Attachment problems complicate the transfer of information between EMRs

UK - NHS - A complex problem has become evident in the UK as a result of the GP2P patient record transfer process. GP2GP allows a complete patient record to be transferred from one EMR system to another in the UK. However it has quickly become apparent that attachments are a potential problem in the transfer process.

In an EMR system, the majority of data resides directly in the application - this is the clinical information and discrete data that is either entered in manually at the time of the patient encounter or enters the EMR via and interface such as discrete lab data. In addition, data is also stored as attachments e.g. documents received via secure transfer or documents scanned into the EMR. However these documents may exist in standard formats such as .pdf files or Word documents or in other formats that are not as universal. There may be word processor documents in proprietary formats, TIFF files, JPEG images, GIF images etc. Each of these formats have specific characteristics. Some may be high resolution but extremely large requiring lots of memory. Others may be smaller but may require a separate file for each document page.

In addition, attachments may be stored directly within the EMR application and as a result would be within the 'trusted' document area. Other EMR systems may manage attachments by storing them in a separate directory on the computer 'outside' of the trusted EMR application.

All of these configurations create separate difficulties in the transfer of records from one EMR system to another. Multiple attachments can create massive files that need to be safely and securely transmitted between systems. If not stored in secure areas within EMR systems and in standard, accepted formats an additional complexity is added to the record transfer.

Quoting from an article in eHealh Insider:

Dr Paul Cundy, co-chair of the joint IT committee of the GPC and Royal College of General Practitioners (RCGP), told EHI Primary Care: “Clearly GP2GP transfer is nonsense if the associated documents are not transferred at the same time and document management system suppliers need to work urgently with the project to sort this problem out.”

Practices involved in the pilot sites for GP2GP record transfer are unable to send attachments electronically because of problems with third party document management systems, it has emerged. The NHS Connecting for Health (CfH) project, which is currently being piloted in Gateshead and the Isle of Wight, has discovered that most third party document management systems cannot extract and pass on scanned documents in electronic format. CfH says it is working with the system suppliers to try and resolve the problems but in the meantime the practices involved in the GP2GP project must continue to rely on paper transfer alone.

The problem has been publicised by the British Medical Association’s General Practitioner Committee which this week called on document management system suppliers to work with CfH to try and resolve the difficulties as soon as possible.

To read more, go to: Attachment problems thwart GP2GP transfers.

What can we do in Canada to ensure we do not encounter these problems? If you would like to comment on this article or add your thoughts to this complex issue, click on the 'Comments' link.

Comments

[Mike Ramsden]

This is not just an issue with transferring documents "electronically." I have come across this with respect to producing documents for medical legal purposes, which is unfortunately something that comes with my territory (as a rheumatologist I see a lot of post-MVA patients who end up later in litigation.)

When the lawyers want "a copy of the entire chart" it is simple to press a button to printout the EMR clinical notes, however the attached documents may be in several different formats and there is no simple way to print them out, other than one at a time. This can be very cumbersome particularly in the instance where I have previously scanned the "paper chart" from the period before I started using the EMR. This can become a very large time commitment for my office staff.

I have been through two different EMR packages and neither of these were able to deal with this in a straightforward fashion.