Campbell Watt

1
Campbell Watt

• Practice Manager, Dalbeattie Clinic

2
Practice Background

• Rural Practice (Dumfries Galloway)
• Four Partner Training Practice
• List size 4950 patients
• Clinical system - GPASS
• Paperless - Docman
• Typical IT Knowledge and Resources

3
Location

• Dalbeattie
• Dumfries and Galloway
• South West Scotland.

4
Docman Installation

• Docman was installed in the practice in April
  2005.
• Full implementation January 2006
• Gradual implementation, first with Temporary
  residents, OOHs etc building up user
  acceptability.

5
Gradual implementation

• Gradual implementation allowed us to get all
  users familiarly and confident with the system
  prior to going fully live.
• Nine month transitional period allowed us to
  identify limitations with the clinical software.

6
Problem identified

• Now that we are paperless what do we do with
  our-
• Patient Message Book
• Practice Protocols
• Warfarin Sheets

7
Historically

• Historically when we were a paper-based practice
  we had a folder which we used to store patient
  Warfarin, DMARDs sheets etc in.
• When we became paperless, neither GPASS nor
  Docman had the functionality to allow us to
  create an easily up-dateable sheet which we could
  use to record this information.
• No software solution on the market addressed our
  problem.

8
Our solution

• Our practice solution was to create a simple but
  effective web based intranet
• paperless results.

9
System requirements

• For the system to work it required three
  pre-requisite requirements-
• Microsoft Word (pages saved as web pages, not
  documents).
• Microsoft Excel
• Computer Network
• If is anticipated that these three components
  will exist in nearly all practices. Subsequently
  no additional resources in terms of hardware or
  Software are likely to be required by any
  practice to implement our system.

10
Who could use our solution?

• Our solution in its present format could be
  introduced by any practice. It is not liked to
  the clinical system and as such, could easily be
  introduced by any practice regardless of whether
  they are paperless or not.

11
First step

• It could even by used as the first leap of faith
  for those practices that are looking for the
  first stepping stone towards moving away from
  paper based records (or whilst waiting for Docman
  to be installed).

12
Paperless Results

• Paperless Results system was initially set up to
  record Warfarin results but quickly grew to
  meet our other needs.
• Could also be used by a practice to introduce its
  own basic intranet.
• The following are screen prints of our
  demonstration system.

13
How does the system work?

• There is a paperless results icon on all desktops
  within the practice.

14
Choice Screen

• The user simply selects the information which
  they require (for example Warfarin) by double
  clicking the relevant button.
• Upon selecting Warfarin, a list of patients will
  be displayed.

15
Warfarin Patients

• With the mouse the user simply selects the
  patient record they require.

16
Patients Warfarin Record

• The patients record is then displayed.
• Clinicians can update the information displayed
  (for example once a new result has been
  received).
• Others can only view the information.

17
Practice Protocol

• Patient Warfarin Sheet linked to appropriate
  Practice Protocol instantly.

18
Warfarin Management Chart

• Since this part of the programme utilises Excel,
  the functionality is created in the initial
  spreadsheet design which allows the data that is
  entered to be displayed in graph format, simply
  be pressing the chart button. This is a useful
  feature as it easily provides a graphical
  representation of the patients clinical
  management.

19
The process

• The most time consuming activity in devising this
  system was deciding what we wanted.
• The creation of the system required limited IT
  knowledge (Microsoft standard Help files almost
  sufficient).
• The system is so easy to use it can now be
  managed by a staff member who had limited IT
  knowledge.
• It takes less than two minutes to add a new
  patient record to the system.
• Takes seconds to update the patients record.

20
Benefits

• There are several benefits of this system in
  comparison to the old paper based system-
• Results are accessible by all users on our
  computer network, some of whom are not located in
  our main surgery building (this was not possible
  using a paper based system).

21
Benefits

• Multiple users can access the system at any one
  time. Thus allowing data or results to be given
  simultaneously.
• Again this was not possible using a paper based
  system.

22
Benefits

• User access rights have been established which
  allows clinicians to update sheets, but others
  viewing rights only
• This could be configured to individual practice
  requirements.

23
Benefits

• When a patient calls looking for results, the
  relevant information can be retrieved quicker
  than the paper system.
• All document histories are auditable.

24
Benefits

• The system operates as a basic web page.
• There is therefore no requirement for users to
  know how the system works.
• Graphical representation of clinical management
  at the press of a button.
• Patient Data Sheets linked to appropriate
  practice protocols.

25
Benefits

• Consistant adherence to practice protocols
• Data backed-up automatically.
• 100 legibility
• 100 user acceptance within our practice.

26
What happens when the patient leaves the practice?

• When the patient leaves the practice, the
  information entered into the system can simply be
  printed or transferred to the new practice
  electronically.

27
Sources of help

• Microsoft Help Screen
• Key words
• Creating a Web Page
• Hyperlinks.

28
Closing Words from Winnie-The-Pooh

• Here is Edward Bear, coming downstairs now,
  bump, bump, bump, on the back of his head, behind
  Christopher Robin. It is, as far as he knows, the
  only way of coming downstairs, but sometimes he
  feels that there really is another way, if only
  he could stop bumping for a moment and think of
  it. And then he feels that perhaps there isn't.
  Anyhow, here he is at the bottom.
• Often we do something in a particular way
  because weve always done it that way. It is not
  until we stop and look at the wider picture can
  we identify possible alternatives.

29
Thank you.

• Additional information available from
• Campbell.watt_at_nhs.net