Saturday, 11 October 2014

Why do GPs use IT like its ‘paper under glass’?

#GPFUQ 146  How do you get big projects started and finished? 
This is the how do you herd cats question. First recognise and work on all the different elements; the political dimension, the personal dimension, human behaviour, organisational behaviour, other interests, motivations and blockers, the time and timing. Second make a start (it’s the essential first step), work at it (it won’t happen by accident), accept steady progress (it will take time to deliver), try to create independent brokerage (avoid any conflicts of interests), recognise any vested interests (pander to them when necessary), encourage friendship (like each other and be happy), bring dissenters inside the tent (use their ideas and energy), deal with key stakeholders individually (formally and informally and be flexible with your approach), be trustworthy, honest and open (but leave some room for secret manoeuvres).

#GPFUQ 147   What’s the secret of life?  
Honesty and fair dealing. If you can fake that, you've got it made.  Groucho Marx

#GPFUQ 148 Why do GPs use IT like its ‘paper under glass’?
Practices have been paperless for years but often they use the new technology to work in the old ways - the ‘paper under glass’ mistake. Practices fail to use IT to its full extent.
Some suggestions for action
·      Ensure consistent use of practice computer system by the practice team. This does require training and expense - but makes notes much more useable
·      Have regular sessions to share ‘top tips’ on how to use IT in the practice.
·      Find out and use all the shortcuts like macros on your computer system
·      Stop duplication of any work that’s on paper and computer
·      Have all the forms and letters you use formatted as mail merge so they are automatically filled by the computer
·      Build synchronized actionable alerts (i.e. they routinely prompt at the right time what’s needed for good long term care) in the EHR, and train the team exactly when to act on them in their daily routine.
·      Make sure that when you design something it fails safely. For instance don't send out emails saying "get back to me if there is a problem on this"
·      Gets patients to enter more information in the EHR - home BP, Glucoses, questionnaires
·      Use non-clinical portions of EHR templates to record other important information e.g. contact details for next of kin, key worker for mental health patients so that any clinician can find this information easily
·      Use internet technology that facilitates new ways of communication mechanisms e.g email consultations with patients, use web cam link from patients home to surgery, videoconferencing, facebook, twitter, shared documents etc
·      Automate data extracts and collection – e.g. on referrals, workload. Data drives improvement.
·      Use e-mail to ask clinical questions and to liaise with and get support from secondary care
·      Use email distribution lists, always use a subscribe and unsubscribe option
·      Use Youtube to spread learning e.g. instructions for patients on self management
·      Avoid looking at the screen instead of looking at the person - this is a false economy in terms of time, people need to feel listened to
·      Use Voice recognition software instead of typing to enter clinical notes and write letters
·      Get joined up with the other relevant health and social care IT systems. Liaise with third parties like Hospital Trusts to ensure GPs can access hospital IT systems from their desktop PC. E.g. access pathology reports
·      Insist on having ‘single signs on’ to access the various other systems you need to use on your computer. Single signs on will increase their use.
·      Integrate referral pathways from third sector partners
·      Use decision support tools that help you provide informed consent e.g. What are the numbers needed to treat for the intervention you are recommending
·      Make sure information does not need to be entered more than once
·      Allow patients access to a copy of their personal health record and gets them to check that its correct

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