Following heath secretary Jeremy Hunt’s recent challenge to the NHS to ‘go paperless’ by 2018, doctors and hospitals are going to need IT tools to coordinate care electronically.
Care coordination is essential to avoid duplicate treatment and to prevent medical errors. Whether it is a GP, hospital, other healthcare provider or local authority, they are all at different levels of implementing IT. In fact, many are still manually posting or transporting health records to other members of care teams, which can take days. Even if a patient moves from one doctor to another down the corridor in a medical building, the patient may have to carry records in a paper folder rather than their being accessed or transmitted digitally.
For healthcare providers to properly exchange information and coordinate care, it should be in “near-real time.” A phone or fax machine may not be good enough but there are numerous ways that the NHS can rise to the health secretary’s challenger
1. Make more use of existing, national tools that are already up and running:
a. NHSmail is a secure, encrypted email service that can be used instead of ‘inhouse’ email systems. It means that secure emails containing patient-identifiable data (PID) can be safely sent anywhere within the NHS. NHSmail 2 is coming soon, which will have even more functionality. There’s really no need to send letters and faxes to colleagues anymore!
b. Choose and Book (CAB). About 60% of all first outpatient referrals are now done through CAB. Make it 100% to get the most benefit. Consider the other functionality within the application such as the ‘Advice and Guidance’ section to avoid inappropriate referrals.
c. Summary Care Record. A surprising amount of useful clinical information can be found here. The more it’s used, the more useful it becomes.
2. Automate the discharge summary. It’s virtually impossible to attain the NHS standard of discharge summaries to GPs within 24 hours without using electronic systems. A good electronic patient record system should permit electronic discharge summaries to be sent to GP systems easily.
3. ePrescribing. This is a high-impact patient safety issue; no more problems with doctors’ notorious handwriting! ePrescribing can be ‘standalone’ or integrated into an EPR. It may be best to start with a gradual roll-out in enthusiastic areas, rather than a ‘big bang’ approach. Once the benefits are seen, clinicians will clamour for it in other areas.
4. View results electronically instead of printing out paper. Get into the habit of accessing pathology and radiology results without printing out paper and consider using a Single Sign On tool so that you don’t have to remember multiple passwords.
5. Exploit ‘departmental’ systems to the maximum. For example, if your trust has a theatre management system, see if you can use it to record the clinical record. A relatively easy start is the surgical operation note. But, make sure that any ‘bespoke’ systems can talk to others using Health Level 7 standards.
6. Don’t duplicate. Paper records are not more valid than electronic ones, so you don’t have to do both. If you’re told to write paper records and create electronic ones, someone’s missed the point. One consultant I heard of confiscated all the pens of her trainees when they came to her clinic!
7. Know your ‘business continuity’ policy. Inevitably there will be times when electronic systems are not available, so you need to have robust alternatives in place just in case.
8. Develop a ‘portal’ mentality. This means automatically pulling information from multiple sources into a single area. There are various ways of achieving this, but make sure the patient is the ‘context’, that is, you only view information about one patient at a time. This is an important patient safety factor in order to avoid confusion.
9. Find out about your trust’s IT strategy. Your IT department needs your input. Do you have a clinical lead for IT, or even a chief clinical information officer (CCIO)? Could you do it? You don’t need to be a ‘techy’ or have a Master’s in Informatics; this is about improving patient care, it’s not an IT project.
10. Enjoy the digital revolution! The NHS is ‘data rich but information poor’. In the era of ‘big data’, find out ways of exploiting data for patient benefit and/or professional development. For example, how do you compare against your colleagues, other trusts, international best practice? Annual appraisal and revalidation requires individual, practitioner-level information, and nobody wants to bottom of the league table!
Dr Paul Shannon is a consultant anaesthetist in the NHS and medical director at CSC