Another view: Neil Paul

My handwriting is getting illegible. It’s probably worse than that of my six year old. I just don’t do it anymore.

Other than sign 100 prescriptions a day and the odd cheque, I rarely have to write anything. Perhaps the occasional x-ray card or insurance form. I type everything.

Putting writing on ICE

I may soon be able to write even less. My local hospital IT team tells me that it is going to expand its order comms system to include radiology requesting. This will mean that I can tick boxes and type what I need.

It would be even better if I could add relevant clinical information onto the request. Unfortunately, the Anglia ICE system doesn’t seem to have this functionality.

Yet, to me, it would seem very sensible if it automatically added significant problems and drugs to the requests.

After all, how many times do we get a reply back from the hospital saying “is the patient on B12?” or “what dose of thyroxine are they on?” or “is the patient known to be diabetic?”

It also strikes me that we are missing out on a huge source of potentially valuable information on different doctor and practice behaviour.

The Anglia system must be recording who is ordering what and how often. If you could access this it might be interesting reading. I’m convinced that there is a huge variation inside my practice and I bet there is a bigger variation between practices.

Comparing normal result to abnormal rates from requester to requester might also be interesting.

I’m convinced I have a high hit rate of abnormal immunology tests; whereas I think some other GPs just order them all the time and get loads of negatives on expensive tests.

From fit notes to all kinds of notes

Now, if only we could get more forms more automated my life would be more productive.

The other evening I went online and bought my wife’s road tax by typing in one number. The website checked the relevant insurance and MOT databases and I had almost nothing to type in.

Compare this to the HGV medical form; which I seem to get asked to fill in all the time. I have to handwrite the patient’s name and date of birth on each page.

I have to tick boxes that switch from being ‘yes’ for normal to ‘no’ for normal, which can be confusing and which has occasionally led me to tick the wrong one.

There are boxes that are missed out if some other responses are negative, and there are bits that just require me to copy what is on the screen on to the paper.

Now, recently, EMIS introduced an electronic fit note to its system. You press a button, fill in a few fields, and out of your printer pops the form. All you need to do is sign it.

It is great. In fact, it’s probably the best thing since the ICE system. Not only does it save time, it keeps a record – which makes filling in insurance forms easier, as not all my partners are good at recording sick notes.

Why can’t we have something similar for HGV medicals and other standard forms, like the Department of Work and Pension ones?

Even if all they did was ask you a series of questions, and then print the form with the name and surgery details on it, and the right boxes ticked, it would save time.

Even better would be a system that took data such as current drugs from the clinical system and put data back into it when I answered a question like current blood pressure or smoking status. Other forms could follow.

Dealing with insurance

We could also do with a standard life insurance report that auto builds and includes the right data. At the moment, we get paper requests from companies that ask the same things but put them into different formats.

Now, it is true that efficient people have designed form letters that can be printed out, and which try to match the requested information. But the whole process seems overly paper orientated and slow.

Why not an electronic inbox that presents me with a request similar to my repeat ordering? All I would have to do would be to review the built report press ‘send’ – and it would be securely sent to the right company.

Surely this would speed the whole process? I’d try to get the companies to pay for the development, as the ones in the system would have a clear speed advantage.

Having said that, I wouldn’t be surprised if we got to the point where insurance companies were requesting full electronic copies of their client’s records to add to their own data warehouse.

Data warehouses seem very much the thing at the moment, and I’ve started to become aware – and a little concerned – about how many anonymised copies of our data there are out there.

Lots of great databases – but how secure are they?

My primary care trust (all three clinical commissioning groups) recently signed up for Eclipse Live, which has the medicines management team in rapture. It runs off a monthly data extraction from practice systems.

I’ve been approached by the Diabetes Research Network, which would like me to sign up to ‘Farsite’; a Salford data warehouse that is run by a not-for-profit organisation that includes academia.

It appears to be an anonymised, searchable database that can be used for research directly or to identify patients suitable for clinical trials.

The primary care research people would like me to sign up to something called the ‘Clinical Practice Research Datalink’ that seems to be much the same thing, but run by different people.

My practice has for a while been signed up to the QResearch database, which always produces interesting results.

I was also talking recently to one of our local consultants about the National Diabetes Audit and where that – albeit limited – subset of data is stored and who has access to it.

Now, all of these projects have good intentions and I’m minded to sign up for all of them. They all claim to be secure and safe; but are they?

Some will presumably keep postcodes or parts thereof. Some will know ages and disease registers and medication and presumably gender, ethnicity and perhaps even employment, smoking and exercise status. Is it possible to stay truly anonymous?

Is it right that everyone has their own copy or would it be better for them to query a nationally held database that could supervise who was doing what?

About the author: Dr Neil Paul is a full time partner at Sandbach GPs, a large (21,000 patient) practice in a semi rural Cheshire. He is one of five executive GPs for NHS South Cheshire CCG and has a mixed portfolio that includes IT.

He was previously on the PEC of NHS Central and East Cheshire. He also writes iPhone software, runs a primary care clinical trials unit and is involved in several exciting IT projects.