|
|
|
 |
| Staying in control |
22-Jul-2008 |
|
|
|
An add-in to clinical software can help GPs keep track of patient information.
By Dr Anton Knieriemen
JUST prior to diving a submarine, the ship’s control panel is checked for a ‘straight board’ to make sure there is a completely unbroken row of valve position indicators for the major valves, which can let seawater into the submarine.
Medical software can provide a similar display before the patient leaves a consultation. The reality is there is nothing in modern software to reassure doctors that we have done all we should to follow even the simplest of current guidelines and standards of preventive care.
Some attempts have been made to provide prompts for certain preventive care items in medical software. These usually appear in a message box at the beginning of a consultation, interfering with workflow. Often these are disabled by time-poor GPs who don’t necessarily want to spend 30 seconds clicking through a tirade of message box prompts before they can access other functions such as writing a script.
To encompass script checks, MBS item numbers and the RACGP’s Guidelines for Preventive Activities in General Practice (the Red Book), prompts such as a message box system would need more than a dozen different types of prompts, making the software virtually unusable for quick data entry or writing that quick script.
A doctors’ control panel (DCP) displays the information available within the clinical database on a colour-coded display panel. It obviates the tirade of message box prompts and reduces the risk of ‘sinking the submarine’.
With this background I am going to detail the results of my usage of a homebrewed DCP add-in to my practice’s clinical software. The add-in was written in Microsoft Visual C# (one of the software development tools in Microsoft Visual Basic) and connects to our Medical Director 3 database. I have made the DCP available to other adventurous users of Medical Director 3 and PracSoft 3 via the Health Communications Network Forums at www.hcn.com.au and via it’s own new web site www.pracsoftutilities.com
Please note that the DCP requires both Medical Director 3 and Pracsoft 3 to be installed. It can be downloaded from the web site and installed on any workstation. It has read-only access to the database and does not transmit information offsite, even in the event of application error so it is perfectly safe to try out.
Various prompts are available. Headings are in blue; items are coloured red if they are incomplete, yellow if they are overdue for repeating and green if they are up to date.
In order to provide clear concise guidelines for individual patients the DCP can be configured to pop up after new patient records are opened. It automatically syncs with the record showing colour-coded prompts indicating the status of various preventive care items.
The clinical section indicates clinical history items of note.
The items section indicates available MBS items with their status colour coded. The PIP diabetes prompt is yellow indicating that a previous PIP item number has been billed and is due for repeating.
Clicking on the prompts shows more detailed information such as last measured values, last test dates, last MBS item dates, criteria and time span until the test should be repeated.
The DCP can also display a billing timeline showing colour-coded billings over the prior 12 months.
The medication section displays suggested medications based on medical history.
The immunisation section prompts for adult vaccinations including influenza, pneumonia, cervical and tetanus.
The measures section displays prompts for measurements based on Red Book guidelines and diabetes management guidelines. If the prompts are red (not done) or yellow (overdue) this indicates the need to update.
The DCP uses a set of configurable rules to determine whether prompts are shown and information in the database to determine status. The default set of rules are set to emulate the Red Book guidelines for basic measurements and pathology testing. All of the criteria are configurable within the application settings so you are free to change them as you wish. Rule criteria include age from, age to, Aboriginal or Torres Straight islander, sex, abnormal measurements, past medical history (include and exclude) and medication count (for MBS Items).
The DCP also allows printing of data collection sheets and action lists for the day’s appointments. This allows staff to implement the data collection.
One month after implementing the DCP, the results were very impressive. From the preventive care aspect our practice has greatly improved coherence with Red Book guidelines — particularly in blood pressure, height, weight and waist measurement. We have started a PDSA (plan, do, study, act) for these items and are currently in cycle 2.
The DCP started a significant trend within the practice to utilise electronic recording of measurements within Medical Director 3 over paper files which we still use for patient notes. It feels reassuring when the DCP is ‘green across the board’. It has also stimulated an impetus for moving to fully digitalise patient notes.
We have also increased utilisation of MBS preventive care items, and thus increased billings on these items.
The DCP is still in development. Our utilisation of the DCP is growing at a rapid rate. We have four GPs in the practice, all of whom have now jumped on board.
Dr Knieriemen is a GP in Ormond, Victoria.
|
|
|
| | Related Articles - Practice management - IT/computerisation | |
|
|
|
|
Subscribe to our daily newsletter
|
|
|
|
|
|
| |
|
|
| |
|
Submit your feedback here: