Information Governance Ironies


Going to the hospital always frustrates me but it is an opportunity to watch – people and processes, communication and clues on culture.

waiting chairsI’m actually writing this sat patiently in the waiting area – we have just been told the clinic is running more than an hour late. So I watch people come and people go.

Last time I was here I wrote a blog about information governance, about how, when you arrive in clinic, you have to declare all your personal details to the full waiting room. I did give them this feedback by the way and I also recognize the challenges in the clinic area. Today the same ritual continues.

[pause – I’ve been in to see the doctor who was lovely. But I’m back for another wait…. so I continue…..]

I am not sure that declaring your personal identifiable information in public is best IG culture.

notesThe next thing made me smile. A man with a big trolley arrives in the clinic. The trolley is piled with notes – over it is a sheet. He gallantly throws it back to reveal and remove a set of notes. Then back again when he is done. Either he is keeping the dust off or he is trying to protect them from view. I gaze on as people adjacent to him continue to declare their full name, address, date of birth and GP including the GPs address!

Meanwhile I overhear someone near me, after seeing the man with the notes tell a story: ‘eeee*’ says the lady to her (assumed) daughter: ‘you will never guess what they told me about my notes?’ The daughter asks for more information. She continues ‘they parceled mine up into a brown paper bag and sealed it with tape when I was going for my scan. I asked them why. They are MY notes after all. She told me they sealed them so I couldn’t open them as they could charge me £15 to look at my notes. This was to stop me looking at them!’

I listen and I watch and I despair.

Nothing really ever changes very much.

clinic

I’m being called again…..

*’eeeee’ is a Yorkshire expression that preceeds an interesting fact!

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Thank goodness it was ophthalmology clinic and not sexual health.


I have lost many hours of my life talking about Information Governance (IG) and to make it worse it is not the subject that makes my heart sing.

computerI worked on the National Programme for IT and I have to say, despite what people might say, Information Governance was taken very seriously. So much so that the technical solutions that we worked on to create the best possible situations for holding and sharing the very sensitive information about people became increasingly elaborate and in many cases the solutions themselves were beyond my understanding. I think if we fell into a trap it was that one about increasing complexity making the issue worse, not better, and that we should have gone back to the citizen and kept it very simple.

We had complex use cases that tried to cover every possible sensitive scenario and tried hard to find solutions to them all.

It was hard and not very enjoyable work. But I do think we tried, we tried really hard to make sure it was the best it could be. I’m not sure we succeeded – my test for this is whether the debates have abated, they have not – but I know we put in much determined effort.  I was glad when I moved onto other more interesting and engaging work for me.

caldicottI know IG is a sensitive issue. I get it. I do my training every year and I am clear about my personal responsibilities. I have read Caldicott 2 and I understand not only my responsibility to protect information but also my duty to share when it the best for the patient.

I contrast this effort and experience with my visit to clinic on Friday which I tweeted about at the time. I arrived to the reception desk, in front of a very full, busy waiting area. The seats face the place you stand to book in and are actually quite close. The receptionist is lovely. Both this time and the last time I attended the same clinic I watched her offer very compassionate help to a number of people. But the booking in process stinks! I was asked for my name, address, date of birth and GP in front of the full waiting room; everyone must have been able to hear. I certainly heard every person who followed me recite their information.

waiting chairsI don’t think its OK to blame technology or the people who work in informatics and this feels like where the debates circle. I understand that electronic information can be accessed and shared potentially more widely than that single clinic with the 25 people who were sat observing but I have to say these are people who may well know me, my friends or my family, as they are local. Thank goodness it was ophthalmology clinic and not sexual health.

I accurately gave the feedback about my experience in the exceedingly small feedback box on the friends and family card including the feedback about the lovely receptionist.

Information governance is not just about IT!