Technology to ease your workload on home visits
Dr Chaand Nagpaul
Dr Nagpaul, the BMA GP Committee Chair, and his practice have recently started using mobile technology that has achieved a reduced workload, and has made a tangible and positive difference to the way in which they care for housebound patients.
Until recently, like most GPs, he used to print out a brief two-page summary of patients’ records to take with him on home visits. These visits are for patients who by definition are mostly elderly, frail, and have multiple or complex morbidity.
“This limited summary of the patient’s record significantly compromised my clinical management – I was unable to refer to previous consultations or results, or answer questions from patients regarding a hospital admission or test results, and for those patients with memory impairment I could not rely on direct questioning.
I would scribble handwritten notes and then return to the surgery and duplicate effort by typing the entry into the patient records. If the visit took place after evening surgery, there would be a delay in the information being entered until the next morning.
For many patients, I had to defer making a clinical decision and go back to the surgery to look at the full clinical records, phone the patient back, and in some cases even revisit them. Multiply this rigmarole by a number of visits, and the workload generated and time potentially wasted were significant.”
He now uses EMIS mobile. This is a software program that is loaded on to a tablet (iPad or Android device) and wirelessly downloads the patient’s clinical data from the EMIS clinical system.
Other clinical suppliers offer similar products, but only a minority of practices use this nationally. Systems such as this provide a scaled-down but comprehensive version of patients' medical records on the tablet during a home visit, including data on consultations spanning the past year, investigation results, medication, details of referrals, major alerts, quality and outcomes framework reminders, and even hospital letters.
He records consultations on the tablet while seeing the patient, and with a keystroke this is synchronised wirelessly into the practice clinical records in real-time. No more going back to the surgery to type up the consultation or calling the patient back because vital information wasn’t available during the visit. The scenario is all the more advantageous when visiting multiple patients in care homes.
Not only has this significantly saved on time and work, but has the added clinical-governance benefit of managing patients more effectively and safely with access to their medical records. It has information-governance advantages of no longer carrying around pages of confidential patient data, and allows contemporaneous remote recording of my clinical entry into the patient's records while visiting a patient.
His CCG funded the software and subsidised the costs of tablets. Dr Nagpaul said “This is a facility I believe should be fully resourced by all CCGs and equivalent bodies in the devolved nations, and I strongly recommend that you ask your CCG to provide this. At a time when Government emphasis is on managing patients out of hospital, this is an inexpensive investment that can optimise our ability to care for our most vulnerable patients at home, while saving ourselves work and time.”