Dr John Lockley provides further tips on how preparation of the practice computer can improve your efficiency
The Keep it simple, stupid (KISS): Invest at the outset and reap the rewards later article focused on effective preparation of the practice computer and how time spent on this activity will repay itself handsomely.1 This month’s article in the working smarter series continues with this theme, providing more examples of how upfront preparation can save significant time in the future.
How to save time on frequently performed tasks
Computers are thick, but tireless. One of the best ways to use them is to give them as much of the repetitive work as you can. The more you can automate, or minimise, frequently performed actions the more time you’ll save, and the less stressed you’ll get. Look through all the computer functions that you use frequently and see if there is anything that you can:
- select with fewer keystrokes.
If you aren’t that confident in setting up the computer, then you may find that your CCG’s IT department or clinical IT lead can help. The tips and tricks listed below may help you to save time on frequently performed tasks.
Create standard templates and forms
Create a separate template for different types of letter, such as those for NHS or private referral, and for letters that don’t contain NHS information (e.g. a letter to the patient’s employer)— these templates will automatically incorporate all the relevant information required, ready for you to add your final free text. Templates can be set up to add in the addressee’s name and address (from a local database), along with your name and qualifications at the bottom. Next time you write a letter, simply call up the appropriate template, and all the relevant information will automatically appear without you having to waste time adding it manually. Doing it like this also leads to consistency, increased accuracy, and completeness.
Likewise, it may sound like too much effort to create a personalised imaging request template for each doctor which includes their full name, surgery, and status, but imagine how much time it will save if you don’t have to type all that information each time you want someone to have a chest X-ray or an ultrasound. Doing it like this not only saves time, it also reduces stress and hassle because it is one less thing to do, and prevents copying errors, so clinically speaking it is safer.
Set up macro use
Macros can be created to carry out frequent activities, such as actioning incoming letters and lab reports, or reauthorising medications. Macros speed up the process by gathering together a whole sequence of instructions which, with a single keyboard activation, trigger an action (or series of actions), such as an acknowledgement that you have read a letter, made a comment of ‘No action required’ and filed it away, prior to showing you the next letter from your in-tray. Alternatively, you could create some macros for lab reports— one that puts ‘Normal’ against the result; another to indicate ‘Make an appointment to see the doctor’; and yet another for ‘Repeat test needed’.
Exactly how you do this depends on your primary care system, but the principle remains the same: if you can gather together a frequently used series of keyboard strokes and mouse clicks that can be triggered with a single keypress or icon-click, then a macro can help. Can you create a macro to trigger the input of blood pressures, urine dip tests, or write out common clinical observations, which the user then edits according to the findings in the individual patient? Every one of these ideas can make life considerably easier for you. The great thing is this: once you have taken the time and trouble to set up these shortcuts they will be there for you and your colleagues forever.
For more information on using macros, read the first Guidelines in Practice article on this topic.1
Get Microsoft Windows and Office to assist you
The Quick Access Toolbar in all Microsoft Office programs is a real timesaver. This is a single, configurable line of tiny icons above the main Microsoft Word menu. Having them there means that you don’t have to burrow inside the main tabs to find your most common commands—just click on the appropriate icon in yourQuick Access Toolbar. It saves time, and makes creating documents that much more intuitive and smooth.
What you put in your own Quick Access Toolbar is up to you, and depends on how you need to use Word, Excel, etc. My own Word toolbar has these icons, in the following order:New, Open Recent File, Open, Save, Save As, Close, Quick Print, Format Painter, New Comment, Insert Footnote, Show All, Undo, Redo.
Open Recent File within File Explorer is another innovation—in fact, I have only discovered in the last 10 days how useful it can be! Within Windows 10, open File Explorer. At the top of the file structure on the left is a heading ‘Quick Access’. Click on it, and two lists appear on the right-hand side of the screen: Frequent Folders and Recent Files. If you have been working on a file recently, access ‘Recent files’ and it will appear here wherever it is located within your computer.
Why is it so useful to search recent files? Most of us now have complicated and crowded filing systems, and it is easy to ‘lose’ documents. (‘Did I put that letter I wrote about immunisation targets under "Child health”, "CCG targets” or "Incentive schemes”?’)
Optimise how you input information
Putting clinical information on the practice computer is probably the single most intrusive problem for clinicians as few are good typists. So here are a few tips:
- Why not get a voice processor? Dictate into a microphone and watch your words type themselves out on-screen! There are various types, some integrated into your surgery software, some (usually much cheaper) that are standalone, but whose output can be copied into the patient record, or into a letter. As always, preparation is key. The most important tip? Use a digital microphone. Voice processing only saves time if it delivers a very high accuracy rate, otherwise you will be wasting time going back and correcting mistranscriptions. Accuracy improves markedly with a digital microphone. Similarly, don’t skip the preparation period while it learns your voice. And whenever you come across a dictated word that has been mistranscribed or misspelled, or which is new to it, use the correction facilities within the voice processor, which will then memorise the changes—again, saving time and hassle in the future
- Learn to touch-type. The computer itself can teach you this, and over the years this skill will save you a lot of time and vast amounts of stress. I learned to touch type in 3 weeks using a program called ‘Mavis Beacon teaches typing’. By showing on-screen where the keys are you can both learn ten-digit touch-typing without looking at the keyboard and have instant feedback on what you have done right or got wrong. It really works—and quickly, too
- Make Word help you: if you constantly misspell certain words then get Word to autocorrect them. Accessing autocorrect depends on the type of computer you are using: either go to the File tab, then Options, then to Proofing, then click on the Autocorrect button across the top of the page, or, if using a Mac, go to the Tools tab and click on Autocorrect on the drop-down menu. You can then put in the wrong and the right spellings of all the words with which you have problems. The next time you type in the word with the wrong spelling the computer will automatically correct it for you, in front of your very eyes!
- Use copy and paste: if you regularly use standard sentences and paragraphs for official written reports, think about ways for the computer to memorise and reproduce them when needed: this could be by using Word macros (built in to Microsoft Word) or even using a Read-only document containing a variety of standard paragraphs: simply copy and paste the relevant ones. Again, this all saves time and reduces errors.
Simplify how you run reports
A clever trick for simplifying how you obtain computerised reports from within your patient database, is to create reports that relate to a time period rather than linked to a specific date (e.g. ‘since 2 August’). Why? A report that looks back over the last 6 months can be run on any day you want and will work without further customisation; if you specify a start date then every time you want to use that report again you will need to remember to change the date (and check each time that your changes work correctly).
- Time spent setting up the computer, the paperwork, and the processes is a good investment and will continue to save time in the future
- Set up standard letter templates that automatically insert relevant information from the patient’s record
- Macros can shoulder the burden of typing in complicated but repetitive reports, or by calling up complex routines such as recording comments on incoming lab results
- Inputting patient information can waste a lot of time. Make it more efficient by learning to touch-type, or by using voice processing.
- Lockley J. K.I.S.S:* invest at the outset and reap the rewards later. Guidelines in Practice 2016; 19 (9): 40–42.