Another view: of quite a lot going on

I sometimes complain that the pace of change of IT in primary care is not fast enough. So I wrote down some of the things that had happened or come up in the last month to try and pick something positive to write about.

Once I’d done that, I was surprised by how long the list was. I thought, therefore, I’d just go through it and give a flavour of what’s going on at the moment.

The CSU: IT support from our commissioning support unit was taken over by another CSU. While it’s largely the same people we are dealing with, their new bosses seem more enlightened – or perhaps it’s not having the upset of being TUPE’d that has allowed things to progress. But one way or another, there is quite a lot of positives to report.

Patient wi-fi: ok, that’s now a national thing, which has perhaps given it some weight, but it is something our practices have been asking for for some time, and now it looks like it is happening.

The new CSU already does patient wi-fi for some of its existing clients, so it seems to know how to do it securely, and we’ve been promised dedicated landing pages and questionnaires for visitors to the practice.

Video consultations: Not a huge hit with GPs for a variety of reasons that I will go into, but we have some clinicians and some practices wanting to try it out.

We are probably going to go with the system that best integrates with our clinical system and its appointment book to minimise disruption, which is otherwise one of the big concerns.

I was recently asked by a journalist why I thought video wasn’t taking off, and my other reasons were:

1. There is no hardware on my desktop to do it; and who is paying for that?

2. Everyone talks about commercial products like Skype, but I’d prefer a system that integrated with my clinical system

3. The concept of Skype being always on doesn’t appeal

4. The medico legal aspects are dodgy: what if someone asks me about a mole and it looks ok on a low resolution video link, but it turns out nasty? I can see GPs being pressurised into diagnosing things over the link – but can I reliably tell jaundice, pallor, yellow lemon skin?

5. Do the medico legal problems mean we have to record all videos, and how are we going to do that?

6. People incorrectly think that a head and shoulders is enough to examine someone; when a patient comes to see me, I watch the time it takes them to walk down the corridor, the way they open the door, the way they walk in, the way they sit down and so on – I’d miss all of this on a video

7. I think the power of video over phone has yet to be proven (every bit of research shows that phone consultations are now widely used; partly because that is faster, and partly because the medico legal problems don’t apply, as it’s obvious I can’t see someone over the phone – while I can ask to see them if I really need to).

Remote access: Perhaps the biggest bugbear for some GPs, who want to be able to work from places other than their desk; in a patient’s home, in a nursing home, at their home, at a conference.

Well, locally we appear to have made a small step forwards. We are trialling Horizon virtualisation. I can sit at home on my Mac or iPad (or PC), and log-in almost as easily as I can at work. That gives me full access to Emis, although we haven’t worked out how to do the smartcard log-on, yet.

The biggest outstanding problem is that we can’t get into Docman yet to do letters; but hopefully we’ll crack that one soon.

Two way SMS messaging: The local CSU has bought iPlato for all its practices, and it is being rolled out. This should be good, and some of the tools look really good – although there is always room for improvement.

Collaboration tools: Our GP federation has been having nightmares with collaboration tools; we’ve put a lot of effort into trying to find the right one.

While we have an Office 365 subscription, I just don’t get on with SharePoint and OneDrive. We tried Basecamp for a while and it has many features we like. However, we built our own inter-GP news and announcements/ Q&As platform from some open source software – we call it GPask – that has more than 250 users.

Unfortunately, it’s not a good messaging client; so we are trialling Slack. It’s a bit of cross platform IM software with some nice features. The good news is the local firewalls and polices don’t appear to block it and it reduces the hassle on NHSmail – perhaps NHSmail2 will have a IM client, but even if it does, I’m not sure it will be as good or as cross platform.

Mail: Speaking of NHSmail, it has been a right pain recently. Every day almost there is a message saying it’s not working properly. I’m convinced I’ve missed some emails. Certainly some takes ages to arrive. Ok, the problems are meant to be coming out of an upgrade; but it’s very frustrating.

Back-up (this bit is not a success story): We had a little local difficulty when there was an explosion in Crewe, our local large town, which apparently took out the power to a comms hub.

It turns out the ‘uninterruptable power supply’ that kicked in was only rated for 15 minutes (or so I’ve heard) and, of course, the power didn’t come back on for several hours. So the main switch didn’t work; and took down several practices.

This kind of problem is strange, as years ago we were all encouraged to go onto centralised servers – we were promised proper, reliable kit and tons of benefits. Yet I can recall numerous episodes where we have been without IT for several hours at least, and the benefits have been slow in coming.

Of course, the outage happened to us on a Monday, when we have almost 20 doctors in; all doing extended hours. We had about 100 irate patients, who failed to understand that we just can’t do anything without the computers these days.

Perhaps handheld records aren’t a bad idea! Web based records wouldn’t have helped, as we had no internet access or phones. What was really funny was that the CSU support line was down, as it was on the same network…

ECG reports: We have been working with Technomed, and trialling their reported ECG service. I have to say Docman has been a bit of an issue with this, as well.

We were initially pleased to hear that Docman users can access an NHSmail box. This means they can extract attachments and add them to the Docman workflow. It also meant that Technomed could email the surgery the ECGs and that Docman would put them in the requesting user’s inbox for review. Sounds great.

Well, converting the image to the lowest resolution black and white isn’t that useful when the attachment is a small, but nice pdf and the report uses a RAG system to highlight problems. We are working with Technomed on either doing the conversion to Tiff first or bypassing Docman and using DTS instead.

Once we’re through the file format bit, the idea is to standardise and harmonise the quality of ECG reporting in our federation’s practices. Different GPs differ in their ability to read ECGs. Often, referrals are made because of what a GP takes to be a weird reading on an ECG, that is actually either normal or not significant.

We are testing out the Technomed service to try and prove to our clinical commissioning group that it is worth buying en masse; on the grounds that a £10 ECG report is much better than a £150 outpatient referral.

The problem is although the hospital charges £45 for an unreported ECG, a lot of practices do their ECGs in-house for free, which looks better than £10, even if a number end up as referrals.

The CCG is worried the cost of doing the ‘free’ ones does, in fact, outweigh the benefit. So, I hope I’m proved right. It’s got to be a better service to have the answer straight away.

Linking to consultants: On this line of trying to speed things up, we are also about to test Medefer and Kinesis ways of getting quick advice from consultants.

So quite a lot on!

Neil Paul   Dr Neil Paul is a full time partner at Sandbach GPs; a large (23,000 patient) practice in semi-rural Cheshire. He is also one of the directors of Howbeck Healthcare Ltd, which helps support several GP Federations. Dr Paul has been involved in primary care IT and health service management for more than ten years in various roles, including PEC member. In his spare time, he writes medical iPhone software and is a keen photographer.