Pt Vila, Efate Is Tuesday 3 August 2010

As Mike and Lanie prepare to fly home to Australia tomorrow we reflect on one aspect of the program … Medical Records

Mike (who, by the way, is 62 today!!) takes up the story …

A few posts ago, there was a comment from Mike about the ‘bondage’ of medical records and how these kept him on the boat a number of times whilst other crew members went ashore.

Well, a brief word of history and explanation…

During 2009 Mission 3, Dr Graeme Duke came along as the Mission Doctor and also an MSM crew member.  When we commenced our first clinic, Graeme commenced his normal consultation process and recorded results and notes for each patient on the standard Vanuatu Prevention of Blindness Program Patient Form.  When he returned to the boat, he commenced entering the day’s patient records on the computer.  After about two records, it became obvious that between us, we had some skills to help design an excel spreadsheet and to record all the data for each clinic.  Data entry was cumbersome, so forms were developed to ease the ‘tedium’ and speed up the process.  And so was born, the first ‘general’ electronic individual patient records for the Vanuatu Prevention of Blindness Program and as we were to learn at a later date, the first individual electronic patient records for these people.

You may say there is nothing unusual about recording basic medical details, blood pressure, heart rate, temperature and blood sugar along with base demographic details (clinic, date, name, age, village etc).  It’s what happens each time you go to the doctor and who in many cases have your records since you were born. In the remote villages, the local nurse (if they are lucky and have one!) maintain some notes, but also have a good memory.

And so it was, that during the 2009 Mission 3, medical records were created at the end of each day’s clinic, and by the later clinics, a computer was taken ashore (with a data entry operator) to complete the records in the clinic.  Have you ever used a computer with a dozen heads looking over your shoulder? It does change the way you type!

At the end of the Mission, Don McRaild mentioned these records to the Deputy Minister of Health during his regular post mission ministerial update of the Program.  The records were grasped enthusiastically and quickly analysed from a health perspective (well! quickly for a government department), and soon passed on to the Education Department for further analysis.  From the feedback the program received, we understand they were their first electronic individual patient records for the remote islands.

And so we pass to 2010, where recording the individual patient records for all Missions is a standard part of the program. We estimate that about 30 records an hour can be input.  With about 600 records for this Mission, plus referrals many hours were spent inputting the records by Matthew, Lanie and Mike.  Of course, checking each entry is correct is also time consuming – have you tried to read a doctor or optometrist’s writing and interpret their medical shorthand and their hieroglyphics?

The current Vanuatu Health Ministry statistics became more clear during our recent visit to Mary Tabi and the Lolowai Hospital. Rob, Matthew and Lanie had gone ashore soon after dropping anchor and had met a range of people including a person named Jackson the ‘hospital statistician’ who was keen to find out what medical records we kept.  A meeting time was arranged and statistical stories ‘enthusiastically exchanged’.  Jackson was the Medical Statistician for the Panma Region, which includes the islands of Pentecost, Ambae and Maewo.  Each month a one page activity summary is collected from the 34 Aid Posts and 17 Health Centres across the region. These are entered into a PC based system and each month (along with Lolowai Hospital patient discharge records) are sent on a flash drive (electronic storage device) by plane to Port Vila.  There is no email or internet access available in these areas.

Jackson then proceeded to describe how he was trying to catch up with his data entry, as his computer had recently been away for a couple for weeks in Port Vila having a software upgrade applied.  However, with a broad smile, he turned to me and said “I happy, I nearly catchup!”. He took great pride in what he did and had recently been on a two weeks training course in Brisbane to learn the full medical coding system.

Following his description of the medical summaries, I then described and demonstrated the medical records we kept as part of the program – “we don’t keep individual patient records was his response, only record the discharge records from this hospital.  Maybe its something for the future!”  With that the significance of (and value of the records became more apparent). They gave the health department the opportunity to identify issues at a clinic and village level and respond with the required treatments and education.

The Mission 3 data entry is complete and final aggregations and summaries being made before they are emailed to Richard Tatwin, Graeme Duke and Don McRaild for their further analysis and use.

We are now back in Port Vila and have email facilities available.

Smooth Seas, Fair breeze and completed medical records.

Mike Clarke