THERE have been some big promises made about the benefits of increasing the use of technology in delivering healthcare, with supporters arguing that doing so will cut costs, save resources and improve patient care.
Finding ways to provide better care in a more efficient way has long been the dream of many an NHS manager and is proving particularly pertinent in these economically straitened times. Motivated by the hope that advanced IT systems are key to realising this dream, the Department of Health in England has launched a campaign to dramatically ramp up the use of telehealth in the NHS over the next five years, while the Scottish Government has also signalled its support to increase uptake.
When talking about technology in healthcare, there are various terms in use, but the most common are telehealth and telecare. The former is generally defined as the use of electronic equipment to monitor patients at a distance (through mobile phones, internet services or self-monitoring equipment). It also includes practice-based technology such as patient self check-in and ‘surgery pods’ to monitor patients’ blood pressure, weight, alcohol consumption and more.
The term telecare, meanwhile, tends to refer to the use of technology to help patients live independently in their homes (i.e. falls monitors and motion sensors) and may be less relevant to general practice management.
The main aims of using technology in healthcare are to prevent unnecessary hospital admissions, deliver cost savings, improve quality of life by giving patients greater control over their care and to reduce pressure on NHS resources.
Technology in practice
For practice managers, some relevant telehealth systems include texting patients with blood results (which can reduce use of staff resources), texting appointment reminders (reduces Did Not Attends), emailing prescriptions (increases accuracy and is easy for staff to fit around other duties), self-testing at home (reduces need for practice appointments and home visits) and patient self-testing pods in the surgery (reduces consultation times, increases ‘patient ownership’ and results can be uploaded direct to patient records).
Each week seems to bring new reports of the latest projects making use of technology in healthcare, but there are still many practices who have yet to get on board. Any new idea has its supporters and critics but if practice managers carefully consider which hi-tech systems suit their practices’ needs, then technology can provide an effective means of delivering more efficient patient care.
One practice that has embraced telehealth is Tranent Medical Practice in East Lothian, near Edinburgh, which has a patient list of 13,000. In the last few years, they have launched a new website (www.tranentmedicalpractice.co.uk) which allows patients to order repeat prescriptions, complete a patient survey, update contact details and even update their clinical record online. The site also links to the practice’s Twitter feed, offers various information sheets and forms to download and plans are also in place to introduce online appointment bookings once the software becomes available.
A patient newsletter was launched late last year and mailed out to all patients in the catchment area, informing them of all the new developments.
One of the biggest changes seen by Tranent’s patients is the addition of the computerised ‘surgery pod’, installed in a discrete area next to reception, that allows patients to perform their own tests. The touch-screen pod is programmed with practice-specific settings and measures blood pressure and weight and can record alcohol consumption. Patients can use it before consultations or at their convenience during practice opening hours. The results are then automatically uploaded to their clinical record and any abnormal results are immediately flagged up and acted on by practice staff.
Patients attending for appointments are given the option to use the self check-in system, while the new Patient Call system tells patients, through an audio and TV screen, when/where to see their GP.
A driving force behind many of the big changes at Tranent is practice manager Jill Thomson.
She says: “We brought in the surgery pod because the practice has 1,800 people on its hypertension register and it was a huge task trying to recall them to be tested every nine months. We weren’t able to give them the service we should have given them – but this way we can.
“We don’t enforce the use of the pod, and staff are always on hand to help, but the response has been fantastic with 1,110 patients using it in the first six months. It is also safer than more traditional machines because the results go straight into their record and abnormal results are flagged up.
“In terms of cost, it has paid for itself already as it saves the time of practice nurses and healthcare assistants and frees them up for more appointments. We also now meet every QOF target relating to hypertension.”
Jill admits the self check-in has not been such a big success but believes this is because it was situated next to reception, meaning it wasn’t very visible to patients. She is now looking at moving it to a better location in a bid to drive up usage.
Jill says: “It’s important to carefully consider any new technology and to make sure it meets the needs of your patients. Everything we do is about delivering a better service to patients and this technology has been a huge benefit to the practice. The patients are happy and feel more in control of their care so I wouldn’t hesitate to recommend it to other practice managers.”
Checks and balances
As with any system that holds/transmits patient data, it is vital to always respect patient confidentiality and to comply with the Data Protection Act. PMs who want to text patients with results or reminders should be sure to first ask patients for their consent – a mobile phone may be accessed by people other than the patient and may not be a reliable means of communication.
Equally, when considering emailing patients, gain consent first, ensure you are sending to the correct address and aim to use more secure NHS email systems rather than personal, web-based accounts. Messages should contain the minimum amount of detail necessary and data should be encrypted where practical. It is advisable to allow patients to opt-in to any new service, rather than automatically including them.
PMs should ensure GPs/GDPs know they must clearly indicate if test results are urgent so that this can be included in any text/email communication. In urgent cases, it may be advisable to communicate with patients by more traditional means to ensure they have received the message and understand the urgency of any action required.
Many practices now allow patients to book appointments online, order repeat prescribing online or even amend their clinical records via the practice website. It’s vital that systems are put in place to ensure data is secure and that a staff member closely monitors emails/alerts indicating that a patient has booked online or communicated in any way with the practice. If one dedicated staff member is charged with this, ensure monitoring continues in their absence.
Any telehealth system is only effective if the equipment is functioning properly and is used in the correct way. You must ensure equipment is maintained and checked regularly to ensure readings are accurate and that both staff and patients are trained in its use. Where relevant, you should provide a discrete space for patients to use equipment that requires inputting personal information.
Joanne Curran is an associate editor of Practice Manager