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Patient Confidentiality

98.9% of doctors and 95.1% of nurses own a smartphone. There’s nothing particularly surprising in that, although it is ahead of the UK average; but what is perhaps surprising is that 92.6% of doctors and 53.2% of nurses find their smartphone to be useful or very useful in helping them to carry out their clinical duties.

That was the finding of a multicentre cross-sectional study which was recently published in BMJ Innovations. Whilst a proportion of smartphone use related to using the phone in place a more traditional ‘bleep’ the study also revealed that health professionals were routinely using apps, picture and text messages to send patient information to colleagues.

Whilst there is nothing intrinsically wrong in using smartphones to speed up communications, the study does raise concerns over the security of information which is being shared over unsecured media. In their conclusion, the study’s authors comment that “healthcare organisations need to develop policies to support the safe and secure use of digital technologies in the workplace.”

In truth, organisations which have yet to draw up policies relating to the safe use of technology are behind the times but it also has to be acknowledged that the speed of technological change may have caught out some healthcare practices. When the industry as a whole is talking about overarching concerns such as the safe storage and sharing of digital patient records on a countrywide basis, it is perhaps easy to overlook the fact that individual health professionals are using day-to-day communications to speed up treatment.

It certainly has to be acknowledged that the digital storage of patient records, the maintenance of electronic diaries, or even the sending out of appointment reminders by text have helped to smooth out patient communication and treatment pathways. But whether the data is being managed on a national level or within a specific health practice the importance of respecting patient confidentiality cannot be underestimated. That’s why our systems are set up to respect the privacy of your clients.

However securely data is maintained, at the end of the day security is a state of mind and it is up to every health professional to ensure that when they share information they do so with confidentiality and security in mind. As an NHS spokesperson, commenting on the survey, said “Apps and other online services offer powerful benefits to clinical practice but it’s vital that doctors and nurses know which ones are safe to use.”

When this article was originally written in 2015, the concern was over the safe use of digital records but the safeguarding of physical records should also not be ignored.  Reviewing this article in February 2017, reports have come to light of the ‘misplacing’ of some 500,000 NHS patient documents.  Early indications are that these were stored in a warehouse rather than being filed in patient records or sent to GPs.  There is no indication at present whether these records would have had a material impact on patient care but it does highlight the importance not only of patient confidentiality but also of ensuring that records are complete and up to date.

Stretching Therapies

Looking back at old newsreels of athletes training it is striking how little variety there is in the exercises shown. Admittedly this may be down to the personal preference of those who made the films but whether looking at footballers in training or holidaymakers limbering up at summer camp, there seems to be little variation from the sit ups, press ups and touch your toes type of exercise.

But times have moved on and now the emphasis is very much upon providing bespoke exercise and mobility training which not only suits individual pursuits but also the individual athlete. The old favourites are still there but they are supplemented by other activities.

Cross-training is also very much in evidence. For example, athletes may look to yoga training to enhance posture and core control, or take up dance or gymnastics to improve overall mobility and rhythm. Swimmers too no longer spend 100% of their training time ploughing up and down a pool but look to other forms of strength and conditioning work to supplement their water work. And this idea of choosing the right type of exercise to help the individual is not simply confined to athletes. Mainstream healthcare too is exploring the way in which a range of different platforms can lead to faster recovery times and increased mobility.

For example, according to the Chartered Society of Physiotherapy website a group of physiotherapists from Edinburgh are exploring the benefits of tai chi. More than 50 physiotherapists have signed up to the event and it is hoped that more will be planned in future. Commenting on the event occupational  health physiotherapist Jo Gordon said that they were  “interested in options for exercise to recommend to our patients and contacted the centre to ask if they would consider hosting a class or introductory session so we could find out more.”

This idea of moving away from the traditional and exploring other options is not just confined to physiotherapy. Right across the health service we are seeing practices embrace new treatments and new ways of operation in a bid to maximise the service which is being provided to patients. So tai chi and reflexology are coming in but so too are a raft of simple exercises which people can carry out in their own homes. This health professional/patient partnership in which the patient is responsible for some of their rehabilitation not only provides a more consistent recovery regime, patients also take more of a stake in the success of their care plan.

And for health professionals themselves, technology has brought a new range of options including electronic diary management, automated SMS appointment reminders and electronic storage of patient information.  In fact anything which can cut down on day-to-day administration and maximise patient focus is being looked at in a bid to increase the time spent with patients and provide as swift a response service as possible.

Today’s health service is looking towards having a relationship with patients which optimises treatment on an individual basis whilst maximising efficiencies. Sit-ups and old-fashioned courtesy may still be part of the package but those who look to maximise patient care are constantly broadening their horizons, looking for alternative treatments and operational efficiencies.

Use your Imagination

Think of an apple, a sunset, the face of a loved one; what do you see? For some, the pictures in the mind’s eye will be vivid and clear, whilst others may see blurred impressions or individual features. But now scientists have identified a condition which results in people being unable to visualise mental images.

Called aphantasia, the condition was identified by a team of Exeter University researchers led by Prof Adam Zeman. Commenting on the research, Prof Zeman said the condition is not uncommon, affecting up to 1 in 50 people but that having aphantasia, or its opposite hyperphantasia, makes quite an importance difference to people’s experience of life.

As with many other conditions, the way in which it affects people’s lives will vary. Some may find it life limiting, whilst for others it is just the way they are. And the condition certainly doesn’t mean people lack imagination; it just means that they are unable to form visual images inside their head.  In a way this puts it in the same category as having excellent or virtually non-existent spatial awareness, being good or poor at map reading, having a good ear for music or being tone deaf. In other words, they are conditions which you were born with and there is not a lot that you can do to change them.

But there are other areas in life which we do have the power to change but which can sometimes seem so intrinsic to our lifestyle that we never think of doing so. Take the long work hours scenario for example. Particularly when we own our own business, it is all too easy to become sucked into a mindset which sees throwing hours at the problem as the only solution. When we start out, we do everything simply because we are looking to control costs and we do have some spare time. As the business grows, rather than looking to outsource some of our work we simply shorten our lunch hour or add-on a little time in the morning or evening. Then we add on a bit more time and a bit more until every spare moment is taken up in administration.

It doesn’t have to be like this. Stop for a moment and think about how you envisaged the business to be when you originally set out. Now take some steps to move business reality closer to your imagination. Do you need to rush to answer phones or could you outsource calls, does your diary have to sit on your desk or could it be managed by others, and do you really have to spend every evening in telephoning clients to remind them about their appointments or could this be managed in another way?

Being honest, we all have things about us that we would rather change. Some of them arise directly from our chromosomes and we might as well just get on and do the best we can with the hand we were dealt. But in other areas we can be our own worst enemy and perhaps it’s time to take positive action in pursuit of a more balanced lifestyle.

Card Acceptance

Has the idea of a cashless society finally moved away from the theoretical and into the plausible? It would certainly seem so if a number of surveys in 2015 are to be believed. According to the Payments Council, in 2014 for the first time cash became less popular than cards as a means of payment although it still did account for 48% of all transactions.

A separate survey by the Halifax in April of this year revealed that amongst its customers cash withdrawals accounted for just £18.33 of every £100 spent. Debit cards at £30 and faster payments at £15 were also proving increasingly popular according to the Halifax analysis.

The UK may not have gone as far as Denmark which earlier this year proposed a law which would allow businesses to refuse to accept cash for transactions but it does seem that we are well on the way towards seeing cash as simply one method of payment rather than as the main payment option. The launch of Apple Pay in the UK last week can only add to the range of payment options and encourage people to choose the most appropriate payment method for each transaction.

The increased acceptance of cards as a payment method is also good news for those organisations which seek to move their customers away from cash and cheque and towards alternative payment means such as credit and debit cards. Being able to take card details at the time of booking helps those businesses which rely on appointments to secure payment. This is particularly appropriate in the independent health sector where no-shows can cost physiotherapists, osteopaths and others both time and income.

Interestingly it has been found that taking card details at the time of booking helps to improve attendance rates.  It seems as though there is something about having handed over card details that acts as a reminder to attend booked appointments.  Add on an appointment reminder either by SMS text or phone and the chances of clients turning up for treatments are increased; or at the very least clients may be prompted to get in touch to cancel, enabling replacement bookings to be made.

For those few who still fail to make it to their appointment, the fact that card details have been taken in advance enables the practitioner to take a no-show fee in accordance with advertised practice. Once card details have been taken either on the telephone or via an online booking system, the card can be pre-authorised, effectively reserving a balance to be taken once the appointment has been completed. Should the client opt to use a different card or pay by cheque on the day, the preauthorisation can simply be cancelled.  Either way, the invoice delay time is effectively eliminated, helping to streamline cash flow.

We may have some way to go until we are a fully cashless society but the more that options such as secure card payment processing move into the mainstream, the closer we will get; whilst at the same time having the added bonus of enabling businesses to reduce no-shows and smooth out their cash flow.

Paying the Price for Missed Appointments

Nearly £1billion. According to a recent speech by the Health Secretary, Jeremy Hunt, that’s the annual cost to the NHS of missed GP and hospital appointments. It’s the equivalent of training some 14,000 nurses, or over three and half million hospital bed days.

If you add on top of this figure the £300 million being wasted on medicines each year it’s no wonder that the Health Secretary is pushing for patients to take on more personal responsibility for the use of NHS resources. As Jeremy Hunt said in his speech “People who use our services need to know that in the end they pay the price for this waste.”

Whilst the government is currently holding back from charging people for missed appointments, in future, those who do miss appointments will be told how much that missed appointment has cost the NHS. In addition, medicines which cost more than £20 will be labelled with the true cost as a way of encouraging people to think more responsibly about the medicines which they have been prescribed and to complete the course of treatment.

But missed appointments don’t just affect the NHS. Health practitioners such as physiotherapists and chiropractors, dentists, beauticians; in fact anyone who relies on a customer appointment system can suffer if the client fails to turn up. Not only does a no-show result in lost revenue, it also deprives someone else of the chance to receive treatment.

One method which is proving increasingly popular within health practices is the use of an SMS text or telephone reminder. For those who had simply forgotten about the appointment or had made a note of an incorrect date or time, appointment reminders can be a useful way of helping to boost attendance, or at least encourage people to phone up and cancel, thereby freeing up the appointment sot for another patient.

Health practitioners who charge for their services have another simple option which not only speeds up payment but also helps to encourage attendance.  This option involves taking card details at the time of booking the appointment. Not only does this tend to concentrate people’s minds about the need to attend the appointment; in the event of a no-show, the health practice can take a fee in accordance with their published criteria.  And once the appointment has been completed a simple confirmation means payment is taken on the spot, saving paperwork and smoothing out cashflow.

Regardless of SMS text reminders or card prepayment’s, at the end of the day it is up to patients to take more responsibility for their own health. However, it is also up to the health profession to play their part, to create a partnership of understanding in which health practices and patients work together towards a shared wellness goal. And helping to ensure that treatment times are optimised is a win-win for patients, prospective patients and health practices. As Jeremy Hunt concluded: “Responsibility for our health, responsibility for our families, responsible use of public resources. A revolution in personal responsibility to match the revolution in health and care provision that we are all determined to offer.”

From Sun Up to Sun Down

By the time that you read this article, the chances are that the US Masters golf tournament will be over and all of the speculation about whether Rory Mcllroy or one of the other front runners will triumph will have been answered. In the run-up to the tournament, apart from spotting potential winners, one of the main stories revolved around Tiger Woods and his return to the competition trail following treatment for injury from physiotherapists and other health professionals.

Commenting on his comeback Tiger Woods said “People would never understand how much work I put into it to come back and do this again, it was sun up to sun down.” His comments are hardly surprising, given the champion he once was.

Getting to the top in any walk of life requires a measure of determination and hard work and getting back to ones best after a set-back requires an extra measure of grit and courage.  But such courage is not simply confined to top sportspeople. The determination to improve, to get better, to overcome injury or other setbacks comes from within and can be found in all walks of life. It’s something which physiotherapists and other health professionals see on a daily basis. Octogenarians recovering from a hip replacement, children regaining the use of broken limbs following a fall, the middle aged recovering from a rather too strenuous gardening session in the spring weather; whatever the reason, when we set our minds to a task it is surprising how the results will follow.

It is one of the key motivators and rewards of being in the health profession; seeing others improve, watching them stretching themselves to the limit in a bid to return to fitness. It also can be one of the prime challenges; balancing people’s desire to return to ‘business as usual’ against their ability to recuperate. Get the balance wrong one way and overwork could lead to a setback. Swing the pendulum too far towards caution and the ability to return to maximum mobility could be lost forever.

Getting the balance right, deploying your professional skills to the benefit of patients is challenging but success can be personally rewarding. Discharging an individual from your care as they step out renewed to live as full a life as possible marks a success point in a busy profession. Sadly the procession of those in need is never-ending and physiotherapists, osteopaths, chiropractors and others could easily find themselves working from sun up to sun down in a bid to meet the ongoing demand.

Taking full advantage of time saving devices is one way to keep administration time down to a more manageable level. Electronic appointment booking, card payments, SMS text reminders, virtual assistant services; whatever the mix, finding ways to free up time will help busy health professionals to manage their day effectively. Who will win the Masters? We just don’t know but what we do know is that winning those everyday battles for fitness, fought by ordinary people of all ages, is for them every bit as important as any trophy could be.

On Your Feet Britain

On April 24th 2015 (29 April 2016) the Get Britain Standing campaign in association with the British Heart Foundation is challenging British workers to sit less and move around at work more whilst raising money for heart research. Studies have shown that even those who are active at some times in the day can still damage their long term health by sitting for prolonged periods during the day.

This means that the daily jog to work may have benefits on one level but if you then sit without moving for hours at a time you are in danger of developing heart disease, type 2 diabetes or even some cancers.

Released in connection with the challenge, a survey of office workers revealed that 45% of women and 37% of men spend less than 30 minutes a day on their feet at work and that more than half regularly eat lunch at their desk. Apparently sitting for long periods affects the way in which the body controls areas such as sugar levels, blood pressure and the breakdown of fat so the challenge is on to regularly stand up and walk around.

That doesn’t necessarily mean that work will suffer as we look to our health. Suggestions from the On Your Feet team include standing up to take phone calls, walking to a colleague’s desk instead of phoning or e-mailing them and having standing or walking meetings.

Having said that, there are some professions in which having the chance to sit down for a few moments would be welcome. For example, when health professionals are faced with a continuing parade of patients through their practice, any time spent away from treatment can easily be taken up in paperwork rather than in looking after oneself. Whether you stand up a lot and need to sit down or sit down a lot and need to stand up, taking a few minutes out every now and then can help to reduce stress levels as well as give the body a much needed change of position.

This means that anything which can be done to reduce time taken on routine paperwork is time which can be better spent, either on further treatments or on ‘me time’. Online bookings, card payments, electronic patient notes, automatic appointment reminders; the list of potential time savers goes on.

But the best thing is that not only do these measures save time, they can also help to smooth out the working day. For example appointment reminders help to reduce no-shows whilst electronic note filing saves all that time looking for misplaced records. Given the pressure that the health service is under, it is tempting to plough all of that saved time back into patient treatment.

However, in the spirit of ‘physician heal thyself’ it is important that health professionals take regular breaks in order to stretch and move around, or simply to unwind the mind. It is inevitable that over the course of the day fatigue may set in, but the more we can take time to refresh the better we will feel at the end of the day and the better and more focused treatment we are able to give to our patients.

The Get Britain Standing campaign wants is to stand up, sit less, move more. Whether we need to follow their advice or whether sitting for a few moments would be a blessing; the important thing is that the campaign makes us think more about how we approach our working day.

Business Spring Cleaning

The second week in March has sadly not lived up to the promise of the first with cold, wet and dull weather taking the place of sunshine. Nevertheless spring is well on the way and with it our thoughts turn to the annual challenge of spring cleaning.

No-one knows where the tradition of spring cleaning started. The practice has been shown to have roots in several ancient cultures but it is almost tempting to speculate that even back in cave dwelling times, ancient people stepped out from the crevices in the rocks which had given them winter shelter, sniffed the fresh air of spring and started to clean.

But there is a darker side to spring cleaning. As we vacuum and scrub, mop dusty floors and persuade over-wintering spiders to leave the home, the emergency services are poised waiting for the call. Every year, casualty departments are called on to treat those of us who thought that balancing on a rickety chair or table would be a good idea when cleaning windows or reaching high ceilings. Others will have to call on the services of physiotherapists or osteopaths to help sort out sprains and strains caused by repetitive movements such as overenthusiastic dusting or polishing.

With health professionals such as physiotherapists being stretched by all of these seasonal injuries, it may be time for them to carry out a little spring cleaning of their own. When we start out in business we tend to adopt coping mechanisms, working through processes which may cost us in time but save cash flow. With more mature businesses it may be time to spring clean some of these practices, bringing processes up to date.

For example, in the early days with few clients it can be a simple matter either to hope that they will turn up for appointments or phone them with a reminder.  Growing businesses which try to continue this practice may well be spending time on client reminders which would be better spent on treating a growing client base.  And in truth, what business nowadays can afford to operate under a model which allows for gaps in appointment times when clients fail to turn up. Simple remedies such as SMS text reminders, the availability of online booking and switching phones in busy times can free up a significant amount of time.

SMS text reminders also help to cut down on no-shows, but it still leaves businesses open to the possibility of a reduction in income, should clients fail to turn up for their appointments. One practice which can help to alleviate this problem is the taking of credit or debit card details at the time the appointment is made. When clients turn up for their appointments the card payment can simply be confirmed, considerably smoothing out the invoice/administration process. However, should clients fail to attend appointments; a no-show fee can still be taken in accordance with the health practice’s publicised tariff.

As we are looking at spring cleaning for efficiency, ask yourself if it is really necessary to have all of those paper records cluttering up the office?  Electronic filing can not only help to clear away paperwork, with patient records available at the touch of a button it can also help to save time when clients come to call.  It doesn’t take much to spring clean business processes, but health professionals may find that taking a little time out to review the way the practice is set up now could make a measurable difference in the future

Secure Card Processing

Black Friday, Cyber Monday; whichever day you have earmarked as the time to break the back of your Christmas Shopping the chances are that both shops and internet will be working to capacity. In fact, as a speech by the Managing Director of the Payment Systems Regulator, Hannah Nixon, revealed recently our love of automated transactions is growing apace. And the more we use our cards the more important it is for the payments industry to ensure that secure card processing happens as a matter of course.

According to Hannah Nixon, in the UK in 2014 some 40,000 transactions are made every minute on average. With early reports that spending on the two ‘major’ Christmas shopping days so far this year was well up on 2013 it is easy to believe that transaction volumes also were far higher than average.

One of the reasons for Hannah Nixon’s speech was to highlight the way in which the PSR is working to improve payment systems in order to provide new options for consumers and to make existing options better and easier to use. Much of what she said was more directly relevant to those who provide the systems rather than end users but if the PSR vision is realised then we will have “world class payment systems operating in the best interests of service users and the wider UK economy.”

Over the last few years we have already seen a huge development taking placed in the payment card sector. Contactless payments, online payments, swift transfers between accounts; all have improved payment options for businesses and consumers alike. We now expect to be able to use our cards as a prime payment method. And with that expectation comes the acknowledgement that ease of payment for consumers and swifter receipt of funds for retailers delivers a win-win result.

Take booking health appointments for example. By allying a secure card payment processing service to online booking, health practitioners can take a pre-authorised payment at the time of booking. Once the appointment has taken place, payment can be confirmed, helping to smooth out cashflow. Another advantage of secure card processing is that it tends to reduce the number of ‘no-shows’, particularly if clients know that they will be faced with an automatic cancellation fee if they fail to turn up for their appointment. Should clients decide to pay by an alternate means then the pre-authorisation can simply be cancelled.

Secure card processing is just one way in which the health practitioner can reduce administration time whilst at the same time helping to ensure that appointment slots are filled as much as practicable. SMS text reminders also help to reduce no-shows and can be pre-scheduled to be sent out at a set time before the appointment. Health practitioners may only account for a small proportion of the billions of transactions which already take place every year but if secure card processing can help to cut workflow and smooth cashflow then the more developments in card payment options which the PSR can encourage the better.

Prescribing Physiotherapy

New laws in Wales have opened up the way for physiotherapists, chiropodists and podiatrists to be able to prescribe medication to their patients. The change will bring Wales into line with England and Scotland which brought similar regulations into play in August 2013 and May 2014 respectively. The ability to prescribe medication is an important facet of physiotherapy and allied health services.

For a start, with physiotherapists and others prescribing medication as required, treatment pathways can be smoothed out with patients no longer having to wait for doctors to prescribe before they can continue a course of treatment.  Not only that, by integrating physiotherapy into the treatment/prescription mix, health professionals are able to deliver a more holistic treatment plan.  As a consequence, this practice speeds up recovery time whilst simultaneously reducing the burden on the rest of the NHS

Speaking about the new laws the Chartered Society of Physiotherapists said “We have noticed that the new powers have made a particularly strong impact in both neurological rehabilitation and in the treatment of musculoskeletal conditions, such as back and neck pain” whilst Welsh Health Minister Mark Drakeford said patients would get “a faster, more effective service with quicker access to the medications they need.”

Subject to training, other health professionals such as pharmacists and optometrists already have the power to prescribe. Moves such as these have the potential to have a profound effect on standards of patient care as well as making a more efficient use of health service resources. With increasingly busy lives and increasingly long lives, these resources are going to be stretched more and more unless further measures are taken to enable health professionals to optimise patient care. In fact, recent statistics have revealed that the number of those reaching the 100 mark has soared in the last decade, with (in 2013) nearly 14,000 people in the UK alone having passed that milestone with 710 living beyond 105.

Putting additional powers in the hands of those who need them is one way of helping our health services.  So too is any move which enables specialists to concentrate on clinical time rather than on administration time.  After all, if we are giving physiotherapists and other health professionals the tools which enable them to deliver a more holistic and complete level of treatment then the least we can do is ensure that their patient-facing time is optimised.

That’s where making the best use of technology comes into play. Measures such as on-line appointment books which patients or virtual receptionists can access remotely, electronic filing of patient records, or the ability to switch routine calls to a virtual receptionist service are all designed to free health professionals from routine administration tasks. Not only does this give those working in physiotherapy practices and other health services more time to practice the skills which they were trained for, they are also more able to take on additional clinical duties such as prescribing.

Working smarter not harder may seem like a cliché but it is one which can have a profound effect on patient recovery times and on the ability of health professionals to do their jobs to the best of their abilities.

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