Paper tsunami: how the move to digital medical records is leaving us drowning in old paper files



What to do with our old paper medical files now that records are going digital? As a recent Brisbane case demonstrates, not all files are heading straight for destruction.
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Gillian Oliver, Monash University and Peter Bragge, Monash University

The recent case of paper medical files from a Brisbane hospital found on a busy street highlights the need for secure, controlled disposal of medical records.

The files were said to be from out-patient clinics and contained patient names and their appointments, but not medical details. Now Queensland Health is investigating the circumstances of how the files came to be found in public, rather than being safely destroyed by a contractor.

So how are hospitals and clinics handling their old paper records as they move to electronic systems? How are they dealing with the tsunami of files that need to be safely disposed of?




Read more:
The Cabinet Files show that we need to change the nature of record-keeping


Your medical records, whether paper or electronic, need to be kept while they’re relevant to your care, with restricted access to protect your privacy. But who decides when medical records are no longer needed? What happens then?

Governments at all levels have legislation for this. For instance, the Queensland health department specifies what is destroyed and when, according to a schedule from Queensland State Archives. This covers medical records in the public health care system in physical form (paper, photographs, film), in electronic form or a mixture of the two.

This, for example, says “records displaying evidence of clinical care to an individual or groups of adult patients/clients” should be kept “for ten years after last patient/client service provision or medico-legal action”. There are a number of exceptions relating to, for example, clinical trials, mental health and communicable diseases. For each exception, there is a specific time period of how long the file needs to be kept.

Queensland State Archives also advises on how records are to be securely destroyed, either by shredding, pulping or burning.




Read more:
Our healthcare records outlive us – it’s time to decide what happens to the data once we’re gone


Hospitals can contract commercial services to destroy paper files. But the document owner, in this case the hospital, is ultimately responsible for ensuring this is carried out legally.

The Royal Australian College of General Practitioners (RACGP) has established practice standards for GP clinics. These require the secure destruction (for instance, by shredding) of paper records before disposal.

So, hospitals and GP clinics need to develop and implement policies and procedures that state explicitly when and how medical records should be disposed of, and also keep a record of when that happens.

However, to determine whether an individual medical record among the vast quantities held has passed its “use by date” can be extremely resource-intensive for administrative staff.

This means the ultimate driver of paper record destruction is more likely to be the need to free up expensive office or storage space. It’s this sort of scenario that might eventually play out into records being accidentally or deliberately dumped wherever, whenever.

The move towards digital records

The Brisbane situation highlights the limitations of “business as usual” in relation to medical records, which includes paper records held in multiple locations, in hospitals, in GP clinics and with specialists.

Consider your own medical record “paper trail”, which may include files from hospital admissions, records held by your local doctor or other specialist, and results of blood tests and x-rays performed elsewhere.

At both a personal and whole-of-population level, there are clearly numerous opportunities for unintended access to these physical documents. Centrally and securely stored electronic records can address this risk, and also carry a number of other advantages.




Read more:
Opting out of My Health Records? Here’s what you get with the status quo


Privacy breaches relating to paper medical records are in part a function of a worldwide transition from a trusted familiar environment of paper records to electronic medical records.

This dramatically multiplies the volume of paper records needing to be destroyed — from only those that are “out of date” to every record that is scanned and made redundant.

The Brisbane case also highlights the sensitivity of medical records in all their forms, a factor also playing out in the My Health Record debate.




Read more:
My Health Record: the case for opting out


Who do we trust to keep our sensitive medical records safe? Should our trust be placed in the old paper records (part of the the status quo) or a centralised electronic medical record?

The Brisbane situation, by highlighting the limitations of paper records, certainly challenges notions of trusting the familiar and favouring the status quo.




Read more:
My Health Record: the case for opting in


So, what can we expect?

Like all transitions of this scale, there are a range of costs involved in moving from paper to electronic medical records, one of which is the prospect of further paper record data breaches as mountains of redundant records are destroyed. However these transition costs need to be balanced against the ultimate benefit of electronic records.

Even accepting these benefits doesn’t necessarily mean people will automatically become more comfortable with electronic medical records, like My Health Record. For that to occur, people also have to overcome a general lack of trust in government.

However, our research shows it is possible to encourage people to use online government services. By harnessing behavioural science, we have shown that providing customer support and promoting the benefits and ease of online services helps the transition from queuing and paper forms to using online services.

Hope for the future

In the rush to drag people to shiny new online platforms, this illustrates the simple act of talking people through the advantages and supporting their transition can address many of the psychological barriers to change.

Then, hopefully, we can see the end of paper medical records and services, and fewer paper records being dumped on the side of the road. As long as paper records exist they will be vulnerable to unauthorised access – either within a storage facility or in transit to destruction. However, each case of unauthorised access is dwarfed by the number of paper records successfully and securely destroyed, never able to be physically accessed again.The Conversation

Gillian Oliver, Associate Professor and Director, Centre for Organisational & Social Informatics, Monash University and Peter Bragge, Associate Professor, Healthcare Quality Improvement (QI) at Behaviour Works, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Pakistani Christian Sentenced for ‘Blasphemy’ Dies in Prison


Murder suspected in case of Christian imprisoned for life.

LAHORE, Pakistan, March 15 (CDN) — A Christian serving a life sentence in Karachi Central Jail on accusations that he had sent text messages blaspheming the prophet of Islam died today amid suspicions that he was murdered.

Qamar David’s life had been threatened since he and a Muslim, Munawar Ahmad, were accused of sending derogatory text messages about Muhammad in June 2006, said David’s former lawyer, Pervaiz Chaudhry (See “Pakistan’s ‘Blasphemy’ Laws Claim Three More Christians,” March 10, 2010).

David was convicted under Section 295-C under Pakistan’s widely condemned blasphemy laws for derogatory remarks against Muhammad in a case registered at Karachi’s Azizabad Police Station, with another case registered at Saddar Police Station pending. Maximum punishment for Section 295-C is death, though life imprisonment is also possible. On Feb. 25, 2010 he received a sentence of life in prison, which in Pakistan is 25 years, and was fined 100,000 rupees (US$1,170).

Chaudhry, who said he was David’s counsel until Islamic threats against his life forced him to stop in July 2010, told Compass that the Christian had expressed fears for his life several times during the trial.

“David did not die of a heart attack as the jail officials are claiming,” Chaudhry said. “He was being threatened ever since the trial began, and he had also submitted a written application with the jail authorities for provision of security, but no step was taken in this regard.”

Conflicting versions of his death by jail officials also raised doubts.

A jail warden said David was reported crying for help from his cell today in the early hours of the morning. He said that David, who was breathing at the time, was transported to the Civil Hospital Karachi (CHK), but that doctors there pronounced him dead on arrival.

He also said, however, that he had heard from colleagues that David was found dead inside his cell and that his body had been sent to the hospital for post-mortem, not for treatment. Investigations are underway, he added.

Karachi Central Prison Deputy Superintendent Raja Mumtaz said David was shifted to CHK for treatment after jail staff members found him crying for help with “one hand on the left side of his chest.” He said the prisoner was first taken to a local healthcare center, but that doctors there suggested that he should be taken to a hospital for proper treatment.

Mumtaz said that David was shifted to the hospital at around 10:45 a.m. today and was alive when he reached the hospital.

Sindh Inspector General of Prisons Ghulam Qadir Thebo insisted to BBC that David died of natural causes, saying he was housed in a Christian-only wing in which no Muslim prisoners had access to him.

“Our investigations have not yielded any evidence of foul play,” Thebo told BBC. “There is no evidence to suggest he was murdered.”

David’s family reached Karachi today to take custody of the body. An impartial probe and autopsy report is awaited, as no jail officials were ready to say on record whether they had seen any visible injury on David’s body.

David’s son, Aqeel David, told Compass that the family had been informed only that his father had suffered a heart attack and died while he was being taken to the hospital.

“We don’t know anything besides this little piece of information that was given to us on the telephone,” he said. “We are unsure about the circumstances surrounding my father’s death because of the serious nature of the cases against him.”

David’s former attorney said that the trial in which David was convicted and sentenced was a sham.

“The judge acquitted Ahmad in this case, even though all 11 witnesses clearly pointed out his direct involvement in the incident,” Chaudhry said.

In regard to the other blasphemy case registered at the Saddar Police Station, Chaudhry said he had cross-examined witnesses who had again accused Ahmad of mischief and absolved David of any wrongdoing.

“Ahmad’s lawyer had filed an application for re-examining the witnesses when I withdrew from the case,” Chaudhry added. “I stopped pursuing his cases last year because of serious threats to my life by Islamist groups who used to gather outside the courtroom.”

Chaudhry said threats were made “both inside and outside the courtroom.”

During the cross-examining of witnesses, he said, Senior Superintendent of Police Muhammad Afzal had also admitted that Ahmad was the real culprit and that David was arrested on the information of “some sources.” Chaudhry said there was no relation whatsoever between Ahmad and his client before the trial started.

“They were complete strangers,” Chaudhry said. “David was definitely framed in these cases.”

Report from Compass Direct News
http://www.compassdirect.org

EU Visit to Orissa, India Triggers Barrage of Accusations


Hindu nationalists protest delegation as Christians cite injustices.

NEW DELHI, February 8 (CDN) — A delegation from the European Union concluded a “fruitful” trip to India’s violence-torn Orissa state on Friday (Feb. 5) amid a swirl of protests by Hindu nationalist groups and cries of injustice by Christians.

The delegation was able to hold “open and frank” discussions with Kandhamal officials on the visit, said Gabriele Annis of the Embassy of Italy.

“We had a very good meeting with the Kandhamal district administration,” Annis told reporters. “It is fruitful. We had open and frank discussion. It helped us in understanding the situation and understanding happenings over the past 15 months.”

The delegation was led by Christophe Manet, head of Political Affairs of the European Commission delegation to India and consisted of members from Spain, Hungary, Poland, Ireland, Italy, Netherlands, the United Kingdom, Finland and Sweden. A delegation from five European countries had visited Orissa earlier in November 2009, but the government of Orissa denied them permission to visit Kandhamal district, where Christians say they continue to be threatened and destitute.

Archbishop Raphael Cheenath said on Saturday (Feb. 6) that despite the claims of the state and district administrations, life for the Christian victims of violence in August-September 2008 remains far from normal: thousands still live in makeshift shanties along roadsides and in forests, he said, and local officials and police harass them daily.

“The block officers have been playing with the facts, indulging in corrupt practices and cosmetic exercises whenever political and other dignitaries come to visit or inspect,” the archbishop said in a statement. “Innocent people are coerced into giving a false picture. The chief minister must investigate the role and functioning of the entire district administration . . . It is strange that officers in whose presence the violence took place and thousands of houses were burnt are still in office and are declaring that there is peace in the district.”

Following attacks in the area after Hindu extremists stirred up mobs by falsely accusing Christians of killing Hindu leader Swami Laxmanananda Saraswati on Aug. 23, 2008, more than 10,000 families were displaced from their homes by the violence. Since then, Cheenath said, an estimated 1,200 families have left the area. Between 200 and 300 families reside in private displacement camps in the district, and more than 4,400 families still live in tents, makeshift shelters or the remnants of their damaged houses, he said.

The number of attack victims who have received financial assistance from the government, churches or Non-Governmental Organizations (NGOs) is unknown, but is estimated at 1,100 families, Cheenath added.

He criticized Prime Minister Manmohan Singh and the Chief Minister of Orissa Naveen Patnaik saying, “Both of them had promised to provide adequate compensation for the damages caused during the 2008 communal violence. But the victims have not been adequately compensated.”

Cheenath said the state government had decided not to compensate any riot-affected religious institutions even though India’s Supreme Court had directed the government to compensate them for all damages.

“This is a national calamity and demands a special package for the affected people, which should include land, income generation, education and healthcare,” the archbishop said.

Extremist Makeover

Prior to the visit, Christian leaders expressed their shock at Kandhamal district authorities attempting a cosmetic makeover by evacuating nearly 100 Christians from G. Udayagiri.

In letters to the EU delegation, the state government and national human rights and minorities commissions, Dr. John Dayal of the All India Christian Council narrated the plight of the 91 members of 21 families from 11 villages who were living under plastic sheets along a road in the marketplace area of G. Udayagiri.

Dayal said the group included 11 married women, three widows, an elderly man with a fractured hip and thigh, and two infants born in the camp. They had faced almost daily threats, he said, as they had not been allowed to return to their villages unless they renounced their faith and became Hindus.

Soon after the decision to allow the EU delegation, the water supply to the makeshift site was cut off and police and civil officers drove away the residents, who had only plastic sheets to protect them from the cold, he said. The refugees said officers later gave them permission to come back at night but to keep the area clear.

“The families are in G. Udayagiri, they have moved in front of the road, and they are in a very bad state,” the Rev. Samant Nayak of G. Udayagiri told Compass. “They are literally on the road.”

He said that approximately 55 families were living in G. Udayagiri, where they had been given land, and a Christian NGO was helping to construct houses for them.

The Press Trust of India reported that Orissa officials were nervous about last week’s delegation visiting Kandhamal but finally gave permission under pressure from the central government. State officials finally allowed the visit with the pre-condition that the delegation would be allowed only to interact with people and not engage in fact-finding, according to a senior official in Orissa’s home department.

The Kandhamal district collector, Krishna Kumar, told Compass that all went well and “no untoward incidents took place,” but sources reported at least one minor disturbance in Bodimunda village. On Wednesday (Feb. 3), one house was reportedly damaged there in a scuffle that also resulted in two arrests by the local police.

During their Kandhamal visit, the EU delegation was reportedly forced to cancel a meeting with judges of Fast Track courts established in Phulbani, in Kandhamal district, to prosecute hundreds of those accused in the 2008 violence, due to protests from the local lawyers’ association.

Kumar, however, pointed out that the lawyers’ protest was secondary to the lack of clearance from the High court for the meeting with the judges. “The same was not informed to us prior to the visit,” he added.

Justice Denied

The anti-Christian violence in August-September 2008 killed over 100 people and burned 4,640 houses, 252 churches and 13 educational institutions. Archbishop Cheenath said justice is critical to long term peace.

“The two Fast Track courts, and the court premises, have seen a travesty of justice,” he said in the Feb. 6 statement. “Witnesses are being coerced, threatened, cajoled and sought to be bribed by murderers and arsonists facing trial. The court premises are full of top activists of fundamentalist organizations. The witnesses are also threatened in their homes with elimination, and even their distant relatives are being coerced specially in the murder and arson cases against Member of Legislative Assembly [MLA] Manoj Pradhan.”

Though some witnesses have testified on Pradhan’s alleged involvement in crimes in depositions, he has been acquitted in case after case, the archbishop added.

“We are demanding a special investigation team to investigate every case of murder and arson,” he said. “Similarly, there is also need for transferring the cases against politically powerful persons such as Pradhan to outside Kandhamal, preferably to Cuttack or Bhubaneswar.”

Cheenath said victims have filed 3,232 complaints at Kandhamal police stations, but officers registered only 832 cases. As many as 341 cases were in the G. Udayagiri area alone, 98 in Tikabali and 90 in Raikia, he said.

“Even out of this small number [in G. Udayagiri], only 123 cases were transferred to the two Fast Track courts,” he said. “So far, 71 cases have been tried in the two courts, and 63 cases have been disposed of. Of these, conviction occurred only in 25 cases, and even that is partial as most of the accused have not been arrested or brought to trial.”

Only 89 persons have been convicted so far in Orissa state, while 251 have been acquitted, supposedly for lack of witnesses against them, he said.

“Among them is Manoj Pradhan,” Cheenath said. “It is strange that in the case of 10 deaths by murder, nine cases have been closed without anybody being convicted, while there has been partial conviction in the case of one death. Who will bring justice in the case of the nine murder cases?”

The archbishop demanded that independent lawyers be allowed to assist overworked special public prosecutors.

Hindu Nationalist Protests

Protesting the delegation visit was the Vishwa Hindu Parishad (VHP) and other Hindu nationalist organizations. VHP State General Secretary Gouri Prasad Brahma had lamented on Jan. 31 that the visit would trigger tension and demanded their immediate withdrawal.

“There is no business of the outsiders in the internal matter of the state,” he said.

The delegation also faced the ire of the Hindu extremist Bajrang Dal on the day of its arrival in Bhubaneswar, capital of Orissa, on Tuesday (Feb. 2). Hundreds of its cadres met the delegation at the airport shouting loudly, “EU team, go back.”

Five Bajrang Dal members were detained for creating trouble, Deputy Commissioner of Police H.K. Lal told media on Wednesday (Feb. 3).

After the delegation had left, the Orissa Bharatiya Janata Party (BJP) heavily criticized the central and the state governments, with BJP state President, Jual Oram telling a press conference that the state had allowed the visit to “divide people on communal lines.” He said that the delegation had not met any Hindu leader during their visit to Kandhamal, which “exposed their communal agenda.”

Oram accused the delegation of violating protocol in trying to meet the judges of fast-track courts in Kandhamal, saying this “amounted to interference into internal affairs of a sovereign independent member state under the U.N.”

At the same press conference, BJP MLA Karendra Majhi said that allowing the visit was an attempt by the chief minister to win back the confidence of minority Christians. He alleged that the delegation had held secret meetings in a Catholic church at Phulbani with church leaders and select NGOs to facilitate conversions to Christianity.

“I have every reason to believe that the promised assistance of 15 million euros to Kandhamal by the EU delegation will be utilized for conversion activities,” Majhi said.

Report from Compass Direct News