Peterborough 30th November 2006

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Welcome to the Peterborough GP Engagement Forum

• Peterborough 30th November 2006

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We mustnt lose what we have

• Tom Davies FRCGP
• Yaxley Group Practice
• Chair NVUG

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Outline of talk

• YGP / TMD
• Progress of IT over last 25 years
• Advantages of EPR - British GP The lead
• Quality
• Local Situation
• The Future

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GP Computing

• Chair RCGP Computing Group 1992-96
• Chair JCG 1994-96
• Chair GP EDIFACT Messaging Group 1993 1995
• Member ICWS Project / RFA / Legitimisation
• Chair NVUG 2001
• Member JGPITC / Pan User Group
• GP2GP Project advisor

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YGP

• Full time GP 13,600 patients 6.5 wte
• 140 registrations per month ( 100 leaving)
• Training Practice from 1971
• Rural Dispensing Practice
• Busy - up 50 consultations a day
• Devoted to Quality RCGP QPA 2003
• Beacon Practice (Patients Association)
• What I am NOT
• An anorak / Typist!!

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Yaxley Group Practice
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YGP Computers

• 1979-81 Ottery St Mary / Winchester visits
• 1981 Micros for GPs - declined
• Preparation
• 1984 Rep Prescribing G G
• 1989 VAMP Medical (Desktop (40K)
• 1995 Vision (Windows)

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Work Smarter !
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Workload Surgery Contacts
Keep Ahead!
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Change in working Practice- Telephone
Consultations 2005
Telephone Consultations gt 16000 Surgery
Consultations gt 66,000
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Speed of data entry
1999 Slide
35 seconds
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Consultation Advantages

• Medical Summary available before patient arrives
• Background Information - Usual name / Next of kin
  / Social - Family details / Address instructions
• Warnings - Prescribing / Allergies
• Prompts Reminders / Claims

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Consultation Advantages (2)

• Only one Version Updated by everyone
• Openness - See letters together / Preventive Data
  / Recording / Photos all ONE click away
• Speed Macros record repeat data entry
  consistently and quickly
• Repeat prescriptions - quick and accurate

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Consultation Advantages (3)

• Informative - Instant Patient printouts
• Use of multimedia triggered appropriately
• Medico-legally safe
• Fully Assessable
• Data exportable in variety of formats

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Breakdown of activity
BP / Smoking / Urines / Weight
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Prevalence of Diabetes
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Prevalence of Hypertension
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Lipid Lowering Drugs
CHD Collaborative
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COMPUTERS IN THE CONSULTATION THE PATIENT'S VIEW

• L Ridsdale and S Hudd BJGP 1994 44 367-369
• Use of computers is now regarded by patients as
  normal and indicative of GPs being up to date.
  Confidentiality concerns can be overcome by
  enabling computer details to be visible to the
  patient and shared.

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Changes to the way the Consultation is conducted

• Less time asking questions Information there!
• More time to listen / have eye to eye contact
• Memory jogged Personalised
• I know you saw
• Dr H left a note for me
• You had exactly the same in 1997.
• How is Jim?
• You rang the CO-OP last night
• Your appointment is due.
• We sent the letter
• It is of course a year since
• Your work at ..

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3 Phases of consultation

• Doctor interacts with Patient
• Doctor records on Computer
• AND
• Joint interaction with full Electronic record

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Computerised Consultations

• Interacting
• Writing / (Reading)
• Sharing / Viewing together

• 70 (Passive v Active)
• 15
• 15

Interacting Very different from traditional
Doctor / Patient Model
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Quality is.

• Improved Patient care Work Smarter
• Better team working Shared Patient record
• Accuracy and consistency - Formularies /
  Protocols
• Enhanced Functionality - Digital Photos / ECGs
• Clinical Audit 13 years data
• Improved Financial claims / rewards
• Evidence for Personal / Practice Development
  plans

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Quality Prerequisites..

• EPR Central to showing Quality
• Needs Preparation
• Affects ALL members of the Primary Care Team
  ONE system
• Is an iterative process
• Needs discipline (obsession?) (Training)

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Training

• Clinicians dont engage too busy
• Trainers show ALL ways / Admin biased
• No fixed view of best way
• Too proud / frightened to ask / comment
• EVERYONES BUSINESS

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Quality in IT recording needs

• Taking time to grasp the basics
• 25 hours per week in Consultation
• 5000 Consultations per year
• 30 years
• Like Driving a car Most actions can be done
  quickly, competently, safely
• (with practice / training)

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Add Ons - Digital Files

• Photos
• ECGs
• 24 hour ECG
• Spirometry
• BP monitoring
• ECHOs
• Siascopy (Skin cancer detection)

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Digital Files
Photos
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DXS Decision Support
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Local Initiatives

• Path Links / Radiology Links
• Hospital Website
• PCT Website
• CB Named Consultants / Speed Issues

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Not alone with Problems! USA
Kaiser EHR Troubles Links
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Background
John Lockley Daily Telegraph 18.11.06