In between the joys and pain of routine General Practice I have been spending rather more time on the work 'behind the scenes' with the sharing of clinical information to benefit clinical care.
Whatever the care setting, whoever the clinician and (almost) whoever the citizen or patient, all seem to agree that better sharing of information is essential to improve care and efficiency. We all claim to share this ambition.
In our real world however it is all too easy to sit back and wait in vain for leadership and directives to 'share' informations, drop our barriers and 'open up' the data. And here I must point to the lessons of the last few years. When there are central/national efforts to begin sharing, create opportunity and aspire to a new way of working WE ALL have a tendency to be defensive. We express concern over the lack of ambition - or the excessive scope, we argue over complex security processes - or the difficulty of access, we demand detailed information governance scrutiny - but trust Tesco with intimate details. So though an unpopular message, I believe all of us are at fault for the painfully slow progress of some National projects with amazing potential. The Summary Care Record best exemplifies this problem.
But amid the public and sometimes vitriolic criticism of perceived 'top-down' initiatives, we are witnessing significant progress with local schemes. Sometimes in small or discrete communities, sometimes based around organisations and sometimes around IT systems. One of the common features linking success is 'local ownership', with understanding and drive for local benefit. Within such local schemes it is possible to take control of the sharing agenda, and choose to blur the rules and guidance on security, governance and consent, for a clear and shared aim to improve care and safety. And this IS reaping local benefit - for patients and communities.
So what does this mean for National initiatives? Well, I hope that we can all learn from local success, without developing new and isolated islands of sharing with no ambition to engage with a wider community. 'I've solved my problem' is not a strategy for success in a National Health Service.
I hope that the 'Information Governance Review' under Dame Fiona Caldicott will help to re-establish a level playing field for information governance, that we can use what is left of the shrinking National Informatics resource to share innovative practice. I also still hope that clinicians and commissioners will re-look at National products NOT as a problem to be tolerated, but as an opportunity to use as part of a bespoke 'local solution' to information sharing - between organisations and with citizens.
And for citizens and patients viewing their own records? To learn quickly how to make best use of this opportunity, not telling citizens what to do, but responding to their suggestions, the requests for interaction and a new level of trust and shared control. The 'cutting-edge' enthusiasts, the reluctant followers and the 'sceptical laggards' all have a role to play. Access to GP records is a tiny element in the change we are all witnessing, that we cannot control, and that threatens the 'comfort zone' of care providers like myself. I think I am learning that although we share ambition this will not be a comfortable ride!
Peter S.
Saturday 28 April 2012
Tuesday 10 April 2012
LIES - Damm lies & STATISTICS!
Yes - I know - statistics can prove or disprove anything, yet we (?) in the scientific and medical community are constantly pouring over and analysing them to seek out 'evidence' of where we do well, and where we need to improve.
SO for me another confession - the result of running an audit of activity 'on-line' at my surgery in the last year. The 'audit tool' we are provided with is very basic, producing a single massive file - too big to fit into excel! So first note to self (and suppliers):
1) Provide us some basic tools to report on activity - please.
So for the last year from April 2011 to March 2012:
It appears I vastly under assessed the number of patients who use our 'on-line' facility, based on information from another part of my surgery IT system reporting (confusing!!!). We have had 808 individual patients access the surgery system at least once in the last year, which means almost 9% of my surgery list.
So, second note:
2) Ensure reporting 'on-line' activity is consistent in all modules of IT system.
Before I sit back in bask in the 'warm-glow' of self satisfaction I have to point out there are some wide variations in usage by individuals - evident only by detailed filtering and sorting of the combined report (almost beyond the skill of an ageing, non-technical GP).
The range of 'on-line' usage is from 1 to 857 log-ins per year! There are a number of 'high users' who access our system 100-175 times in a year - using many of the transactional options, however a single user stands out as 'atypical' with 857 successful log-ins in the year and an additional 13 failed attempts. Maximum number of log-ins for that individual is 28 in one day.
Clearly there are other reasons and issues that need addressing separately for this individual, and questions about the benefits and disadvantages for them, the surgery and the wider population and care services.
So third and fourth note (to self and future guidance):
3) What will be the 'accepted' reasons for withdrawal of Records Access privileges, and the mechanism for appeal?
4) Can we have individual reports on usage from the clinical system?
SO totting up the activity I come to an average of 11.3 log-ins per year for active users (or 10.3 discounting our practice enthusiast). So WHEN patients are registered for transactional activity it IS well used - and I am confident it provides a valued additional service AND saves time and money for my surgery.
Last (wishful) note:
5) Please can I have working reports on patient access to the full GP records that I have enabled? How often are they viewed, and what in particular are patients looking at?
Peter S
SO for me another confession - the result of running an audit of activity 'on-line' at my surgery in the last year. The 'audit tool' we are provided with is very basic, producing a single massive file - too big to fit into excel! So first note to self (and suppliers):
1) Provide us some basic tools to report on activity - please.
So for the last year from April 2011 to March 2012:
|
Activity
|
Count
|
|
Repeat Medication Items ordered
|
5135
|
|
Stop Access
|
5
|
|
Make appointment
|
2254
|
|
Log-in
|
9141
|
|
File Change of Address
|
106
|
|
Failed log-on
|
799
|
|
Change Address
|
109
|
|
Cancel Change Address requests
|
1
|
|
Cancel Appointment
|
711
|
|
Archive change of Address
|
3
|
|
18264
|
It appears I vastly under assessed the number of patients who use our 'on-line' facility, based on information from another part of my surgery IT system reporting (confusing!!!). We have had 808 individual patients access the surgery system at least once in the last year, which means almost 9% of my surgery list.
So, second note:
2) Ensure reporting 'on-line' activity is consistent in all modules of IT system.
Before I sit back in bask in the 'warm-glow' of self satisfaction I have to point out there are some wide variations in usage by individuals - evident only by detailed filtering and sorting of the combined report (almost beyond the skill of an ageing, non-technical GP).
The range of 'on-line' usage is from 1 to 857 log-ins per year! There are a number of 'high users' who access our system 100-175 times in a year - using many of the transactional options, however a single user stands out as 'atypical' with 857 successful log-ins in the year and an additional 13 failed attempts. Maximum number of log-ins for that individual is 28 in one day.
Clearly there are other reasons and issues that need addressing separately for this individual, and questions about the benefits and disadvantages for them, the surgery and the wider population and care services.
So third and fourth note (to self and future guidance):
3) What will be the 'accepted' reasons for withdrawal of Records Access privileges, and the mechanism for appeal?
4) Can we have individual reports on usage from the clinical system?
SO totting up the activity I come to an average of 11.3 log-ins per year for active users (or 10.3 discounting our practice enthusiast). So WHEN patients are registered for transactional activity it IS well used - and I am confident it provides a valued additional service AND saves time and money for my surgery.
Last (wishful) note:
5) Please can I have working reports on patient access to the full GP records that I have enabled? How often are they viewed, and what in particular are patients looking at?
Peter S
Wednesday 4 April 2012
21 and counting....
It may not be a landmark in terms of activity, but we have 21 patient requesting access to medical records at the surgery so far. This may be around 0.23% of my practice list, but it is still considerably more than most practices in England. Leaflets advertising the service are prominently place on the main reception desk, and disappear regularly!
Now perhaps where this gets interesting is in comparison to the number of patients who are active users of 'on-line' transactions. Contrary to my previous publications and claims, it turns out we only have 272 active users out of a practice list of more than 9,000. This is despite ACTIVE encouragement, and offering leaflets about on-line access to all who newly register at the surgery, So:
Perhaps the figures are starting to make some sense?
If I had 25% of my surgery list registered for 'transactional services' then I could expect around 170 people asking for Records Access - if all the trends continue.
SO - priority of work at the surgery is to get as many people as possible registered for, and using, transactional services. RA may well follow-on naturally. This is likely to bring the most immediate benefit for patients in terms of convenience and 24 hour access to appointment booking and medication requesting, AND for the surgery in terms of efficiency and reducing front-desk and telephone contacts.
The other question to address is how difficult do patients find it to register for simple transactional services, let alone full records access. I wonder if the RCGP, BMA and System Suppliers can come up with ways to make this easier - and if the Information Governance review being led by Dame Fiona Caldicott will give any direction to remove barriers?
Peter S
Now perhaps where this gets interesting is in comparison to the number of patients who are active users of 'on-line' transactions. Contrary to my previous publications and claims, it turns out we only have 272 active users out of a practice list of more than 9,000. This is despite ACTIVE encouragement, and offering leaflets about on-line access to all who newly register at the surgery, So:
- 3% of my practice list are enabled users of on-line service
- 7.7% of those registered for 'transactional services' have asked for full Records Access
Perhaps the figures are starting to make some sense?
If I had 25% of my surgery list registered for 'transactional services' then I could expect around 170 people asking for Records Access - if all the trends continue.
SO - priority of work at the surgery is to get as many people as possible registered for, and using, transactional services. RA may well follow-on naturally. This is likely to bring the most immediate benefit for patients in terms of convenience and 24 hour access to appointment booking and medication requesting, AND for the surgery in terms of efficiency and reducing front-desk and telephone contacts.
The other question to address is how difficult do patients find it to register for simple transactional services, let alone full records access. I wonder if the RCGP, BMA and System Suppliers can come up with ways to make this easier - and if the Information Governance review being led by Dame Fiona Caldicott will give any direction to remove barriers?
Peter S
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