Making the right choices in a digital world

The changing world of patient information

When I first entered the world of primary care as a bright-eyed young medical secretary 38 years ago, I quickly learned the art of juggling a huge number of responsibilities in a highly-organised, but incredibly time-consuming way. There were vast swaths of paper documents, often covered in illegible hand-writing to process, file and sort – and the speed at which we worked meant that sometimes vital information resided in a colleague’s head, rather than in an accessible repository. 

In my earliest days, patient referral letters were typed on an old portable typewriter, with a carbon copy for the patient notes. For those of you too young to remember those days, the word processor is a wonderful invention!

The seeds of change blew my way in 1989 when, as a new practice manager, I oversaw the implementation of a computer system across the practice. For me, technology was new and exciting. Technology would revolutionise the way we worked. Technology was progress. 

But computerising patient records was also hard work.

Ensuring that the relevant nuggets of patient information for 2,500 patients were correctly inputted into the system was a daunting task. Where to start, how to prioritise… and what were read codes?? 

At that time, there were no guidelines or suggestions, no paper-light practices, no information governance and no magic medication uploads. For printed prescriptions, we had to upload the repeat medication for all of our patients, and all of this whilst running the practice in the usual way.  

Obstacles to digital adoption

I was lucky to work for a team who were quite progressive for that time. Once we had the system up and running, it transformed the way we worked. Since then, I’ve worked for, and with, organisations whose leaders were quite opposed to digital adoption. And surprisingly, many of the objections heard today are the same concerns as were voiced back then.

Data quality, privacy, implementation, cost, training, confidence in the system, job security fears, and resistance to change were all hurdles to overcome. Many GPs worried technology would create more problems than it solved. 

The unreliability of early systems didn’t allay these fears either, so to push on to the next stage of a technological journey could be met with even more resistance. In 1990, the new GP contract came along, enabling us to forward plan and assess our funding options and opportunities. Those changes revolutionised general practice, making the use of technology vital if we were to remain in profit.  

Of course, during the nineties, there were very few choices for general practice IT, but a couple of the main suppliers managed to see it through to the millennium and continue to bigger and better things. Throughout the 2000s, systems started improving and changing at a head-spinning rate. Just keeping up with the changes was a job in itself and IT managers started to be recruited alongside practice managers to support the pace of change.    

Innovation stalled while the National Programme for IT attempted to implement one system across the NHS. When that programme ran aground, it was with relief I saw the focus was on localised investment, with system integration and interoperability at its heart. 

Innovation was back on the agenda.

In 2012, I became a regional customer training manager for EMIS and started witnessing new, innovative digital systems springing up with increasing regularity. The steep curve of digital acceleration went hand in hand with the formation of new regulatory bodies to help maintain standards of compliance and interoperability across the healthcare sector.

With GPs and practice managers now somewhat reassured that digital systems would work and keep patient data safe, they found themselves with a welcome, but dizzying, choice of products and services to choose from.

So, where do you start?

Making the right decision for your practice

With hundreds of IT solutions now available, how do you know what’s best for your practice? What will deliver the best ROI and practice efficiencies? How do you coordinate different products and services within the practice? When does a practice management team even have time to review the options? 

It can be easier to carry on with the familiar daily routines, rather than be spun around by the torrent of digital options, leaving you confused and nursing a headache. However, the time that you spend assessing and implementing something new, could save you hours, days, or weeks in the near future. 

It’s the initial decision to drive business change that takes time and forward-thinking.  

A few simple rules to get you on track

Every primary care organisation is different and will need different solutions to drive efficiencies. Still, I’ve learned from my many years’ experience of IT procurement, implementation, integration and training, that there are some universal guidelines can help you make the right digital choices and avoid pitfalls along the way:

  1. Keep it simple. If you can’t see how a system can deliver benefits straight away, it’s not going to work.

  1. Accreditations. Make sure your digital partner meets NHS and industry standards,  so you know you can trust them with your data.

  1. Testimonials. Speak to people who’ve used the system. Discover what they’ve enjoyed and any snags they’ve experienced along the way.

  1. Support. Make sure you’ll be fully supported when you need help and advice.

  1. Business Change. Encouraging your team to help shape the business change will go a long way to ensuring its success – whether you’re implementing an ‘add on’ piece of software, or a complete system change. Examine the way your individual team members work now, and ask them to suggest changes. Track the changes and progress, and give feedback.

  1. Benefits. Ensure your team understands the benefits of the proposed changes for themselves, the medical staff and patients.  

  1. Training. Ensure that training is adequate and that protected time is given for staff to become effective.  Make sure all staff involved are happy and ‘buying in’ to the new system and its possibilities.

A last thought 

For those of you old enough to remember the pink and blue cards placed in Lloyd George Folders to enable staff to pick out the diabetics, or smears due, or childhood vaccinations, think about the way that technology has enabled us to offer fantastic patient care, with working efficiencies across the board.  

Would you have believed the way things are now compared to  35 years ago? I definitely wouldn’t have believed it. If I need to get a list of who needs a flu vaccination now, I can do it within five minutes of sitting at my computer and get the recall letters printed at the same time. 

Technology is moving forward at an alarming rate. We need to keep up to take advantage of all it has to offer.

Lynn Tomlinson is a former practice manager, senior manager at PCT level, and GP practice clinical data trainer. Lynn is currently the clinical data specialist at Medi2data, responsible for auditing consented eMR patient data extractions from the GP practices’ clinical systems and the integration of clinical code releases (Snomed CT) with eMR.

An interview with Richard Freeman 

The origins of eMR 

by Phil Rowe, Vision in Primary Care

Could you give us a brief background to your company and eMR?

“In March 2019, eMR was launched into Primary Care by MediData Exchange Limited. 

eMR, an electronic patient medical reporting technology, is saving GP practices at least 50% in time and costs when processing SARs (Subject to Access Requests). It is offered to GP practices at no cost.”

How can a commercial business offer a highly sophisticated piece of software for free?

“You’re right- there are lot of people asking that question. Sometimes I think it may have been easier to have put a nominal charge on it!

“The NHS is under significant financial pressure and it gives me great pride that we can provide this amazing time-saving product to them for free. We have devised a business model where we able to do that, where it really is a win-win for all stakeholders.

We have devised a business model where we able to do that, where it really is a win-win for all stakeholders

Richard Freeman

“The value we have created for third parties such as insurers, means they are willing to pay for a medical report which includes a transaction fee to us and a separate fee to the GP practice. When GDPR came into force in May 2018, we immediately recognised the enormous negative impact this was having on GP practices. So, we made a decision to concentrate the development of eMR, together with GPs and practice managers, on SARS and delay the launch of the AMRA (insurance medical reports) features, to help primary care deal with the GDPR impact.”

Could you explain more about the development of eMR?

“Since we started working on eMR in 2016, GPs and practice managers have been involved in its development and design. We listened to their frustrations regarding the current highly inefficient processes and what was needed to allow our customers to work smarter.

“We ensured that eMR offered options of how to work, so that GP Practices were not confined to one vanilla process. This is most evident when GDPR impacted primary care. Aside from the loss of revenue, it impacted how data should be handled by the practice, patient and authorised third parties.

“We scoped out with GP practices, processes containing high levels of governance, allowing the GP practice to electronically facilitate access to patient data whilst protecting both themselves and the patient. The team quickly responded to our customers’ suggestions and requirements, and that led to a successful launch of eMR in March this year.

“Our team is now focused on completing the AMRA features to eMR, which is the rollout of the fee-paying medical reports from which MediData receives a separate transaction fee from our clients.”

So, in effect you ‘took a hit’, for the benefit of your customers?

“It probably sounds corny to say this, but like many people, I am very proud of the NHS and the outstanding work and dedication performed every day by its medical staff and employees. When you experience first-hand the care provided by this great institution and you then have an opportunity to give something back, why wouldn’t you?

When you experience first-hand the care provided by this great institution and you then have an opportunity to give something back, why wouldn’t you?

Richard Freeman

“I believe, borne out by the numerous testimonials from our customers, that eMR delivers what it says on the tin, which is that it is really simple for our customers to use, it generates enormous efficiencies and provides robust governance for the GP practice.

“eMR is already operational in 115 CCGs, thereby creating the necessary footprint in primary care, needed to successfully service the needs of our fee-paying clients.”

But will it really be free forever, as you say?

“I have never felt, nor will ever feel, the need to charge primary care for eMR and its support and managed services. This would be counter intuitive to my beliefs and indeed to establishing a healthy eco-system within which all parties benefit.

“By being transparent about our business model, I hope you can see rationale behind my decision not to charge GP practices for eMR.”

Working more efficiently through a global crisis and beyond

Transformational change occurring within primary care

Primary care and its delivery of patient care and services has been transformed in the space of just a few weeks. Adjusting to new ways of working amidst a global pandemic takes a considerable toll on the physical, intellectual and emotional well-being of front-line staff.

The BMA and RCGP created workload prioritisation guidance to reassure practices during the COVID-19 outbreak that they can delay routine work while coping with changes on an unprecedented scale.

Despite managing the initial impact on GP surgeries during the last 8-10 weeks of the pandemic, many doctors wonder how they will cope with a potential spike in demand following COVID-19.

Increased demand could overwhelm practices as they continue to manage the ongoing care of shielded patients and those who have yet to present their symptoms and have kept away from GP surgeries during the outbreak.

How technology is helping

Primary care has accelerated its adoption of online and digital tools from the utilisation levels seen before the outbreak. Overnight, GPs started conducting three out of four consultations by video or telephone. Digital processes have been implemented with lightning speed to minimise human contact.

The desire to protect staff and patients has driven innovation. Healthcare technology suppliers have helped where they can, designing new digital services to help relieve the pressure, often for free.

Practices and federations are realising the benefits of digitised processes such as e-consultations, patient text messaging and outsourced medical reporting services.

The suspicion or reluctance that can sometimes prevent digital adoption has been replaced with a drive to do whatever it takes to keep people safe. There are daily discoveries of new, efficient ways of working that save valuable time and use resources more effectively.

Sustaining the digital journey

So what happens when some degree of normality returns, whatever that may look like? Technology and its role in patient care will be part of the ‘reset’ debate because we’ve discovered that when the world is catapulted out of its comfort zone, we can adapt. We can make changes and see results quickly. Hopefully, this outlook will continue into our post-COVID future, trusting technology to create a more effective primary care system and an improved patient experience.

A positive outlook

Our collective ability to adapt and persevere through this world pandemic has been impressive.  There have been mistakes, misinformation and confusion along the way, but as a nation, we are pulling together in a direction not experienced since the Second World War.

So, when we look back at the extraordinary events of 2020, will we remember a time when the world stopped, we looked up and crisis-managed the situation, only to return to the old ways of doing things and viewing our society? Or will this indeed be a documented point in history which changed the way we live and work, as well as allowing us to re-calibrate our moral compass?

Tackling the admin overload in primary care

A system in crisis

In 2015, the steadily increasing pressures on GPs hit crisis point. A decade of underfunding, reduced resources and an ageing population meant that the traditional care model was no longer working. The Making Time In General Practice study in 2015 was commissioned as part of the NHS Five Year Forward View to understand the scale of the crisis and help strengthen services across England.

The study identified that 18 per cent of GP appointments could be avoided if services were organised differently. Plus, GPs were dealing with a rising, more complex workload. There were new pressures, including getting paid, processing information from hospitals, keeping up to date with changes, information reporting, and supporting patients to navigate the health and care system.

NHS England launched the GP Access Fund to help practices adopt practical and innovative practices, such as working in clusters to provide 7-day access for patients, providing access to multi-disciplined teams, offering online consultations and adopting digital solutions to replace manual processes.

Five years on

Yet despite this and other initiatives, current-day workload and patient demand have reached unprecedented levels. Recent research by BMJ Open found average burnout scores among GPs are higher than those for any other medical specialty, other than emergency medicine.

According to the Primary Care Commission, GPs are still spending 11 per cent of their time on administrative tasks in addition to dealing with between 42-60 patient contacts per day.

The introduction of GDPR rules in May 2018 has meant that GPs and their staff are spending huge amounts of time copying and reviewing notes for Subject Access Requests, as well as medical and insurance reports. The majority of these reports are provided for free, and a GP must carefully read through bundles of paperwork and electronic records to ensure that no confidential third-party or harmful information is released.  This whole process is a huge time drain for GPs and their staff, and since it’s launch, there has been a rise in requests.

The NHS long term plan hopes to remove some of the wider administrative load through the formation of Primary Care Networks (PCNs) to help practices recruit and retain staff, manage financial and estates pressures, provide a wider range of services to patients and more easily integrate with the wider health and care system. And the new five-year framework for the GP contract, published in January 2019, put a more formal structure around this way of working.

Looking for a better way

The BMA ‘Quality first’ campaign is vocal in its call for a reduction in bureaucracy which takes precious time away from direct clinical care. And there are a number of long-term measures that could be put in place in order to aid practices to reduce their workload and become sustainable, including increased patient self-care management and an increased skills mix in the practice and in the community.

But what can be done right now?

Trialling new technologies can be the quickest and most effective way to cut admin time, but is often met with resistance from over-worked staff who feel that new systems could be more hassle than they’re worth to set up, train staff, fix any teething problems, with no guarantee it will actually work.

GP IT Futures

The GP IT Futures programme aims to change that by allowing practices to benefit from the rapid evolution of technology, with the reassurance that all the suppliers on the programme have been rigorously assessed to make sure they meet the highest technical, safety and security standards while the software is simple to implement and use.

What this means for general practice is there will be access to a greater selection of modern digital tools and capabilities that are easier to find, understand and (where applicable) buy, that will help them become more effective in meeting the needs of patients.

Small changes can make a big difference

Practices don’t need to overhaul their entire process to make quick improvements. By trialling technologies to automate certain tasks within the practice, the admin overload can be dramatically reduced overnight. It just takes one first step to make the change.

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I have never felt, nor will ever feel, the need to charge primary care for eMR and its support and managed services. This would be counter intuitive to my beliefs.

Richard Freeman