Year of a new graduate in the bush // Alexandra Van Gemert

Year of a new graduate in the bush

Alexandra Van Gemert

Traditionally, the first choice for most new graduates has been to obtain jobs in metropolitan hospitals. I can honestly say that my decision to go against convention and move over 1,000 kilometres away from home to rural New South Wales (NSW) to work as a regional Health Information Manager, has been an enriching and worthwhile experience. My position manages the Clinical Information Services across two activity-based funding sites, and four block funded health services, covering a population of roughly 80,000 residents. I thought I would share some of my experiences and challenges.

Day one and we are off to the local pub for lunch with the General Manager, District Clinical Coding Manager and my team of six staff (Clerks and Clinical Coders). What a great way to meet some of the staff who have worked at the hospital for many years, some since they were teenagers, and have a wealth of knowledge. The hospital is their home. As they share their experiences and stories, I begin to reflect on what lies ahead, having already seen records piled on the floor and shelving exploding out the door.

After being thrown into presenting at the Junior Medical Officers Orientation during my first few weeks, I started to feel much more confident and settled having met the other new kids on the block. My mission was to ensure they all know where the medical record department is located within the hospital and to encourage them to become frequent visitors, even using our 9am coffee runs from the local cafe as a potential lure. Of course, only for work related purposes and to assist with discharge summary completion and clinical coding queries. The presentation went well, although more of a practice run for future sessions. I am pleased to say the content has since improved, now that I have a better understanding of the expectations of doctors and their knowledge on clinical coding and documentation.

A month in and thinking I am on track having successfully streamlined and updated some of the old processes, I am greeted by our local police. There has been an unfortunate death on the operating table in theatre and I am confronted by the detectives, carrying out a patient’s original hardcopy medical record bagged up as evidence. Hospital security are called, and I intercept this. Not only are they taking hospital property off site, they haven’t even bothered with any paperwork or official court order to seek release of the information to them. The detectives proceed to make numerous calls to our local court but of course it is lunch break and phone lines are shut. An hour is too long for them to wait around, so the detectives are back upstairs with the intention of taping off the operating theatres as a ‘crime scene’ until the medical records are released to them. ‘Crime scene’ – was there a murder? No one told me. You can imagine the adrenaline rush. I can confidently say my expectations are now very clearly known to the local police, including the chief superintendent, who made a special visit the following day to hand over necessary paperwork. Following this incident, all staff involved and nurse managers were debriefed to ensure a similar situation did not happen in the future. The meeting included some education regarding privacy and release of information, with reference to district and NSW Health policies and procedures.

All hospitals have those ‘big dreamer’ medical consultants who want everything. I have never come across one as enthusiastic as our own, who expressed to me his dreams of developing an electronic health record that charts observations electronically and automatically triggers rapid responses. Highly

advanced for our little site, but when the consultant states he would be happy to go to Harvey Norman and buy all the equipment to build it, you know he is being serious!

Space and storage issues appear to be never ending for most health services that are still utilising paper medical records. After realising the hospital had not culled a medical record for at least 10 years, the implementation of a culling program presented as top priority. The lack of culling is largely due to the hold on destruction during the Royal Commission into Institutional Sexual Abuse in NSW. Challenge in this project includes identifying records that are dating back to a last attendance in 1975 and are pre the current patient master index (PMI), so you cannot look them up anyway. The frustration then of course comes to sourcing additional staffing to complete the project. For context, it is estimated there are over 80,000 records stored onsite for a 100 bed hospital, excluding those pre current PMI. Roughly 9,000 new records are created each year made up of new patients or volumes.

The next project was to set up a record barcoding system at one of the smaller sites that currently use tracer cards to track records. Having never heard of a tracer card, I knew this task was going to be a challenge. It was a matter of setting up the technology, training staff to use other areas of the patient administration system and some change management, all fundamentals to implementing an electronic medical record, such as our ‘big dreamer’ medical consultant’s idea.

Working in a regional area with limited resources can be challenging and difficult. Some days I experience firsthand the frustrations of doctors and nurses, with medical records being thrown at my feet, complaints about the new electronic medication system and clinicians wanting information to be entered for them or charts printed off to avoid using the electronic system. Other days I was able to scrub up and go into theatre to observe some exciting procedure being undertaken or join ward rounds with the doctors to assist with ‘live documentation’. At times it has been daunting; trying to explain to executive why we need to purchase the new clinical coding books for 11 th Edition as a backup reference or why there may be a potential drop in National Weighted Activity Units as a result of the new Australian Coding Standard 0002 Additional diagnoses. However, it is most satisfying when you gain the respect of staff and become supported and viewed as an expert in your field.

I would encourage all new graduates to consider rural and regional opportunities. The unique experiences and broad skills that can be gained while increasing your confidence in your abilities, even after 12 months, will prepare you well for your future career. The country social life is also very different; quiz nights at the local pub, rodeos, country races, playing sport. All unique experiences of their own and great ways to meet the locals, who are even friendlier when they find out you aren’t a passing tourist.

“I would encourage all new graduates to consider rural and regional opportunities.

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I have thoroughly enjoyed the past 12 months in rural NSW. It has been a big learning curve and I am thankful to those who have provided support and mentoring along the way. My advice to any new graduate would be to take opportunities that offer a challenge and be flexible with the location, as this often leads to great experiences. You should never feel isolated, knowing our professional association Health Information Management Association of Australia is there to provide support with being able to meet and network with likeminded colleagues.

Acknowledgements to La Trobe University for providing a solid grounding in health information management basics and to my District Coding Manager for her ongoing mentoring.

Alexandra Van Gemert BHlthSc(MedClass), BHlthInfoMgt Manager, Clinical Information Services; Tablelands Sector Email: Alexandra.VanGemert@health.nsw.gov.au