Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

Audit of Vital Registration and Vital Statistics Systems: Jamaica
Information Management and Accountability
Current policies and procedures governing medical records and birth/death reporting in
hospitals are contained in a manual developed and issued by the MOH. MOH’s National
Director of Medical Records (NDMR) indicated to us that although the manual is present at
each of the hospitals, most of the staff have not read it and do not routinely refer to it.
According to the NDMR, the hospital administration is responsible for ensuring compliance
with the provisions of the medical record policies. Medical record compliance inspections
are conducted by the NDMR on a routine basis, with a goal of surveying every hospital (23)
at least annually. The NDMR indicated that the role of an accurate hospital medical record is
often not understood and appreciated by hospital management and staff outside of the
medical records department and as a result, deficiencies are common. After an inspection is
performed a report of findings is generated and sent to the hospital Chief Executive Officer
(CEO). According to the NDMR, there is usually little correction of or follow-up on
deficiencies noted in the inspection reports. Consequently, the same deficiencies remain
from year to year. In the last two years, there are only two instances where hospitals even
asked questions about the audit reports. There is apparently no system for holding the
hospital administration accountable to the MOH for addressing the deficiencies noted during
inspections.
We observed that both hospital medical records and coroner records are at risk of being
destroyed because of environmental factors, e.g., humidity, hurricanes, and vermin. This is
troubling because medical records and coroner records are the foundation documents on
which notification and subsequent registration of births, stillbirths, and deaths are based.
RGD’s records management is very good. Records are kept in a climate controlled vault and
on archival-quality paper. In addition, RGD has a plan to scan all birth, stillbirth, death, and
marriage registrations since 1920 which will allow for electronic storage and retrieval.
At hospitals, monthly census summaries are performed manually and are prone to errors.
There is no verification process between these summaries and actual data from medical
records. In addition, counts of births, deaths, and stillbirths are not reconciled with
admissions. Lack of discharge summaries was indicated by the NDMR to be a problem, but
our findings did not support that indication.
At the coroner’s offices, no system is in place to measure or monitor performance so that
improvements can be made in terms of collecting and reporting the appropriate information
in a timely fashion (improve throughput, decrease time to completion of cases, etc.). Monthly
and quarterly reports are generated to indicate the status of the case load. The backlog of
coroner’s cases is monitored by manually counting outstanding cases from the diary (log),
which may include several different ledgers. The coroner reconciles individual completed
cases with the log prior to signing Form E. The coroner does not retain a copy of Form D or
Form E and Form D for a given individual is not linked to Form E for the same individual.
Thus, if a form is lost in transit to RGD, there is no simple way to reconcile or recover that
information. The coroner’s logs do not include the date the police investigation started, so
tracking of progress is not documented.
11