Marianne Carter: a Varied HIM Career in Retrospect
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Professional profi les Marianne Carter: A varied HIM career in retrospect Marianne Carter Why did I study Medical Record Librarianship? speech pathologist and the pharmacist became By sheer default! Having made an early departure lifelong friends. from a dietetics course, I obtained a position as a clerk in the Medical Records Department of the United Kingdom and Italy Queen Victoria Hospital, Melbourne, Victoria.1 In 1971 I ventured overseas and, having spent I’d never actually heard of Medical Records six weeks on a boat, I arrived straight into the Librarianship but my parents emphasized the Northern Hemisphere winter with a great suntan! importance of a professional career so I followed I was extremely fortunate to obtain a position at their advice and obtained a tertiary qualification. St Mary’s Hospital, Paddington, working with Dr Felicity Tunbridge to establish the Staff Health My career journey Clinic. This gave me a great insight into the workings of the British National Health Service. Victoria The position was part time and I also worked as I graduated as a Medical Record Librarian (MRL) a coder at St Mary’s and the University College in 1968. In 1969 I commenced working at Hospitals, London. I then commenced tripping Warrnambool Base Hospital and stayed there for around Europe with two friends in a Morris Minor 12 months as the Medical Record Librarian. I then and, along the way, obtained a position teaching moved to the Bendigo Base Hospital for another English at the European School in Sardinia, Italy. 12 months as the Medical Record Librarian. I recall initially not even really knowing where The work was straightforward at both of these Sardinia was, but once I became established there facilities. However, the then management staff at I enjoyed a memorable and exciting experience, Bendigo hospital were absolutely fantastic and and my love of Italy has remained. I have only thoroughly supportive of the Medical Records once returned to this wonderful country but live Department. The department at Bendigo was new in hope that I may visit again. and had been designed by MRL Joyce Jackel. It was a joy to work in this department as it was Victoria again well situated near Admissions and Emergency, On returning to Australia after a year overseas, I so the patient flow from our perspective was took up the temporary relief position of Deputy excellent. I shared a hospital house with a physi- MRL at Box Hill Hospital in 1972. Later in the otherapist, a pharmacist, a speech pathologist year I was appointed to a newly created position and a dietician; I won’t say we partied every night with the Victorian Cytology Service based at but we certainly had a tremendous time, and the Prince Henry’s Hospital (this hospital, like the Queen Victoria, has also since closed and been incorporated into the Monash Medical Centre). 1 This hospital has since closed and moved to be incorporated into the Monash Medical Centre. 64 HEALTH INFORMATION MANAGEMENT JOURNAL Vol 38 No 3 2009 ISSN 1833-3583 (PRINT) ISSN 1833-3575 (ONLINE) Professional profi les New South Wales indebted to Phyllis for her guidance over many In 1973, I married someone who wanted to years. farm! So in 1975 we moved to Peak Hill in NSW and have lived there ever since, during which Then the light dawned! time we have raised our family. My first MRL It was at about this time that I came to realise position in the region was with NSW Central that the Medical Record is the most important West Health Services. At the time when I first document in the health system. (With the acuity of moved to NSW, the state had just undergone hindsight, I wonder now if I had been rather slow the first of many Regional and Area Health in grasping this truth). Nevertheless, even then Service restructures. I was extremely fortunate I realised that I actually had quite a passion for that the then CEO created the Regional position Medical Records. (which I might add was funded by the Federal I left the Regional position to have a family Government for some reason) and this was and my successor was Helen Brolly, who subse- probably my biggest challenge up to this point quently completed her Masters degree in Medical in my career. However, it was made considerably Records in the then Orana and Far West and easier than it might have been as several months Central West Health Regions. earlier the late Betty James had undertaken a In 1979, I returned to work in a part time review of several of the facilities in the region capacity for a few years at Dubbo Base, Orange and had made some substantial recommenda- and Parkes Hospitals, as the Medical Record tions for the implementation of Medical Record Administrator (MRA); this was the first profes- standards for the maintenance and storage of sional name change. My roles usually included Medical Records (i.e. allocation of Medical Record managing the department and coding. I have Numbers, that Patient Master Index (PMI) cards always fully understood the importance of be kept, ordering of clinical forms, filing medical coding, and in later years strongly supported records numerically and in folders instead of coder education through HIMAA. I was successful envelopes, and that a person on staff should have in making it mandatory that only HIMAA coder specific responsibility for maintenance of medical qualifications were acceptable in the AHS, where records). Betty had developed and written a I was employed. policy document on Medical Records for NSW Then came my next big challenge! In 1989 I Health2. These were the days when registration was successful in obtaining a full-time position of patients was very casual; for example, age was with the Central Western Health Region as the noted on the record rather than date of birth. Regional MRA and Quality Assurance (QA) I spent a short time at the Royal Prince Alfred Officer. The latter role represented a steep Hospital with Professor Phyllis Watson, who gave learning curve for me, and one which, upon me a remarkable understanding of what was reflection, was where I really had to apply the going on in NSW at the time and the direction skills I had learned as a MRA. Quality Assurance in which the state was heading. I am indeed in this organisation was related not only to Medical Records, but to all disciplines within the health services. We had meetings for the engineering and maintenance staff, allied health 2 It is interesting to note that this document has only just been reviewed by NSW Health more than 30 years after it was written! staff, community health staff, and while all this HEALTH INFORMATION MANAGEMENT JOURNAL Vol 38 No 3 2009 ISSN 1833-3583 (PRINT) ISSN 1833-3575 (ONLINE) 65 Professional profi les was being undertaken, Casemix was hot on the space required to store all the paper records. Government agenda. I cannot say these were The work in preparing the submissions for the halcyon days; rather, they were just days that Area Health Service, the ReBOB Planning Team, were extremely busy, while I managed a raft of NSW Health and the Treasury was unbeliev- different issues, including a three-month second- ably daunting and the HIMs involved in the ment to NSW Health in Sydney, where I reviewed preparation of the required information (Kathy coding systems to be used in the Community Borschtsch, Leanne Fletcher, Sharyn MacCallum Health Information Management Enterprise and Jennifer Hughes) must be acknowledged. (CHIME). The money was found after much negotiation, and Infomedix, a Melbourne firm, was contracted Continuing to learn to install the system. The project has now been On reflection, these were the years where I in place for two years at Bathurst Base Hospital came to understand the most significant issues and commenced at Orange Base Hospital in 2009. concerning medical records, and my passion for In 2010, it will be introduced at Blooomfield the profession continued to grow. Healthcare was Hospital. continuing to change rapidly and in order for the Then in 2004, yes, another restructure! Medical Record Administrators and our service in Midwestern Area joined with the Macquarie Area the Central West to stay abreast of things, I had to and Far West Area Health Services to become the be politically astute. I also had to manage a fairly Greater Western Area Health Service (GWAHS), large budget. MRAs at the facilities were not the largest AHS in NSW, the size of Germany in responsible to me, but I always maintained that area. However, while it does not have the popula- in the regional position, I must ensure ongoing tion of the Metropolitan AHS (or Germany!), the training, support; in other words, I had to be 47 facilities and 50 Community Health Centres prepared to go in to bat for them when issues and many outreach services had to be managed arose. I worked with some truly inspiring MRAs over great distances, and in many instances with in those years. limited or problematic technology services. In 2005, while the new Executive staff were Favourite action of NSW Health: busy sorting out the structure of the new AHS, I RESTRUCTURE (regardless of returned to the ‘grass roots’, as the HIM at Dubbo outcome)! Base. This was extremely refreshing for me, as it In 1993, the first of the ‘recent restructures’ in had been a number of years since I had managed Area Health Services commenced, along with a staff in a Department and been involved with change in government, and the Districts were all the issues in a Medical Record Department.