Flierman cites the recent death of a patient who took his own life as an example. Seeing a group of dancers at her farewell ceremony, Flierman discovered that his patient had danced in the past. That fact was hidden somewhere in her EPR, but only now did it dawn on Flierman. “We could have done a lot more with that in the treatment. For example by letting her teach. It might have made her life more meaningful. ”
Hundreds of documents in EPD
The psychiatrist is concerned about the way in which an Electronic Patient Record is turned into a maze of folders and documents in certain cases. This is especially true for patients who, in the case of psychiatric disorders, have been struggling with psychoses and depression for years. In the EPD, as it is also intended, all medical data of and contact moments with a patient are stored. From the first intake to examinations, results, treatments and medication, but also interview reports of telephone calls and the like. Patients for whom the EPR can grow into a file with hundreds of documents during that period.
This data can, and is, entered and stored in the EPR by multiple doctors, practitioners and other healthcare professionals who come into contact with a patient. Not everyone always does this in exactly the same way and with the same folder structure. And especially for patients who have long-term complaints and need to be treated, having a good overview of the course of the disease over the years is of crucial importance. In many of these cases, Flierman is not very pleased with the quality of the EPD. “Since the late nineties there have been various EPDs on the market for mental health care, but above all, vital information is poorly accessible, perhaps even worse than it used to be in the paper file.”
Luck and mistakes
In the interview with Trouw Flierman and some colleagues also talk about luck and mistakes. In certain cases, for example with a patient in crisis, it is important to quickly find out whether there was any compulsory admission in the past and, if so, why. “But to get that data out there is a real wanderings through the file. EPDs do not distinguish between main and side issues. It assigns the same status to all data, whether it’s a disruptive childhood trauma or an everyday note. If you’re looking for something, you should be lucky to click on the right folder. Recently, a colleague of mine overlooked a result of a psychological test from a few years ago. ”
Another psychiatrist, Christien Bouwman, says that she sometimes spends hours retrieving information from the EPR about a patient’s medication history. “Sometimes you don’t find side effects and you may prescribe the same medicine that made the patient ill before. That can just happen. It will not immediately lead to life-threatening calamities, but just starting a treatment that was previously ineffective is of course not right. ”
Such errors, although not immediately life-threatening, must be prevented. Toon Flierman provides proof of this, who could not find any information about the meditation history in a patient he first saw in the EPR. As a result, he prescribed a much too high dose of lithium, which is harmful to the kidneys. Now, ‘normal’ patients are usually articulate enough to provide relevant information about medication use themselves, but this is different for many psychiatric patients, who are often confused and say little or nothing.
Incomplete and unclear EPR
For psychiatric patients who have undergone multiple mental health care admissions, the EPR can become even more chaotic. “Whenever you are fired, close the file. Practitioners have to make a summary of every completed episode, but that does not always happen. If the patient switches to another institution, more data is often lost and entire pieces of history disappear, ”says Flierman.
And then, according to Flierman, there is another situation that does not benefit the usability of an EPD and the findability of documents. When a healthcare institution moves to another EPD transfers then not all historical data of patients will be migrated to the new system in a well-organized manner. Not even if that data was clearly stored in the old system and easily found. “All data older than a year and a half are thrown together and end up in a PDF file of sometimes hundreds of pages, where everything is mixed up,” says Flierman.
Solution presented
With all these experiences and science, Flierman has also come up with a solution. “Create a start page for each patient on which all relevant themes such as medication, diagnosis, social situation and drugs are summarized. If you click through, you will come to a kind of Wikipedia page with more extensive information. And the hundreds of existing documents and reports? They can be stored in the archive. And make sure that important data is always clear and up-to-date. “
Flierman already presented his solution to the Ministry of VWS in 2019. There, the solution was positively received. However, the Ministry of Health, Welfare and Sport states that the GGZ itself is responsible for improving care. Unfortunately, the problem of file management as outlined by Flierman is not a priority within mental health care. This is mainly because the problems occur mainly and almost exclusively in chronic psychiatric patients. The current EPDs are adequate for short-term treatment processes.
