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Advancing Recovery through Electronic Filing of Medical Records

Not so long ago a broken hip would result in weeks or even months of hospitalisation as the bones were left to slowly knit together. Nowadays the broken hip is simply replaced, leading in many cases to discharge in a matter of days followed by recuperation at home.

Admittedly that recuperation requires the help of support services with physiotherapy and exercise advice being supplemented by aids such as walking frames but the new regime is far more effective and far better for the long term health of the patient. The patient is spared the challenge of being confined to bed for weeks and scarce hospital beds are freed up quickly.

But this new regime does bring with it the challenge of moving support services away from the hospital and in to the wider community.  Local health practitioners including physiotherapists are now seeing an increase in demand from patients who previously would have relied on in-hospital services. Depending on the health authority, those requiring rehabilitation and physiotherapy treatments may be offered outpatient appointments at a central or local hospital, treatment in local specialised centres or even home visits from mobility specialists. Whilst this range of options is designed to improve patient outcomes, it does require an increased focus on effective patient treatment plans and the sharing of information.

Luckily, whilst technological improvements have enabled swifter treatment of patients, they have also enabled health practitioners to remove some of the burden of non-essential tasks as well as streamlining data and information sharing. Take patient records for example.  Paperwork has been a perennial challenge for the health profession.   Countless hours which should have been spent in patient treatments have been wasted as records are transferred from one treatment centre to another or are stacked up on administrator’s desks whilst skilled typists struggle to interpret scribbled notes.

Even simply filing and retrieving records can take up time which would be better spent in focusing on patient needs whilst the mobility of patients around treatment centres has increased the danger of patients being lost in the system. Now, thanks to the advent of electronic filing, much of the unproductive time is no longer wasted.  Electronic filing not only reduces instances of mis-filing, it also enables records to be transferred between treatment centres and then brought to hand swiftly as and when required.

With clinical notes organised and important test results and x-rays available on screen at the touch of a button, health practitioners can not only maximise patient treatment times, they can start treatment programmes in a timely manner without having to wait for records to be transferred by post or hand delivered.  Link in online diary management or on-line booking services and yet more time which was previously spent on administration is freed up.

Such is the pace of technological change that medical breakthroughs are coming thick and fast, transforming health services and enabling patients to recuperate at home where once they blocked beds.  With administration also reduced thanks to technology, the face of the health service in years to come will be a very different one from that which in the past was bedevilled by paperwork and the delays and frustrations occasioned by filing, retrieving and transporting patient records.

The cost of health

The Royal College of Nursing (RCN) has overwhelmingly rejected a proposal to charge patients for NHS appointments.  Had the proposal been successful it would have led to the RCN backing the idea of a £10 charge for health appointments, but in the end 91% of delegates at the RCN conference voted against.

Those in favour of the proposal said that making a charge would not only raise much needed revenue for the NHS it would also emphasis the value of NHS appointments.  In other words, charging for appointments would help people to appreciate the value and cost of NHS appointments and in the process make people think a little more about the way in which they use NHS resources This would in turn, the proponents argued, result in the twin benefits of reducing unnecessary appointments and reducing no-shows; both of which waste considerable NHS resources as well as potentially delaying urgent treatments. After all, it helps no-one if health practitioners are sitting idly by waiting in vain for someone to turn up. That time would far better be used in helping another patient.

Commenting on the vote a spokesperson for the Department of Health said “We are absolutely clear that the NHS should be free at the point of use, and we will not charge for GP appointments.”  But with no-shows a constant drain on both NHS and private health care services, practices are increasingly turning towards the use of appointment reminders as a means of encouraging people to attend booked appointments or to cancel them in good time.

Sent by phone, SMS text or e-mail, appointment reminders not only jog patients’ memories, they also act as a spur for patients to get in touch and cancel appointments if they are unable to attend.  This in turn enables health practices to re-book appointment slots.

For health practices such as osteopaths or physiotherapists which do charge for appointments, not only do no-shows waste valuable treatment time, they also act as a cost drain on the practice.  Whilst the option of sending out appointment reminders is one option, another great way to cut down on no-shows is to take a secure card pre-authorisation at the time the appointment is booked.  Having a card pre-authorised tends to sharpen the mind when it comes to remembering to attend appointments. Pre-authorising a card doesn’t prevent the patient from paying by other means when they attend the appointment but should the patient not attend the health practice can charge a pre-agreed sum to the card.  Pre-authorised card booking can be taken either over the phone or when an appointment is booked online.

With a report from the BBC revealing that the NHS may be facing a funding gap of some £2billion in the next year, we suspect that the debate about the way in which health care is funded and managed will rumble on for some time.  Adopting systems such as appointment reminders which help to ensure patient care is delivered when it is required whilst at the same time maximising resources can only be a positive move.

Keeping on track

Whether you are a physiotherapist or a hair specialist, an osteopath or a dentist; it’s a fair bet that you chose your profession because you wanted to help people. It is also a fair bet that the matter of paperwork and records wasn’t really a factor which came to the fore when you were deciding on your chosen profession.

But no-matter what the profession nowadays it seems as though movements are circumscribed by reams and reams of paperwork. And unless something is done to rein this in, the volume of paper can not only seriously interfere with patient treatment times, it can also detract from the provision of effective treatments.

In an era in which every patient and every treatment comes with a paperwork trail, it is little wonder that records can become lost or treatments delayed as records are transferred from one place to another.  Partly in an attempt to smooth out the pathway and partly to improve self-management of long term conditions the Richmond Community Neuro-Rehabilitation Team has trialled a patient-owned folder.  The folder not only contains important contact details, it also contains details of the patient’s condition and therapies which have been agreed upon.

Since the folder was trialled in 2012, the team has seen pick-up time for new patients improve by five days. In addition 92% of patients agreed that the folder helped their therapy as they were able to use it as a continuing reference point.  But even with initiatives such as the patient-owned folder there is still the hurdle of paperwork to overcome.

Moving away from a paper based system to electronic records can make a huge difference.  Paperwork safely stored in an electronic folder can be accessed at the touch of a button.  This not only saves the time taken in finding missing paperwork it also enables health professionals to quickly call up information when patients get in touch as well as facilitating the transfer of information between professionals. All of this not only helps to improve patient treatments, it also creates valuable additional time which can be spent on treating additional patients.

No more searching through filing cabinets, no more waiting for days for the post to arrive; electronic storage of patient records can make a huge difference to the daily practices of health professionals; bringing them back on track to the reason why they joined the profession in the first place – the treatment of patients.

Tackling Late Payments

The economy may be improving but late payment of invoices is still a problem for small business.  So say the Forum of Private Business (FPB) whose latest survey revealed some worrying statistics in respect of late payers.

According to the survey 23% of respondents say that they have seen an increase in the number of late payments whilst 29% report that the number of days payments have been delayed beyond the deadline have also increased.  In the light of this, respondents have called for better publicity in respect of late payment issues as well as a range of sanctions for late payers to include barring persistent offenders from government contracts.

Responding to the survey’s findings, FPB Chief Executive, Phil Orford MBE said “upwards of £30 billion remains tied up in late payments, costing a typical small business 130 hours a year to chase and meaning that a third are forced to seek external finance to cover the gaps in cash.”  Tackling late payments is a challenge which potentially affects every business and even those within the health sector are not immune.  In fact, businesses such as physiotherapy and osteopathy which rely on patients paying for treatments not only have to cope with potential late payers but also with a loss of income from those who fail to turn up for appointments.

Alongside diary management and appointment reminder solutions which aim to cut down on missed appointments, health practices may also wish to turn to secure card processing as a means of ensuring swift payment for treatments.  With booked appointments backed up by a pre-authorised card payment the health practitioner knows that they will receive prompt payment following the appointment.  And if the patient fails to turn up, a card payment can still be taken in accordance with the practice’s cancellation policy.

Pre-authorising a card at the time of booking doesn’t commit the patient to using that card following their appointment.  If they choose to pay by cheque or cash or to use another card then the pre-authorised amount can simply be cancelled.  This means the patient retains payment flexibility whilst at the same time the practice receives prompt payment; helping to smooth over cash flow issues.  The simple fact that a payment has been pre-authorised also helps to act as a spur to patients to keep their appointments, helping to reduce the number of gaps in a practice diary and ensuring that those who need treatment receive it promptly.

Telephone reminders

We’ve written before about the way in which telephone reminders can help to cut down the number of no-shows but it is always a pleasure to be able to report on a practical example.  Earlier this year the Great Western Hospitals NHS Foundation Trust introduced a reminder service for those with outpatient appointments.

Since the reminder service started the trust reports that no-shows have reduced by a third and the trust is therefore expanding the service to its physiotherapy departments.  Using a mixture of texts and automated calls the trust decided to adopt the appointment reminder service as a way of cutting down on the 39,871 appointments missed in 2012.

In announcing the extension of the service the trust’s deputy general manager responsible for outpatients told the Wiltshire Times: “The reminders seem to making a real difference. I hope that patients find the service helpful and it makes it easier to cancel or rearrange. If we know a patient won’t be attending, we can offer the appointment to someone else. By making sure all of our appointments are used, we can see more patients and patients will be seen sooner.”

Patients who fail to show up for appointments are not just a problem for NHS trusts.  Health practitioners everywhere from osteopaths to physiotherapists and from beauticians to specialised health clinicians all need to run with as full a schedule as possible if they are to remain competitive.  Not only can missed appointments lead to delays in treatment times for the patients concerned and others, for those who rely on the appointment to generate income, every gap is a loss.  The Wiltshire trust estimated that for them each missed appointment cost some £108 and the opportunity cost charge can easily be higher for those in private practice.

It is hardly surprising therefore that telephone appointment reminders are increasingly becoming a necessary feature of health practice.  This writer has received reminders within the past few months from their optician, dentist and doctor, all of whom have adopted versions of the reminder system.  Set alongside a virtual assistant service which can also take calls and arrange bookings, even the smallest of health practices can move towards a fuller diary with fewer no-shows.  This in turn means that health practitioners can keep their prices competitive whilst maximising both their income and patient treatment times.

Divide and conquer

A hospital in Derbyshire has been reaping the benefits of a new cleaning rota.  Using an idea gleaned from overseas, the Royal Derby Hospital split its cleaning workforce into teams, each responsible for specific areas such as corridors or toilets.  Previously a single cleaner had been responsible for an entire ward or area of the hospital.

The new system of team cleaning by area has lead to a reduction in cross-infections, traditionally a pre-cursor of the need to close wards for deep cleaning.  In fact this new working pattern has been so successful that the hospital has been put forward for two Nursing times awards including the Golden Service award.

Hospital bosses have also found that by using teams rather than a succession of individuals, cleaning patterns are more flexible.  This in turn has reduced the incidence of wasted cleaning processes, such as cleaning a patient area just before a patient is due to be discharged as well as ensuring teams are on hand in case an emergency clean is required.

The story is a perfect example of the way in which those at the forefront of health provision are finding ways to work smarter rather than harder.  For example many health providers are looking to make savings by replacing follow up appointments with telephone calls or using the phone to make routine check-ups on those with ongoing problems.

It has to be acknowledged that telephone coaching is not universally successful if used in isolation as a study by UK researchers revealed earlier in August.  They concluded that telephone coaching of those with long term conditions is not effective unless it is carried out as part of an integrated system of care.

Health professionals too are using this “divide and conquer” principle to maximise patient treatment time and minimise disruptions.  Simply by outsourcing their phone answering to a virtual assistant service, health professionals can ensure that their phones will be answered, appointments made and reminders sent out whilst the health professional can concentrate on treating their patients.  With no need to interrupt a treatment to answer the phone and no missed calls, professionals such as osteopaths, chiropractors and others can provide a more streamlined and efficient service to their patients.

Innovation Grant for British School of Osteopathy

When finances and funding sit so firmly at the heart of the NHS it can sometimes seem as though every attempt to instil a culture of care is beset by financial restrictions.  Not that care and compassion should be affected by finances but it can be hard to provide a quality service when time and energy is spent in scratching around for cash.

It is therefore good to be able to report on the British School of Osteopathy which has recently been awarded a significant innovation grant.  Totalling just over £250,000 spread over a three year period the grant will enable the BSO to develop a new service called OsteoMAP.

According to the BSO website, “OsteoMAP is designed to support people with long-term musculoskeletal pain, which may be alleviated but is unlikely to be completely resolved by manual therapy alone.”  The programme will initially be developed at the BSO’s clinical centre and then rolled out via training courses to students and qualified osteopaths across the UK.

In recognising and developing multi-layered treatments which address the physical and psychological effects of certain conditions this programme should both reduce the burden on hospital services and help the health services to deliver the Government’s aim of a more patient focused treatment regime.

One of the side-effects of this programme is that community osteopaths are likely to become more involved in the treatment of long term conditions and this could add to the patient mix.  Those osteopaths who have switched to a more streamlined appointment, diary management and patient notes system may be in the best position to take advantage of this increased treatment requirement.

In effect, the more time which is freed up from administration the better.  With phone calls answered by a virtual receptionist the osteopath or other health professional can concentrate on providing distraction-free quality care to their patients.  And when it comes to a treatment such as osteopathy or physiotherapy, the less distraction the better.  Interrupted treatments can not only be less effective, the very fact of an interruption can cause anxiety in patients leading to muscle tension.

Grants such as that announced by the British School of Osteopathy can only help to drive forward quality care in our health service.  Targeted, patient-focused and aimed at providing long term therapies for lifelong conditions; treatment regimes such as OsteoMAP will reduce the day to day burden on hospitals and enable people to live a better quality of life.

Telephone back up

The Suffolk coroner, Peter Dean, is writing to the NHS Norfolk and Waveney primary care trust to emphasise the importance of having a telephone back-up system in place. The correspondence arose following an inquest over the death of a patient whose family had difficulty contacting their local GP due to a telephone line failure.

Whilst the lack of phone contact was not deemed to have contributed to the patient’s death, the coroner did highlight the importance of proper plans being in place to cover telephone outages.  In this particular instance apparently the phone lines were out of action for over 24 hours with calls being diverted to a single mobile.

The coroner’s observations on the importance of telephone answering could equally be applied to any health practitioner.  Calls to make appointments, to query symptoms or to ask for advice are all vitally important to current and prospective patients and if they are unanswered then either the patient’s problem can escalate or they may simply go elsewhere.  For example patients may choose to visit A&E if the GP is unavailable or may go to another chiropractor if their first choice doesn’t answer the phone.

So the problem of maintaining an open telephone line is not just confined to times when phone systems develop a fault.  But for many health practitioners this poses a dilemma with the choice being between interrupting a patient consultation and not answering the phone call.  The answer is to use the services of a virtual receptionist.

Virtual receptionist services can answer calls, make appointments and even screen unwanted sales calls.  Available on a full time or as needed basis the virtual receptionist service means that calls need never go unanswered again.  With added extras such as diary management, appointment reminders and patient records management the virtual receptionist helps to maximise patient treatment time without compromising service standards.

Because virtual receptionists work via the internet, even if the health practitioner’s own telephone line goes down the receptionist can take over, receiving calls and making appointments which the practitioner can view on line.

Following the phone failure incident last year the health centre concerned has upgraded its phone services with a view to avoiding repeat problems.  But the story is a lesson for all those who provide health services on the importance of ensuring a back-up plan is in place before it is too late.

Reducing “no shows”

A recent NHS report revealed that 1 in 10 hospital appointments in 2011 resulted in “no shows”.    This adds up to a staggering 5.5 million missed appointments and costs the NHS £millions each year.  Even if each patient has a genuine reason for missing the appointment, missed appointments have a knock on effect across the NHS.

In announcing the “no show” figures, the then health minister, Simon Burns, said “It is important that people realise that not turning up for their agreed appointments means other patients’ care might be delayed.”  Although the figures were down by 250,000 on the previous year they still have a significant impact on NHS services.

Hospitals are starting to employ a variety of methods in a bid to reduce the number of those who fail to turn up for appointments.   One project in Bedfordshire cut missed appointments by 30% simply by asking patients themselves to write down the appointment time and repeat it back to the receptionist.  Other health providers have started sending reminders to patients by text or e-mail whilst Newham University Hospital doctors now check up on their diabetes patients via Skype.

The problem of missed appointments also affects those in the private healthcare sector.  However with many services such as osteopathy and physiotherapy operating as via comparatively small practices, health practitioners can be torn between the options of treating patients or spending time in administration.  This means that inevitably patient appointment reminders are not sent, raising the chance of missed appointments.

Whilst some private health practices have a policy of charging patients for missed appointments these fees can prove hard to collect and may endanger the patient/practitioner relationship.   There is no point in trying to collect a missed appointment fee if that means missing several other fees in the future.

This is where a virtual receptionist service comes into its own.  Answering the phone, making appointments and sending reminders via text or email, the virtual receptionist service takes the appointment strain, leaving the clinician free to maximise patient time.  Interestingly a study in 2008 showed that those in the 20-24 age group are the most likely to miss appointments followed by the 25-29 and 15-19 age groups. The most tech savvy groups are therefore the worst offenders and a reminder system which takes advantage of text or e-mail could therefore have a significant effect.

The Draft Care and Support Bill

After months of speculation, leaks and pre-emptive comments, the draft Care and Support Bill has been published.  Accompanied by eight fact sheets, impact and equality assessments the Bill is no lightweight.  For those interested in reading the full text or who intend to post formal comments on individual clauses the link to the bill is shown at the end of this article.

In releasing the Bill the Government’s stated aim is to consolidate a number of different laws into a single statute and to transform social care “from a service that reacts to crises to one that focuses on prevention and is built around the needs and goals of people”

One of the central planks of the Bill is the idea that people will control over how their individual needs are to be met.  This includes both a drive towards remaining in the family home for as long as possible and a personal budget to enable individuals to optimise their own care.   This will enable individuals to create a care package which is far more wide reaching than a simple need to be bathed or dressed.  In Factsheet 4 one example given is that part of the budget could be spent on gym membership which provides the exercise needed to aid recovery.

With personal care based on individual needs the way is open for health practitioners to make a real difference to people’s lives.  Whether by providing osteopathy or chiropody services, massage or exercise regimes or even helping with personal appearance; life could become far more fulfilling for those helping to provide personal care services.

This means that it is more important than ever to take steps to maximise patient care times and minimise “office” time.  One vital step in this direction could be the use of a virtual receptionist service.  With calls, diary appointments and even patient records taken care of the health practitioner can concentrate on making the most of helping their clients and growing their business.

By the time the draft Care and Support Bill has would its way through the Parliamentary process it may well be a very different animal from the one we see today.  But, whatever the result, maximising patient care time is one step that we can all take with or without the Bill.

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