purpose, which is the obvious option. An alternative but more challenging option would be a teammember to do this task. As the authors mention, traditionally, junior doctors have been assigned this task of taking notes during meetings like ward rounds and I remain anxious that along with training to be clinicians, team leaders, negotiators, managers, supervisors, teachers, researchers etc, this would increase the expecations from 'basic technological skills' to a higher level. Of course, this would be an advantage for everyone in their career, but as more and more non-clinicalskills are being expected from us, clinicians, the time and energy we haveleft to spend on clinical training is getting lesser.

On the contrary, I have had an experience of ward rounds run in the way explained by the authors and having IT supprot during the meetings wasinvaluable. We were able to access/view information such as drug charts, number of hospital admissions, length of each, number of professionals involved etc instantly. Yet another advantage of such data entries is thatauditing becomes incredibly easy.

Hence, whilst congratulating the authors for their innovative efforts, I would like to draw attention to some important questions like 'Who needs to be the identified member for this task? ' and 'Where do we draw the line whilst striving to achieve non-clinical skills, as clinicians?'
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