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Going Paperlight

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Do your GPs and Nurses record all their consultations JUST on the ... Know who will troubleshoot (pref. not Dr.) Practical/ Technical/ Very technical/ Emotional ... – PowerPoint PPT presentation

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Title: Going Paperlight


1
Going Paperlight
  • Planning
  • Real Practice
  • Accreditation
  • Dr Angus Goudie, Kepier Medical Practice,
    Houghton le Spring

2
Where are you now?
  • Do you have any patient data JUST on the
    computer?
  • Do you use the computer for repeat prescribing?
  • Do your GPs and Nurses record all their
    consultations JUST on the computer?
  • Are your incoming and outgoing patients letters
    stored on the computer?
  • Are messages and telephone contacts recorded on
    the computer?
  • Are you accredited for any data JUST on computer?
  • Is your office still awash with sheets of paper?

3
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4
IMT DES
  • Level 1,
  • Leads appointed ,assessment, IT Plan
  • Training assement
  • Information Governance
  • Level 2 Data accreditation/ Paperlight
  • Notes summarisation for Spine upload
  • Requires we are paperlight - in theory accredited
    now.
  • In practice linked to paperlight accreditation by
    PCT
  • Address updates and ePS
  • Data hosted on CfH approved server

5
Key features for the paperlight
  • Evidence that Adhere to Good Practice
  • Sheet to fill in for the PCT
  • Protocols for everything see below
  • Data Accreditation queries (This morning)
  • Assessment Visit
  • Patient consent for their notes to be checked
  • OK given for DES component 2
  • OK for record to be held all/partly on computer
  • This is for 3 years for the modules we use
  • Can be for 1year, pending evidence
  • Can be appealed against (LMC role etc.)

6
Where are we coming from?
  • Kepier Medical Practice
  • 9300 patients.
  • 5 FTE GPs, nurse practitioner and GP reg
  • Until 2002 in very overcrowded Health C.
  • Short of filing space
  • Short of rooms
  • Keen to do the best job for our patients

7
Why Electronic Record
  • Information for Health (1998)
  • electronic lab results by 2002
  • promise of 24 hour access to records and GP to
    GP transfer by 2005
  • Planned local electronic discharges 2002
  • Promises and frustration
  • 2000 Validation GP computer records.

8
GPs reasons for EHR
  • Clinical Quality
  • Clinical Governance/Audit
  • Miquest
  • Easy access to full record from
  • Surgery, Home and ? on Visits
  • NSF data sets and templates (IHD etc.)
  • Computer guidance on screen
  • Mentor / Prodigy/ Local Guideline

9
Our Reasons
  • Lack of space for paper filing
  • Lack of availability of notes for team
  • Dual entry of searchable information
  • Illegibility
  • Notes frequently missing

10
Practice History
  • 10/89 First computer
  • 9/92 New System (EMIS) every GPs desk
  • 1994-5 GP links (Reg IOS) and Fundholding
  • 1994gtgt Increasing use of templates
  • 6/97 NHS Net (email/ internet)
  • 9/97 GPs/Nurses consult on computer only
  • 3/98 Too many changes-staff roles.
  • 1998 Summaries, Scanning and Printouts
  • Now For accreditation Full documentation
  • Who is responsible?
  • What is the procedure?

11
What Paper?
  • Paper In
  • Non paper data
  • New Paper
  • Surgery
  • Visits
  • Phone Calls
  • Paper Out

12
Incoming Paper
  • Hospital Letters
  • Laboratory Results
  • Case Conference reports (see child protection)
  • Local Guidelines
  • DOH papers (HSC)
  • Data sheets
  • Meeting agendas/minutes
  • Advertising
  • Notes from last practice (see later)

13
Typed Letters
14
Typed Letters
Hospital Letters 600/week
15
Typed Letters
Hospital Letters 600/week
Date-Stamped Scanned
16
Typed Letters
Hospital Letters 600/week
Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
17
Typed Letters
Hospital Letters 600/week
Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
18
Typed Letters
Hospital Letters 600/week
  • Alternatives
  • Staff code the problems, BP, Bloods, ECG, XR etc.
  • Can use templates
  • Drs see post before staff and highlight

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
19
Typed Letters
Hospital Letters 600/week
Types of Scanning
Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
20
Typed Letters
Hospital Letters 600/week
  • Types of Scanning
  • Cut, OCR and paste

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
21
Typed Letters
Hospital Letters 600/week
  • Types of Scanning
  • Cut, OCR and paste
  • Attach image files

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
22
Typed Letters
Hospital Letters 600/week
  • Draw-backs

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
23
Typed Letters
Hospital Letters 600/week
  • Drawbacks
  • Slow

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
24
Typed Letters
Hospital Letters 600/week
  • Drawbacks
  • Slow
  • Stupid when already a computer file at the
    hospital

Date-Stamped Scanned
Doctor Reading, Coding Action (themselves or
highlight for secretary)
SHREDDED
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26
Handwritten Letters
27
Handwritten Letters
Letters (handwritten/provisional/non-scan-able)
Doctor Reading Coding Action (themselves or
highlight for secretary)
Kept till Full discharge letter or review at
2months.
Date stamped Logged on computer
Computer Visit List (Discharges only)
28
Handwritten Letters
Letters (handwritten/provisional/non-scannable)
SHREDDED
Doctor Reading Coding Action (themselves or
highlight for secretary)
Kept till Full discharge letter or review at
2months.
Date stamped Logged on computer
Visit Book (Discharges only)
? Keep some limited types (under review)
29
Electronic LettersHoped for in 2002 from
Sunderland ENT
Incoming Electronic Letters
Doctor Read, Code file on PC
Computer note to PN or receptionist re any action
SHREDDER SCANNER
Almost Obsolete
30
Electronic Letters Achieved
  • Hospital ENT and Diabetic Clinic on hospital
    computer with web access and could be cut and
    pasted
  • OOH service using Adastra send text document that
    will import like lab links into EMIS. (ugly but
    better than fax and scan)
  • Minor injuries unit send to windows for us to
    action. (Graphnet/ GePMail)
  • Pilot 6months, part coded
  • Needs snagging

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33
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36
Non Paper Data In
  • Phone call from
  • Hospital
  • Pharmacist
  • Relative
  • Patient
  • Request for script on on repeat list
  • Report re hospital appointment
  • Report re reaction to treatment
  • Patient related messaging between team

37
Consultations
  • Surgery
  • Doctor
  • Practice Nurse
  • District Nurse/Health Visitor/Midwife
  • CPN/ Social Worker/ Counsellor
  • Use of templates for data quality etc.
  • Telephone calls
  • Visits

38
LV Template
From Northern network of cardiac care Primary
Prevention Toolkit www.nncc.nhs.uk/toolkit
  • (next 5 slides)
  • Template includes all data needed for
    Hypertension
  • (including QOF exclusions etc.)
  • Smoking, alcohol, exercise, weight and linked
    advice
  • ECG, bloods etc.
  • Calculated CVD risk and allocated JBS2 risk band

39
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40
Child Protection Template
41
LV Template
  • (next 5 slides)

42
Visits
  • Summary Printout (whoops thats paper!)
  • Dr to transfer notes back to computer
  • Doctor dictates for secretary
  • Palmtop Computer
  • Laptop Computer gtgt
  • Telephone card in laptop- wireless link to
    practice.

43
Paper Out
  • Prescriptions (ePS on the horizon)
  • Lab requests Forms/labels. ?electronic
  • Referrals
  • Certificates (paper so far)
  • Insurance report automatically generated
    edited printed. (Secure Web transit)
  • DSS reports (still paper.why?)
  • Note request from solicitor printout of notes
  • Patient leaving practice

44
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45
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46
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47
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48
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49
Insurance Report
  • Timesaving
  • Legible
  • Very acceptable to Insurance companies
  • Set up to National eGPR standards
  • But
  • Relies on data being entered onto system
  • Summaries being updated

50
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51
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52
Farewell to the patient
  • Note transfer to their next GP

53
How we pass on the computer record
  • Farewell patient print out
  • Active problems
  • Medication
  • Allergies, family history, immunisations
  • Latest of each type of value/ test result
  • All consultations since September 1997
  • Printout of patient letters (since mid 1998)
  • Case conference reports
  • A copy if relates to more than one family member
  • Computer record tagged as reminder to do this.

54
Article and template on patient data page
of www.sunderland.nhs.uk/beacon
55
GP2GP and CD transfer 2007/8
Image Files Recent scanned letters
Text letter/ Word documents
  • Text File
  • Practice details
  • Confidentiality statement
  • File types and how to use

56
GP2GP and CD transfer 2007/8
  • GP2GP over 500 practices using it for EMIS to
    EMIS.
  • First EMIS to Vision piloted
  • Will be some time before universal
  • Coding issues?
  • CD transfer requires PCT approval of the practice
    and method security/Info Governance
  • Slow to import and not coded
  • http//www.tinyurl.com/pubac

57
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58
Incoming patient notes
  • Need to summarise
  • Data is more than unsearchable text
  • Summary Contents
  • Diagnoses
  • Immunisations
  • Allergies
  • Test results for chronic disease (QOF e.g.)
  • Who to do it?
  • Updating summaries and recording updated
  • Who? How often? Where?
  • Ideal is clinicians with patientsBUT
  • 3 per surgery per GP/ Nurse to keep most
    lt24months
  • Lists of overdue summary updates

59
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60
Sunderland NoteBusters list www.sunderland.nhs.uk/
templates Page marked Coding and templates Word
and Excel
61
Dangers
  • Power Failure
  • Down Time
  • Unexpected Crash
  • Hard Disk Failure
  • Computer Virus
  • DES Physical security policy, Disaster
    Recovery Plans

62
General Protection (DES)
  • UPS to avoid loss of data if power cut
  • Nightly backup to protect stored data
  • Protocols for staff
  • In anticipation of shutdown
  • In event of loss of clinical computer
  • Other backup appointment lists.
  • Antivirus
  • Hosted service Supplier/ PCT

63
Confidentiality/ Security (DES)
  • Individual allocated security role
  • Fully implemented security policy
  • Passwords/ smart cards/ third party users
  • Lockdown/ log-out
  • Any home working risks/ agreements
  • Paper shredding/
  • Use internet/ discs/ downloading
  • Awareness of Good Practice Guidelines
  • Data protection registration
  • Patient notice of policies data/ sharing
  • Security of information transmitted
  • Fax/ verbal/ email/ mobile/ voicemail/ enquiries

64
Has it worked?
  • Getting there, still some paper
  • Painful lessons re
  • Time
  • communication
  • insecurity of new roles
  • regular update protocols and need for everyone to
    know
  • Need to keep on top software updates etc.

65
Has it worked(Problems)
  • What is going on? Barbara says you told her to
    cut and paste.
  • Id rather file the letters in L-G again
  • What are these new printed physio forms?
  • The scanning is still tedious. (BUT)
  • Laptops not rolled out yet...
  • Lab results still need checking, improving.

66
Lessons for us
  • Plan out stages in advance (Incremental)
  • Involve everyone. ? A bulletin/news board/
    meetings.
  • Know who will do what (and write it down)
  • Know who will troubleshoot (pref. not Dr.)
  • Practical/ Technical/ Very technical/ Emotional
  • Regularly take time to review TOGETHER

67
Lessons for us
  • Be bold to discard duplicates. But think.
  • Build in safeguards but review these too.
  • Admit your mistakes.
  • BUT
  • Remember all we can do now that we could not do
    before computers.
  • Easy to forget the hassle and ignorance.

68
Help from the Trusts
  • Readiness to allow community staff to enter
    clinical data on our EHR
  • Move to electronic letters. Until then where
    possible white, typed AE forms
  • Pressure suppliers where hospital software unable
    to cope with output automatically.
  • Training and explicit confidentiality policy now
    wider team accessing records.

69
Help from PCT and CfH/NHS
  • Training courses for staff / protected time.
  • Enough local technical support to install, update
    and troubleshoot. Address books, antiviral,
    intranet.
  • Facilitation of projects
  • DES accreditation procedures
  • Summarisation and archiving
  • electronic prescribing
  • practice web sites and intranets/ extranets
  • Financial backing of progress
  • Clinical input into new solutions

70
Into the Future
  • The biggest step is behind us
  • Advantages clinically and in audit/QOF/
  • A summary/record worth sharing
  • The Spine or locally
  • Plans for eLetters, DN record, web site
  • More work on common templates/data quality
  • GP2GP and ePS

71
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72
Who do our systems serve?
  • Dont forget the Patient
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