carryduff: the paperless practice use of computers in general practice stewart paul jonathan reaney

Carryduff: The Paperless Practice

Use of Computers in General Practice

Stewart Paul Jonathan Reaney

Introduction

Where?• Carryduff Surgery,

Hillsbourgh Rd, CarryduffWho?• Dr J Browne and 3 other

partners, 1 doctor part time, 1 registrar

• 4 nurses • Practice manager, fund

administrator and 8 receptionists

Introduction

What?• Fundholding General Practice• Practice population approximately 8000

When?• Started 1978• Moved to new premises 1989

EMIS GP Computing System

• Invented 1982 by doctors in Leeds• Installed in Carryduff Surgery 1991• System cost: £13 000• NHS paid for 75% of system as part of initiative to

increase use of computers in General Practice

Security

• Encryption• Passwords• Usernames• Firewall

Dr Paper vs. Dr PCAppointments

Dr Paper• One book• patients on hold while

looking up book• 6/10

Dr PC• Appointment book on

computer• Instant access from

any terminal• 9/10

Prescriptions

Dr Paper• Time - have to search

notes• Mistakes• 3/10

Dr PC• Computers warns of

overdoses, allergic reactions

• 9/10

Referral Letters

Dr Paper

• Letters handwritten, stamped and posted

• 5/10

Dr PC

• Pilot scheme with City and some departments in Ulster

• E-mail referrals and replies

• Time saved in deciphering doctors handwriting

• 7/10

Hospital Letters, Lab Results, X-rays

Dr Paper• Time searching

through file• Client on hold• 5/10

Dr PC• Scanned into computer• Doctor input• Filed after scanning• Instant access on

screen• Doctors notes with

item on screen• 8/10

Power Cut

Dr Paper• Can operate close to

normal• Paper notes only

require light• 8/10

Dr PC• Can still operate at

very basic level• Delay repeat scripts• Handwrite new scripts• 1/10

Fire

Dr Paper• Lose everything• 0/10

Dr PC• Everything backed up

daily at 1am and tape put into fireproof safe

• Backed up weekly off site on tape

• Occasionally burn information onto CD

• 10/10

Drug scare or recall

Dr Paper• Impossible to search

through notes for 8000 people

• 0/10

Dr PC• Type drug name into

computer • Computer searches • Results in 1 second• 10/10

Overall doctor scores

Dr paper• 21/60• Only scored higher in

one- power cut

Dr PC• 45/60• Two perfect scores-

fire and drug recall.

Training

• Self training• Balance between

computer and patient

Web Site

• Patients can order repeat scripts on line

• Out of hours information

• View test results• News• www.carryduffsurgery

.co.uk

Voice Dictation“Thank you for seeing

this lady”

“Hank is for leavingthe Navy”

Drugs

• Order• Changing dose• Intelligent system

Scripts

• Print out• Doctor just has to

check and sign• Legible

Records

• Looked up anywhere• Time saving• Doctor must update information

Links

• Books • Documents• Leaflets• Societies• Websites

Further Features of EMIS

• Macros – shortcuts for common phrases• Access to pictures, video and audio to get second

opinion• Can type in drug and see any interactions• Electronic BNF• Can print out patient information leaflets• Can access details of self-help organisations

Development

• GPs all linked up• Voice dictation• Increase security