In the first of a new series on information technology in practice, Dr Gillian Braunold describes how to integrate the computer into your team
The use of computers and electronic records has traditionally been of interest to only a small subset of practitioners, regarded as nerdy anoraks obsessed with bits and bytes. However, some GPs are now demonstrating that using computers to manage information transforms the working environment for everyone in the practice.
Information management is relevant to everyone in the multidisciplinary team, but it requires planning and investment of both time and money to get the most benefit from it.
Realising the full advantages of networked information handling will revolutionise working practices and business processes – but only when the whole team embraces the change. Teams can move forward only at the pace of the slowest member, so the question is, how do we get our reluctant colleagues to join us in our enthusiasm for change?
Convincing the sceptics
We need to be ready to challenge all preconceptions and cynicism regarding the use of IT in the surgery. Concerns might include "How can we minimise time lost slaving over the keyboard and struggling to find information?” and "How will we prevent the computer skewing priorities in the clinical setting?”
To address these reservations it is important to encourage hesitant colleagues to prioritise their learning needs, and to support them in working with the computer without undermining their working practice and workflow.
To be successful in raising the team’s baseline competence, the practice must have an IT strategy that specifically addresses training needs. It must also invest time and resources in support of the new team member with the ability to perform so many of the practice’s administrative tasks: the computer.
Effective strategies to address any opposition to the use of IT should highlight the following areas:
- Clinician benefit
- Patient benefit
- Administrative benefits
- Increased resources
- Time saving
|Figure 1: The practices significant event data for a 12 month period (2001)|
Accurate and systematic coding of diagnoses will be more effectively achieved if the data collected are reported back to the team in a meaningful way.
Figure 1, above, shows the significant event data fed back to clinicians in our practice over a 12 month period (2001).
The six major diagnoses don’t show the dramatic rise that emergency admissions do. This graph would imply that the emergency admissions from our practice population soared dramatically after May. What the graph actually demonstrates is the power of feeding back data.
It had never been important to clinicians to record accurately the fact of an emergency admission. After the searches were set up to run on a monthly basis the team met to discuss the data presented, and the cases that were underlying the figures. My partners wanted to discuss patients whose information would be collated by the computer. The presence of the correct code ensured that their patients were correctly identified for the meeting and the numbers in a previously poorly coded group soared.
You can see dips in admissions in August and October, this reflects the practice’s use of locum doctors for whom there was little incentive to code for emergency admission correctly.
The computer enables us to read previously illegible records which should significantly improve safety in the delivery of care to patients. There is no doubt that when faced with handwritten notes many clinicians turn to the hospital letters first for quick access to information rather than struggle over colleagues’ abbreviations and poor handwriting. Once all patient records are legible, they will provide comprehensive accounts of issues within consultations and we can fully understand what we can each contribute to our patients’ care.
The potential to save time for both clinicians and administrative staff is evident when you list the tasks the computer can execute that are currently performed by practice staff. The benefits range from providing legible retrievable notes throughout the organisation, to financial analysis, payroll, recall systems, and tools for standardising and measuring the performance of the organisation at every level.
If we take the example of pathology links to the hospital, once pathology results flow directly into the patient’s electronic records, time is saved. Practitioners no longer have to phone the laboratory repeatedly to ensure that results are back in time for the patient’s appointment.
This facility can enhance clinical practice. In our surgery, we know that mid-stream urine test results will be back within 48 hours so we are less likely to prescribe antibiotics before the result is reported. We can reliably leave instructions for the patient dependent on this efficient flow of information.
We can effectively use the computer to remind team members to perform tasks that might otherwise be forgotten in a consultation. The computer can create accurate recall systems related to predetermined practice priorities. Achieving the targets of the nGMS contract’s quality and outcomes framework should be much easier when the computer is effectively deployed.
It undoubtedly takes longer to record information on a computer in the consultation than it does to scribble a note with a pen on paper. Therefore, it is important to customise solutions to individual needs and simplify screens and data entry templates to act as aids rather than burdens.
There are many time saving tips that the practice can adopt. For example, the use of macros – using a single keystroke to record what would otherwise be a repeated task involving multiple keystrokes.
An example of this is the letter signed by patients who refuse a cervical smear examination. We have automated this task in the consultation so that a single combination keystroke, in this case Control+Shift+C, will record the code for ‘smear refused’, bring up the mail-merged letter documenting that the patient refuses the smear and print it out. The letter is autofiled in the patient’s records and the print out is ready for signing and sending to the primary care trust. The computer automatically carries out all these tasks in the background while the clinician talks to the patient.
In day-to-day use only a very small part of any software’s capacity is exploited by users. It is important to keep looking for ways to improve everyone’s ability to use and customise the IT system to its full advantage.
People learn in different ways so we need to tailor teaching methods to the individual’s preferred learning style and attention span. In peer group settings, experienced senior clinicians can be embarrassed by their apparent clumsiness with the computer and need time dedicated to learning on a one-to-one basis.
Most software suppliers will provide on-line tools for learning, as well as manuals and training materials to support the team. Preparing for induction of new team members is critical so that they are able to catch up with the rest of the practice as fast as possible. The best trainers are those who are patient, even with individuals who may at first be hostile towards the use of IT.
Successful IT integration
The successful IT strategy will include evaluating its progress on predetermined measures of success for the practice. However, it will be evident that you have succeeded in integrating the computer into your team when every member’s role within the practice is transformed by the use of the computer and he or she feels inadequate without it.