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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.

Osteoarthritis Quality Standards

The National Institute for Health and Care Excellence (NICE) has released new quality standards for the diagnosis and treatment of osteoarthritis. The standards have been drawn up after consultation and are supported by bodies including The Primary Care Rheumatology Society and the British Association of Prosthetists and Orthotists.

Osteoarthritis affects some seven million people in the UK and can be a life-limiting condition. Although its prevalence increases with age, osteoarthritis can be caused by a mix of genetic, environmental and lifestyle factors. This new quality standard covers the management of the condition from initial diagnosis and assessment through to ongoing management and support including the consideration of remedial joint surgery.

In recognition of the fact that extensive investigations, including x-rays and MRI scans, add little to the treatment plan, NICE recommends that a more practical and simple test should be enough to deliver an initial diagnosis. The standards therefore recommend that a simple test of having activity-related joint pain and any morning joint stiffness lasting no longer than 30 minutes should suffice.

As osteoarthritis is a condition which generally develops over time, the quality standard recommends the use of a self-managed plan wherever possible. This will include a multi-level approach including pain control, a weight management plan if required together with an exercise plan. This last should include a mix of muscle strengthening and aerobic exercise.

Although the plan is primarily written for the benefit of patients and the NHS; it is likely that physiotherapists, osteopaths and other health professionals may be called upon to help with treatment plans. Commenting on the Chartered Society of Physiotherapy website, Professor Krysia Dziedzic who helped to develop the standards said “We know that patients want access to non-pharmacological therapies and physios should be leading the way in the delivery of these.”

As people increasingly look for blended solutions, which include ongoing non-pharmaceutical management of conditions, the demand for physiotherapists and other health professionals can only grow; even if the incidence of osteoarthritis were to remain unchanged. However an Arthritis Research UK project has predicted that between 2010 and 2020 the number of people with osteoarthritis of the knee will increase from 4.7 to 6.5 million. It is little wonder therefore that NICE comments that the majority of hip and knee replacements in the UK are due to osteoarthritis and that currently treatment varies across the country.

This places an increasing demand on physiotherapists and others, both in the ongoing management of conditions and in assisting patients to recover from joint replacement surgery.  Whilst some of the burden may be taken up by new entrants to the profession, the challenge is still to find ways of working which will maximise treatment time.

Quoting a cliché, that means learning to work smarter not harder; taking full advantage of technological solutions in order to reduce time spent on the non-treatment elements of patient management.  These solutions include opening up the diary to enable patients to directly book online appointments, the electronic filing of patient records or taking card payment details at the time of booking. To borrow from the NICE standard, the more the health profession can take practical and simple measures to reduce the administrative burden, the more time can be spent on helping patients to manage their condition and get on with their lives.


Bank Holiday Toil

Don’t hold your breath but it seems as though we may be in for some spells of sunshine this bank holiday weekend.  Of course it is nearly the end of May so we are due some sun time but the forecast does open up additional possibilities for bank holiday activities.

Whilst some of us will be heading towards the beach or the park, others may have a full sporting calendar, either taking part or cheering on our favourite team.  Those with children who are taking GCSE or A ‘level exams this year may be facing a more sedentary time as the final chance for revision looms large over the household.

But  for many, this bank holiday weekend is traditionally a time for DIY or for gardening, for clearing out and tidying up, for moving plants and revamping flowerbeds in a bid to get our homes and gardens in top shape for the summer.   This is the weekend when despite our best intentions we do just that bit too much and our bodies let us know in no uncertain terms.  In fact in 2006 some 87,000 people were treated in hospital in the UK as a direct result of gardening accidents with lawn mowers and flower pots topping the list of causes.

Whilst trips and falls may require urgent attention, back and other muscle strains can take a few days to come through but when they do they can require ongoing therapy.  So much so that the Physiotherapy website comments that at this time of year physiotherapists, osteopaths and chiropractors all see an upswing in demand due to gardening injuries.  That site offers a list of eleven handy hints to reduce the occurrence of problems including warming up, using good lifting techniques and taking planned breaks

With the best will in the world even if everyone followed the suggestions there would still be an increase in demand as muscles and ligaments creak under the strain of unaccustomed exercise. This in turn places an increased demand on health professionals such as physiotherapists, chiropractors and osteopaths; all of whom may well see a significant increase in demand for their services in the period after bank holidays. So what can health professionals do in turn to reduce the strain on their own resources.  Our handy hints would include:

  • Offer an online booking facility.
  • Opt for secure card processing.
  • Manage your diary online.

…and of course, call in a virtual assistant service to answer routine calls when you are busy. These measures will all help to cut down on the volume of calls to the practice, thus freeing up time which can be spent in treating those bank holiday injuries. Online booking and diary management allied to a virtual assistant service enable prospective patients to book appointments quickly and easily without impinging on ongoing treatments. Adding secure card processing to the mix not only helps to speed up payment collection times and reduce paperwork, prospective patients who hand over card details at the time of booking are less likely to miss their appointments.

Let’s hope that the forecasters have got it right this weekend and that we can all enjoy some time in the sun without paying too dear a price afterwards in terms of painful joints or in too great a call on our services.

Telling your story once

The NHS in England has announced further initiatives in its drive towards streamlining patient records. The National Innovation Board established by the Department of Health has set out bold new plans to move information off the page and onto the web by 2020.

The plans include a commitment to give everyone access to digital GP records by 2015 with other patient records including those kept at hospitals and clinics being online by 2018. The ‘Red Book’ which records details of a child’s developmental progress and vaccinations is expected to be replaced by a digital version by 2016, thereby enabling parents to view their children’s records at the touch of a button.

Commenting on the announcement Secretary of State Jeremy Hunt said “I want the NHS to be a world class showcase of what innovation can achieve” whilst Tim Kelsey, NHS National Informatics Director, said “We must embrace modern technology to help us lead healthier lives, and if we want – to take more control when are ill.” To this end the NHS is also planning to ‘kite mark’ certain apps which will help patients to access services and take more control of their own health.

Digitising patient records not only helps patients to take control of their own health, it also has major implications for health practitioners. Firstly, health practitioners will be able to quickly access a full patient history without having to wait around whilst records are located and physically transferred between departments or treatment centres. To a health system which is currently geared towards paper records this will have benefits both for speed of access and speed of treatment.

Equally importantly, with records to hand patients won’t have to go through their story over and over again; perhaps missing out vital elements in the telling. As a result there should be a better understanding of patient history, thereby leading to an improvement in treatment regimes and in outcomes. This is particularly important when it comes to areas such as physiotherapy where early treatment can make a measurable difference in a swift return to mobility.

From a pure practitioner perspective the digitising of patient records also helps to reduce unnecessary administration time.  Time taken in filing records, in retrieving records and in waiting for records to be walked or posted from one treatment centre to another is time which could be better spent on actually treating patients.  ‘Waiting for the records’ is a mantra which bedevils healthcare across both the NHS and private practice and it can lead to delays in treatment which would be better avoided.  The ability to sit with a patient and to see their history at the touch of a button will make a measurable difference to long term health care.

The announcement of these initiatives comments that “technology will play a vital role in helping contribute to the £22 billion in efficiency savings needed to sustain the NHS.” Whilst there is no doubt that these savings are welcome, the deployment of technology is not just about cost savings. Rather it is about improving patient lives and that is an ambition which we can all applaud.

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.

Streamlining payments

The days of making manual payments are numbered if a report by Juniper Research is anything to go by. According to the report’s press release the number of household bill payments made via PC, mobile or tablet is expected to top 20 billion this year (2014) with the UK having 16% of the global market.

Driven by Generation Y users, the growing acceptance of mobile payments is only expected to expand further as fears over security are lessened and additional mobile devices come onto the marketplace. Interestingly, when it comes to larger payments, users still seem to prefer the security of a larger screen with PCs and tablets leading the way.

Whilst this report concentrated on household bills, the acceptance of online payments generally is also on the increase. Shopping or booking events or holidays via the internet is also on the up and this means that consumers are far more accepting of the idea of providing credit card details whilst online. And the more accepting we become, the more that online payments becomes part of the mainstream.

That creates tremendous opportunities for health professionals who are looking to streamline administration and payments.  With a ready acceptance in providing card details; when someone makes an appointment to see a physiotherapist or other health professional the next logical step is for them to confirm the appointment by providing payment card details.

Having an appointment confirmed in this way has two benefits for the health professional.  Firstly, the act of providing card details tends to fix the appointment in the patient’s eyes, making it far more likely that they will turn up for their treatment. This not only helps to ensure a full treatment schedule it also makes it more likely that the patient will receive a full course of treatment at the time when it is most needed. Secondly, with card details to hand, it is simple for the health practice to process payments, either in full once the patient has attended or to take a payment on the card in line with the practice’s stated cancellation policy.

Payment card details can be taken at the time of booking an appointment either online or via the telephone. At that stage the payment amount is simply pre-authorised which means that the payment amount is ‘reserved’ against the card. Once the appointment has taken place, should the patient choose to pay by other means the reservation can simply be cancelled.Otherwise the payment is taken at the time of the appointment; speeding up receipt of funds and saving the invoice/cheque/bank clearance cycle.

With time at a premium, anything which helps to reduce administration and speed up payments is a winner in today’s health practice. Pre-authorisation of cards means no delay in payment collection and no need to spend precious time in sending out and chasing bills on a regular basis. And with pre-authorising reducing no-shows and therefore increasing the likelihood of patients receiving the treatment they need when they need it, pre-authorising is a win-win solution for patient and health practitioner alike.

The power of sport

It may be the top sportsmen and women who hit the headlines but the power of sport to engage and enthuse at all levels never ceases to amaze.  From rumbustious back street kick-abouts to photos in the Guardian recently of Brazilian children practicing overhead kicks on a flooded pitch; sport can be a unifying and defining activity.

One thing is certain, with Wimbledon and the World Cup around the corner, our streets and parks will soon be filled with enthusiastic sports players all dreaming that one day they will be able to emulate Murray or Messi, Nadal or Neymar.  But, played at any level, sport can come at a price.

That price is the chance of injury.  You may be a top flight sportsperson, used to training every day and carefully balancing nutrients to optimise body health and fitness.  You may be a weekend player, turning out for the local team before heading off for a drink; or you may be an occasional player, turning out with short bursts of enthusiasm before retreating to more sedentary forms of support.  Whatever level you play at, the odds are that injury will hit at some stage.  And when injury hits, the quicker it is treated the better.

For health professionals such as physiotherapists, chiropractors, sports injury practitioners and osteopaths, the challenge is to be on hand to treat regular clients, whilst at the same time squeezing in more immediate cases.  No-one wants to leave diary slots vacant but equally no-one wants to turn down prospective patients.  The answer is to take every opportunity to ensure that prospective clients can make and attend appointments.

Online booking will capture some clients but others may prefer to speak to a person at the end of a phone.  Switching phones to a virtual assistant will help to ensure that when the phone rings, someone will answer without the need to interrupt ongoing treatments to answer the phone. In fact, using a virtual assistant service has multiple benefits including improving the image of the health practice, establishing a dialogue with clients and freeing up treatment time which would otherwise be spent in answering or returning telephone calls.

Once the appointment has been made it is important both for the patient and the health practice to ensure that treatment starts in the timescale agreed. No-shows not only delay the start of important treatments, they leave empty gaps in health practitioners’ diaries which could have been filled by other patients.

Encouraging clients to keep the appointments which they have made is a two-fold process.  Appointment reminders sent out via SMS text or e-mail have been shown both in the NHS and private practice to reduce the number of no-shows.  Similarly, confirming bookings with a pre-authorised debit or credit card sum also serves to improve attendance rates, generally because this means that the health practice can take a non-attendance fee in accordance with advertised practice.

World cups, tournaments, championships; the sporting calendar rolls ever onwards and with every passing phase brings a new crop of injuries.  Making sure that they are on hand to provide prompt treatment will earn health professionals their own niche in the sporting hall of fame.

Mustn’t Grumble

In a survey to mark Dementia Awareness Week (18-24 May) the Alzheimer’s Society revealed that 54% of people had waited for six months or more before seeking professional help  for signs of dementia.  The time delay appears to be fairly similar in respect of all health conditions with a separate YouGov poll reporting that 57% of adults who had had a health problem in the past year had put off asking for help.

Reasons given for the delay include a reluctance to make a fuss (47%), the fear of having a serious health problem (23%) and embarrassment (22%).  Delays in reporting in particular relate to dementia, heart and digestive problems.

Commenting on the survey, Alzheimer’s Society Chief Executive, Jeremy Hughes acknowledged the difficulty which people have when confronting diseases such as dementia but went on to say that “the sooner you know what you are dealing with, the sooner you can feel in control again and get on with your life.”  But the delay factor doesn’t just affect those with potentially serious illness.  For every patient who seems to live in the surgery, another will hold off reporting even persistent complaints.

This can lead to minor strains or injuries being exacerbated up to the point at which they become debilitating.  When patients do finally pick up the phone, if they don’t receive an instant answer, they may drop the idea of further help.  This means that prompt telephone answering is not just vital for health professionals such as doctors and dentists; other professionals such as chiropractors, podiatrists and physiotherapists all have a responsibility to ensure phones are answered as swiftly as possible.

For smaller practices this isn’t always as easy as it sounds.  Curtailing a treatment to answer the phone is not only unprofessional, it can in some cases result in further damage occurring.  And whilst some patients may be prepared to leave their details on an answerphone, many will be reluctant to do so. This is particularly the case when someone has delayed asking for help; the unanswered call acting as a trigger to retreat away from the decision to seek help and back towards trying to manage the condition without outside intervention.

The solution is to link up with a virtual receptionist service.  Virtual receptionists can answer the phone and make appointments on behalf of the health practice, leaving the practitioner free to concentrate on what they do best, helping people to recover from illness or injury. Not only does this help to ensure that treatment plans are carried out smoothly and without interruption, it can also free up vital time which can be used in treating additional patients.

One in three people over the age of 65 will develop dementia and it’s a fair bet that almost 100% of people within the same age bracket will develop strains, foot problems or other similar treatable problems at some time or other.  Taking steps now to help them to contact a health professional easily and swiftly may just help to prolong their overall health in times to come.

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