Dr John Lockley offers tips on improving efficiency through effective preparation and use of the practice computer system
Many practices don’t realise how much time and stress they could save with a little pre-planning.
Let's start with the computer. Do you hate it? Does it get in the way? If so, you’ve probably not set it up for maximum efficiency. Time spent in preparation will repay itself hand over fist, continually, in the future.
Missing the opportunity
Is this you? A practice takes delivery of its new computer system. It seems unbelievably complex, so everyone spends the first 2 months learning the basics. Once they've got it working (sort of) no one wants to waste more time on it—especially as they might just mess up what's actually functioning at the moment.
So their expensive, potentially helpful computer is never used to its full capacity. The practice doesn't even know what its full capacity is. Worse, they may inadvertently be using it in the most awkward way possible, perhaps like having a Formula One racing car; too complex for most people to drive, so they push it round the track instead!
Here's the antidote
- Change your mindset about the computer. It's a tool to be customised and used.
- Computers are thick, but tireless. Wherever you can, give the computer the routine, automatic, boring jobs that don't require human judgment.
- Remember that there are many ways to speed up how you and the computer work.
- Don't just learn keypresses—instead, get to grips with how to think about using the computer in your healthcare work.
- Set aside time to fine-tune your computer until it is just right. This will save you ages in the long run.
Think about customising the computer both at the level of the practice and of the individual workstation/user. Consider ways of automating every part of its work, for example how you:
- input data
- manipulate that data internally
- pass messages
- write letters
- produce reports
- integrate the computer with the paper and physical aspects of the practice.
NB: different practice computer systems do things slightly differently, so think of the advice in this article as general guidance rather than detailed instructions. If you aren't that experienced in using the computer, seek advice from someone who is: you could try contacting the National User Group for your practice system or alternatively your CCG's IT clinical lead.
Get the background information right—and keep it up to date
Let's start at the very beginning: getting the basic information right.
Practice computer systems generally have system settings and user-based settings.
Start by getting your practice manager (PM) or IT manager to customise the system settings—those things that affect everyone throughout the practice. For example, the computer system our practice uses has some great messaging features. You can quickly select a recipient using a pre-populated drop-down list—but first my PM has to ensure that all the right people appear on each list: for example, all those who are allowed to view safeguarding information in patients' notes; those who can prepare and issue prescriptions, create appointment rotas, etc.
This isn't a one-off activity. All practices have a turnover of staff; and over the years staff may change the nature of their work, their experience, and their responsibilities, often needing to have higher or different levels of permissions in line with their new levels of responsibility. Therefore have a policy of regularly reviewing:
- basic permissions and settings for the practice as a whole
- the lists of people working within the practice, their current roles, and levels of permissions-don't forget locums here.
Customise messages and responses
Similarly, there may be a number of places where you can customise messages and responses, for example, adding routine comments to lab results. Creating a comprehensive selection of standard messages to add to lab reports can save users a lot of time by comparison with laboriously typing out ‘Tell patient normal’ on each result.
Think about the best way to do this in your practice. Create some stock messages and then try them out for real: this is when you discover your messages may need some subtle tweaking! For example, what message might you give when almost all results are normal, and the out-of-range ones aren't considered to be clinically significant? Legally, it's probably wise not to write 'Normal' because strictly speaking, they aren't (my preferred response is 'clinically satisfactory').
In the same way, there may be many places within your primary care system (messaging, results, incoming letters, tasks, prescribing requests, etc.) where you could usefully create:
- standard text responses or actions
- drop-down menus of people to whom you might want to send messages or delegate actions
- ways of notifying others (or even reminding yourself) of important actions
- a library of standard documents, guidance, protocols, and advice for patients.
Customise each workstation
Consider customising each computer's start-up routine so that as soon as it's been switched on it automatically loads all the programs that particular user needs.
Pin commonly-used programs to the Taskbar (right-click on icons on the desktop, or on the Start Menu, and select 'Pin to Taskbar'). Now users can select these programs without having to minimise what's already on their screen.
Consider putting the Windows Snipping Tool on the taskbar. This allows you to take a snapshot of a specific area of the screen which you can then copy into other documents—a great way of rapidly getting a snapshot of the part of the screen you are trying to troubleshoot.
Think things through
Think around the repeated processes done in the practice: recording information, creating referral letters, requesting imaging and lab tests, running the same report on a regular basis. Many repetitive activities like these can be customised and/or automated. Not only does this save time and minimise transcription errors, it ensures that all the relevant information is transferred every time. Spend time thinking about your needs here.
Similarly, teach people the correct way to use those parts of the practice's programs that will specifically help them—for example, searching for free text within the patient's record; seeing what prescriptions were issued on a particular day; finding the next available appointment for a particular clinician.
Set up the toolbars
If your computer system allows, customise the icons on your toolbars. Although it may take time and patience to set these up properly, once done they are permanently available. For example, do you have a separate label printer? Is it fiddly getting to the right part of the program to print off a label? Could you instead attach this command to an icon? If so, set it up. Now, whenever you want a sticky label containing the patient's details, just click on the icon and it will instantly print off a label. It saves ages—and also, makes the work feel so much easier and so more intuitive, which in turn lessens your own stress.
Set up macro use
Think about installing a macro program, or alternatively (or in addition) use the macro facilities within individual programs on your computer. These can save vast amounts of time and stress.
Macros are collections of individual keystrokes, mouse movements, and mouse clicks that are gathered together, to be triggered by a specific key combinations which you yourself allocate, for example, CTRL+ALT+H (though the exact key combinations available will depend upon your individual practice system). Instead of laboriously entering these collections of stored key-presses and mouse clicks each time you need to do a particular task, now you can simply activate the macro (in this example, by holding down the CTRL and ALT keys and dabbing the H key) and the stored actions are then all inputted automatically and sequentially.
Macros can be an incredibly quick way of carrying out routine but complex tasks reliably—especially for inputting information into the patient record, into letters, documents, lab requests, or reports.
You may already have macro functionality within your practice system; or within Microsoft Office; or alternatively you might choose a third-party macro program (such as Macro Express)—though do make sure before purchasing that it (and your use of it) will be compatible with your existing software.
Prepare each individual macro beforehand. Each will then be remembered forever, or at least until you change it.
One macro might input free-text wording saying 'O/E SLR (R)90°, (L)90°, ankle jerks normal, knee jerks normal, power in ankles and knees normal, no cauda equina symptoms or signs, lumbar side-bending normal L1-5'. Let's say you've allocated this macro to ALT+CTRL+L. Now even the slowest clinician typist in the practice can enter all that text in the patient record (in a jiffy, and with no mistakes!) by hitting ALT, CTRL, and L. Then she can go back and change anything that isn't true for the particular patient. So she might trigger the macro with ALT+CTRL+L, then change the measurement of right-sided straight leg raising to 75° and she's just put in a complete, detailed lumbar spine examination, tailored to that specific patient, in three keystrokes!
I did this some years ago, allocating different text to each of six macros, one for each of the bigger systems within the body (CVS, lungs, abdomen, CNS, urogenital, back). I could now input a detailed record of my examination findings in just six combination keypresses (plus a few extra tweaks for any changes I needed to note down). And all the complicated characters (like degrees, brackets, and the forward slash) went in without trouble too. When entering text via a macro, for legal reasons make a point of always reviewing (and if necessary amending) the entry before saving, so that if challenged you can confirm to a court that all text entered in this way will invariably be an individually accurate, checked description of your findings.
You can also use macros to trigger actions, for example, those needed to reauthorise a drug for four more issues, print a sticky label, or call up a particular report.
Macros can save ages—but you will need to think through beforehand how and where you could use this type of feature within your own clinical system. Don’t be put off by this: take time to do some planning because, properly used, macros can save hours of time, large amounts of stress, and improve accuracy no end.
*K.I.S.S=keep it simple stupid
- Time spent setting up the computer, the paperwork, and the processes will save significant time and stress in the long run
- Take time setting up the global settings and lists of current users for the entire practice and keep them up to date. In particular, customise lists of standard responses to lab reports etc.
- Macros can shoulder the burden of typing in complicated but repetitive text, or calling up complex routines such as repeat authorisations of medication:
- customised icons can do the same.