eRecords

Paperless Working Tips

 

  Topic Comments
General Training

IT Facilitators are available for help
Read the SCIMP and MDDUS guidance ’Moving to paperless working’ etc .
  Workflow Advise scanning is the first process for every paper coming in – any exceptions to be well-reasoned e.g. for staff temporarily attached and not trained up yet.
  Pace of change Dual systems are inevitable – have a plan to minimise duration otherwise you will have the worst of both worlds.
  Coding 1

Agree level of coding,  a formulary beyond QOF e.g. SCIMP 800, who does what when in the workflow.

Note – SCIMP 800 is currently being reviewed in conjunction with the OSCAR project (Optimal Summarising, Coding & Accurate Records project in West Lothian) and a new list will be published shortly. Such a list can be used to improve uniformity of coding across different coders keeping the ability to use the wider Read code formulary when necessary. The new list will be accompanied by coding advice for both retrospective and maintenance data entry.
  Summarising All records should be summarised electronically before moving to paperlight working.  The OSCAR Project has published standards.
  Back-scanning You will need to decide whether to scan in all records; or records only from a certain date.  If your coding and summarising is 100%, then the backscan period can be unnecessary.  Exceptions can be met by pulling notes as required.  Partial back-scan of Grey Summary sheet often useful, also the last Clinical sheet.
Clinical Software Note-taking

Typing as freetext or added to Read Codes.  Macros not well understood, but predictive texting /Autocomplete should be supported, also spellcheckers – optional for heavy acronym users.
Keyboard shortcuts wherever possible by the clinical system. 
Voice recognition – no enthusiasm, many failures – acoustics issues.
Voice messaging – little understood but promising.
Usability priorities in bold Efficiency

Write-once, read-many is axiomatic – data once entered should be usable throughout system.
Data-entry templates for common scenarios, customisable per user.
  Record Structure

Enables display of clinical text with user-selectable filtering of views.
Integrates all file-types e.g. email items, images, voice messages.
Time to operate comparable to that of a structured A4 record.
  Decision support Should be context-sensitive (to be faster than an indexed book like MIMS)
  Clinical messaging Replaces the Case-notes as a vehicle of Post-It or other notes around the premises. Clinical messages to integrate with that patient’s ePR.
  Prescribing

Formulary and copying of previous scripts for speed.
Must support Drug and Clinical Interaction Alerts

  Coding 2 Another common task needs fast usability e.g. special text may trigger relevant chapter of codes, formulary support. 
  Data quality

Error-checking e.g. nonsense values, out-of-range dates.
Editing for maintenance or else live “data gardening” won’t happen.
Significant fields mandatory or prompt for entry.
  Desktop configuration

Quicklaunch toolbar can give 1-click link to any internet site, or internal network location. 
Similar links from Favorites and Start button need 2-or-more clicks.
Options to standardise a basic set of these.
Desktop profiles can roam, to be available on any workstation.
Wallpaper can be an ice-breaker esp. with kids.
  Access control Can this be linked to preset codes e.g. sexual history.  Levels of Sensitivity 1-5.  Screensaver preset to blank if unattended >5mins, password-protected to clear, can be started by hot-key to hide data on-screen.
Hardware issues Resilience – in case of system crash Critical – quarterly active restores mandatory, and rehearsed fallback routines desirable e.g. printout of appointments, swap-in spare PC or swap-out clinician to another consulting-room.
  Pointer

Optical mouse reliable, trackballs or touchpads reduce Work-Related Upper Limb Disorders (WRULD).
Scroll function e.g. by wheel to be s/w supported.

  Printer Quiet, fast, dual-bin for Patient Information Leaflets
  Monitor 17” minimum, the bigger the better; display 1024 x 768 minimum; locate at apex of triangle with patient for sharing their record, option to swivel for privacy.
  Patient-held record

CD-writer and one-click export routine in s/w.
Or desktop access to USB port for pt-held flashdisks.
Screen print an option
  When to shred?

Absolute and documented resilience essential.

For a few “shuttle” pts e.g. students, contract workers - may retain Case records as may be easier to return to PSD an intact  large Case record than to printout an electronic one.
  Consultation issues

Some advise live entry of values, but narrative and codes afterwards.
Some advise use of Script print to terminate a consultation.
Check ePR before patient enters.
Start screensaver discreetly by hotkey as a time reminder……