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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.

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.

On Your Feet Britain

On April 24^th 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.

Exercising Choice for a Fitter Health Practice

It’s January and that means only one thing; a host of fitness and diet related stories have hit the headlines. In a bid to either persuade us to keep those New Year resolutions, or to even make some belated ones, news media are leaping on any health related story they can find and putting it out there for our consideration.

Are we swayed by the headlines? Well perhaps some of us will use the research conclusions to kick start an improved lifestyle, but for others the exhortation to improve diet or fitness levels will merely be of passing interest and will have no effect on ingrained lifestyle patterns.

Actually when you stop to analyse some of these stories, the advice given generally only amounts to common sense. The study which concludes that a brisk daily walk, even if just 20 minutes, can add years to life expectancy is hardly surprising; although it was interesting to see that the research concluded that twice as many deaths a year are attributable to inactivity than to obesity. Similarly, a report which concluded that working as part of a team, either with a partner or with others, can help people to stick to lifestyle changes makes sense when you consider that a self-supporting team is less isolated than an individual.

But if some of the conclusions are simple common sense and may well lead to lifestyle changes, others may have varying measures of success. A report which suggests a correlation between wearing high heels and the chance of developing osteoarthritis may be unlikely to sway the majority of those who enjoy wearing shoes with high heels. On the other hand, a report which suggests that moderate alcohol consumption is linked to reduced heart failure risk may well be seized on by those who enjoy the odd drink but were feeling guilty about its affects on health.

In essence this is the beauty of having free will, and not just on health related issues. We can look at all of the advice and choose that which seems best to us. That’s why some businesses interrupt client conversations to answer the phone whilst others have set up a system which diverts phone calls to a virtual assistant. That’s why some businesses still file records by hand whilst others have embraced digital filing methods. And that’s why some health practices offer online booking and card pre-payment methods whilst others stick to phone bookings and collect the payment later.

Whatever the business, whether you offer one-to-one health consultations or regular pre-booked fitness classes, the key to success is to know your customer and offer a business model which will best meet their needs. Special offers and discounts are all very well in attracting new custom, but people won’t stay unless you offer them a level of service which encourages them to return time and time again and to recommend you to friends. So going back to one of our earlier examples, if your clients tend to have busy lives then online booking is a quick and simple way for them to make an appointment. On the other hand, if your client base is more elderly then they may feel more comfortable making telephone bookings.

No matter how seemingly strong the research, whatever the ‘experts’ tell us, at the end of the day all research and all ‘best practice’ advice is there to act as a guide. What we do with it, how we turn advice into great customer service and a strong and fit health practice is up to us.

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.

Redesigning Your Therapy Service

A discharge team working out of two West Midlands’ hospitals has been recognised with a national award for creating an integrated discharge process which includes a focus on early identification of appropriate therapy. The idea behind the scheme is simple but it has already reduced patient hospital stays by over 13% and saved the Trust around £2.5m.

Simply by giving therapists ‘trusted assessor’ status, patient assessments can start earlier, even before the patient has left hospital. Not only does this lead to the provision of a care plan which starts even before the patient has left the hospital, it also this means that seamless ongoing care can be provided. With therapy plans already in place, patients can be discharged into home care far earlier than before. This in turn means that treatment is more focused, not only meeting the immediate needs of the patient but also their long term rehabilitation needs.

Prior to the inception of the integrated discharge process, patients would have to stay longer in hospital to ensure that they had recovered sufficiently well to enable them to be discharged into a home or other environment. Moreover, once they had been discharged they would have a period without treatment arguably at a time when treatment is most effective; having to wait for community assessment at home and potentially facing a relapse of their condition in the meantime. So not only do the new procedures save bed space they also help to speed up rehabilitation.

The idea of creating seamless and integrated processes is not just one which is confined to hospital discharge. When reports reveal that generally the health system is under some strain, anything which can speed up patient treatment and therefore recovery times is welcome. Health practitioners across the board are therefore looking for ways to cut down on administration and maximise treatment time.

Quite frankly, anything which can reduce the time spent on routine administration, and therefore non-treatment, time is to be welcomed. That is why practices such as SMS text messaging to remind patients of appointments, online booking and digitising patient records are becoming more widespread as health practitioners look to automate the non-treatment elements of their daily round.

For health practitioners who need to charge for their services secure card processing helps not only to smooth out cashflow but also saves time in sending invoices and chasing unpaid accounts. And using the services of a virtual health receptionist means that patient treatments can run without interruption from multiple phone calls, leaving the health practitioner to provide therapy whilst others take the administration strain.

Thinking outside the box, thinking smart; whatever you call it the result is the same. As health practitioners find new ways to leverage the advantages to be gained from technology and look anew at routine processes, they can make a measurable difference to ongoing patient treatments. As Physio Karen Lewis, one of the award winning West Midlands team said, receiving national recognition “really shows the value of physiotherapists leading innovative service redesign for the benefit of patients.”

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.

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.

Whole person care

The Institute for Public Policy Research (IPPR) has issued a report examining the measures required should England’s health and care system move towards the provision of ‘whole person care.’ With the benefit of making the connections between physical health, mental health and social care needs, and supporting people to remain in their own homes as long as they wish, whole person care provides joined up responses to individual needs.

Success is dependent on a number of factors including a long-term investment mindset, aligned incentives, effective use of technology and a flexible workforce. The report concludes that there is clear potential to deliver better outcomes if care services are more coordinated.

Commenting on the report Chartered Society of Physiotherapy (CSP) professional adviser, Eve Jenner, said that “physiotherapists were well placed to support whole person care” adding:

“They can act as single point of contact, care coordinators or as part of a team of health and social care professionals providing holistic assessment and treatment to people with long-term conditions.Key success points for whole person care include peer support, tapping into the expertise of others with the same condition, and personalised care plans. For professionals, the ability to share online access to personal health and care records is also vital. This last point echoes moves already being made within the health profession to share records. Not only does this lead to streamlined care, it also saves time and costs and helps to speed up effective treatments.

Simple measures such as electronic storage of patient records are a key step towards this goal. But not only does electronic storage facilitate the sharing of records, it also streamlines processes. When patient records are available at the touch of a button there is no wasted time in searching for mis-filed records, no wondering if the record shown is the latest one and no time spent on gathering evidence in preparation for each client appointment.

For health professionals such as physiotherapists and osteopaths, the electronic storing of patient records helps to save administration time which can better be spent on patient treatments. For health and care professionals as a whole, the move towards whole person care will help them to cost effectively provide the best treatment pathway available for the individual. The IPPR has identified many issues which are critical for the success of whole person care and they will be looking at these in more depth over the next 12 months. We’ll keep an eye out for these follow-ups and report as appropriate.

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