Completing the Paperless Journey


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  • IW
  • IW
  • AAPM Staff Development Day
  • Completing the Paperless Journey

    1. 1. Completing the Paperless Journey Dr Ian Williams Practice Principal Jan Chaffey Executive Officer Camp Hill Medical Centre
    2. 2. The beginning <ul><li>In 1943 the Allies developed the earliest programmable electronic computer to break the German coding machine Enigma </li></ul>
    3. 3. The year is 1954
    4. 5. What is this?
    5. 6. The year is 1956 <ul><li>    It's a hard disk drive  back in 1956... with 5 MB of storage.   In September 1956 IBM launched the 305 RAMAC, the  first 'SUPER' computer with a hard disk drive (HDD). The HDD  weighed over a ton and stored a 'whopping' 5  MB of data.   </li></ul>
    6. 7. The journey continues <ul><li>In 1975 , the first personal computer was sold - to start the machine there were 25 switches all requiring a precise sequence for the machine to work !!!!! </li></ul>
    7. 8. Our Story
    8. 9. The story continues
    9. 10. And continues...........
    10. 11. Camp Hill Medical Centre
    11. 12. Living the dream <ul><li>Family Health Care since 1947 </li></ul><ul><li>Holistic, quality lifetime care for our patients </li></ul><ul><li>A medical home </li></ul><ul><li>In a medical neighbourhood </li></ul><ul><li>Quality team </li></ul><ul><li>Quality systems </li></ul><ul><li>Quality facilities </li></ul>
    12. 13. Camp Hill Medical Centre <ul><li>Accredited General Practice – (5 th round 2010) </li></ul><ul><li>14 Doctors </li></ul><ul><li>2 Practice Managers </li></ul><ul><li>3 Practice Clinical Nurses </li></ul><ul><li>1 Community Nurse </li></ul><ul><li>1 Diabetes Educator </li></ul><ul><li>2 Mental Health Nurses </li></ul><ul><li>Consultant Pharmacist </li></ul><ul><li>12 Reception and Support Staff </li></ul><ul><li>Visiting Allied Health </li></ul><ul><ul><li>Dietitian </li></ul></ul><ul><ul><li>Podiatrist </li></ul></ul><ul><ul><li>Psychologists (2) </li></ul></ul><ul><li>Pathology </li></ul>
    13. 14. Camp Hill Medical Centre <ul><li>Database of 40,000 </li></ul><ul><ul><li>1,250 over 75 years </li></ul></ul><ul><ul><li>1,700 under 5 years </li></ul></ul><ul><li>Ten (10) consulting rooms </li></ul><ul><li>Three (3) treatment areas </li></ul><ul><li>Diabetes educator consulting room </li></ul><ul><li>Community Nurse room </li></ul><ul><li>Mental Health Nurse room </li></ul><ul><li>Approximately 1350 consults /week </li></ul>
    14. 15. It’s all about the team! <ul><li>What is a practice team? </li></ul><ul><ul><li>A group of people making different contributions towards achieving a common goal </li></ul></ul>
    15. 16. Practice Structure Principal Doctor R.Nurses Practice Manager C. Nurses Patient Executive Officer Principal Doctor Community nurse Diabetes educator Mental health nurses Consultant Pharmacist Doctors Nursing Staff Clinical nurses Administration Staff Community Resources
    16. 17. Teams within Teams
    17. 18. About our team: <ul><li>Meet Regularly </li></ul><ul><ul><li>Agenda / Minutes / Action list </li></ul></ul><ul><li>Develop Goals & Objectives </li></ul><ul><li>Develop Action Plan </li></ul><ul><li>Review Process and Outcomes </li></ul><ul><li>Redefine Processes </li></ul><ul><li>Always Strive for Innovation and Best Practice </li></ul>
    18. 19. Continuity…… <ul><li>Continuous process </li></ul><ul><ul><li>Team development and strengthening </li></ul></ul><ul><ul><li>Systemisation of procedures (intranet) </li></ul></ul><ul><ul><li>Quality improvement framework </li></ul></ul><ul><ul><li>Patient focused </li></ul></ul><ul><ul><li>Outcome focused </li></ul></ul><ul><ul><li>And it continues……… </li></ul></ul>
    19. 20. Our Team
    20. 21. The Jargon Hardware Software Gigabyte RAM POP 3 Router MHz Hub Floppy Disk
    21. 22. Systemisation of your practice <ul><li>Project plan </li></ul><ul><ul><li>driver </li></ul></ul><ul><li>Hardware </li></ul><ul><ul><li>Getting it right! – 5 year plan </li></ul></ul><ul><li>Software </li></ul><ul><ul><li>Choosing the best for your practice </li></ul></ul><ul><li>Training </li></ul><ul><ul><li>Doctors </li></ul></ul><ul><ul><li>Nurses </li></ul></ul><ul><ul><li>Allied Health </li></ul></ul><ul><ul><li>Staff </li></ul></ul><ul><li>Competencies </li></ul><ul><ul><li>All </li></ul></ul><ul><li>Support </li></ul><ul><ul><li>Hardware </li></ul></ul><ul><ul><li>Software </li></ul></ul><ul><ul><li>In-house </li></ul></ul><ul><li>Risk Management </li></ul><ul><ul><li>Backups </li></ul></ul><ul><ul><li>Passwords </li></ul></ul><ul><ul><li>Firewall </li></ul></ul><ul><ul><li>Virus protection </li></ul></ul><ul><li>Upgrades </li></ul><ul><ul><li>Software </li></ul></ul><ul><ul><li>Hardware </li></ul></ul>
    22. 23. Consulting Room / Front Desk <ul><li>KISS </li></ul><ul><ul><li>Training, training, training </li></ul></ul><ul><ul><li>Templates </li></ul></ul><ul><ul><li>Shortcuts </li></ul></ul><ul><ul><li>Generic referrals </li></ul></ul><ul><ul><li>Reminder letters </li></ul></ul><ul><ul><li>Recall systems </li></ul></ul>
    23. 24. Templates <ul><ul><li>Community Nurse </li></ul></ul><ul><ul><li>Health Assessments </li></ul></ul><ul><ul><li>GPMP & TCAs </li></ul></ul><ul><ul><li>Diabetes Educator </li></ul></ul><ul><ul><li>Mental Health Nurses </li></ul></ul><ul><ul><li>Consultant Pharmacist </li></ul></ul><ul><ul><li>Shared resources for the care team </li></ul></ul>
    24. 25. Practice Systems <ul><li>Information Management System </li></ul><ul><ul><li>Who is responsible ? and for what are they responsible? </li></ul></ul><ul><ul><li>What is your role? </li></ul></ul><ul><ul><li>What knowledge do you need to fulfil your role? </li></ul></ul><ul><ul><li>Do you require additional training? </li></ul></ul>
    25. 26. Practice – Hardware/ Software <ul><li>Hardware / software contacts </li></ul><ul><li>How many computers? </li></ul><ul><ul><li>Programs on each (full audit of each workstation) </li></ul></ul><ul><li>Where is software stored or is it online? </li></ul><ul><li>How many workstations </li></ul><ul><li>Type of server(s) </li></ul><ul><li>Printers </li></ul><ul><li>Modems </li></ul><ul><li>Scanners </li></ul><ul><li>Is it documented? </li></ul>
    26. 27. Risk Management <ul><li>Security of data </li></ul><ul><ul><li>Is it password protected? </li></ul></ul><ul><ul><li>Do all users have individual passwords? </li></ul></ul><ul><li>Security of server </li></ul><ul><ul><li>Does it have a UPS? </li></ul></ul><ul><ul><li>Is there a RAID system? </li></ul></ul><ul><ul><li>If there is loss of power – is it set up to </li></ul></ul><ul><ul><li>‘ down gracefully’ </li></ul></ul>
    27. 28. Backup <ul><li>What systems are in place? </li></ul><ul><li>Is it manual or automatic? </li></ul><ul><li>Who is responsible? </li></ul><ul><li>What is being backed up? </li></ul><ul><ul><li>Server (what information) </li></ul></ul><ul><ul><li>Individual computers – C drive data </li></ul></ul><ul><li>Backup Tested / Restore Performed </li></ul><ul><li>Does someone check every day that backup has been successful? </li></ul><ul><li>Where is the backup stored? </li></ul>
    28. 29. PDSA Cycle
    29. 30. When there are problems! <ul><li>Isolate the problem </li></ul><ul><ul><li>Is it hardware? </li></ul></ul><ul><ul><li>Is it software? </li></ul></ul><ul><ul><li>Is it operator error? </li></ul></ul><ul><li>Check manuals – troubleshooting sections </li></ul><ul><li>Know who to call for help </li></ul><ul><li>Stay calm! </li></ul>
    30. 31. When all else fails! <ul><li>Have a disaster plan </li></ul><ul><ul><li>What do the doctor’s need to keep working </li></ul></ul><ul><ul><ul><li>Script paper </li></ul></ul></ul><ul><ul><ul><li>Referral forms </li></ul></ul></ul><ul><ul><ul><li>Letterhead </li></ul></ul></ul><ul><ul><li>What do the receptionists need to keep the front desk running </li></ul></ul><ul><ul><ul><li>Manual receipts </li></ul></ul></ul><ul><ul><ul><li>Manual bulk billing forms </li></ul></ul></ul><ul><ul><ul><li>Manual eftpos / credit card forms </li></ul></ul></ul>
    31. 32. IT Troubleshooting <ul><li>Remember once the computers are working again all data must be entered </li></ul><ul><ul><li>Clinical data </li></ul></ul><ul><ul><li>Accounts/receipting data </li></ul></ul>
    32. 33. General Practice - Snap Shot <ul><li>2004 </li></ul><ul><li>Majority of practice have hybrid systems </li></ul><ul><li>2010 </li></ul><ul><li>Almost all practices fully electronic </li></ul><ul><li>Why? </li></ul><ul><li>Generational change </li></ul><ul><ul><li>New practitioners proficient with technology </li></ul></ul><ul><ul><li>Different skill set </li></ul></ul><ul><ul><li>Increased expectations of technology as a reliable tool to assist in day to day running of practices </li></ul></ul><ul><ul><li>Business case </li></ul></ul><ul><ul><li>Competitive nature of clinicians </li></ul></ul>
    33. 34. A Practitioner’s Perspective - 2004 <ul><li>Team decision </li></ul><ul><ul><li>Do the research </li></ul></ul><ul><ul><ul><li>Network with other practices </li></ul></ul></ul><ul><ul><ul><li>Talk with division </li></ul></ul></ul><ul><ul><ul><li>Listen to the experts </li></ul></ul></ul><ul><ul><li>Present the proposal </li></ul></ul><ul><ul><ul><li>Show the benefits </li></ul></ul></ul><ul><ul><ul><ul><li>Quality records </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Time saver </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Great space saver </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Improved morale </li></ul></ul></ul></ul><ul><ul><ul><li>It is inevitable! </li></ul></ul></ul>
    34. 35. A Practitioner’s Perspective -2004 <ul><li>Make the decision </li></ul><ul><ul><li>Set the date </li></ul></ul><ul><ul><li>Train everyone </li></ul></ul><ul><ul><li>Do it in one go! </li></ul></ul><ul><ul><li>Stay positive </li></ul></ul><ul><li>Support </li></ul><ul><ul><li>Hardware </li></ul></ul><ul><ul><li>Software </li></ul></ul><ul><ul><li>Practice troubleshooter </li></ul></ul>
    35. 36. A Practitioner’s Perspective -2010 <ul><li>I want more! </li></ul><ul><ul><li>Reliability of hardware and software </li></ul></ul><ul><ul><ul><li>No downtime ( and no my time!) </li></ul></ul></ul><ul><ul><ul><li>Fast network </li></ul></ul></ul><ul><ul><ul><li>Decision support (delivery of evidence to clinician) </li></ul></ul></ul><ul><ul><ul><li>Electronic prescribing </li></ul></ul></ul><ul><ul><ul><li>Data mining </li></ul></ul></ul>
    36. 37. A Practitioner’s Perspective -2010 <ul><ul><ul><li>Electronic referrals to and reports from: </li></ul></ul></ul><ul><ul><ul><ul><li>Medical specialists </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Allied health </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Radiology </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Public hospitals </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Private hospitals </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Government departments e.g. Centrelink, DVA </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Workcover, Comcare </li></ul></ul></ul></ul><ul><ul><ul><li>Tip: On bottom of referrals </li></ul></ul></ul><ul><ul><ul><li>Camp Hill Medical Centre prefers to receive reports electronically through ................. </li></ul></ul></ul>
    37. 38. A manager’s perspective 2010 <ul><li>What I want </li></ul><ul><ul><li>Intranet </li></ul></ul><ul><ul><ul><li>‘ If it’s not electronic.........’ </li></ul></ul></ul><ul><ul><li>No scanning </li></ul></ul><ul><ul><ul><li>Everything electronic </li></ul></ul></ul><ul><ul><li>No manual faxes –sent/received </li></ul></ul><ul><ul><ul><li>All from computers with automatic logging and tracking </li></ul></ul></ul>
    38. 39. We’ve come a long way!!!
    39. 40. The way forward – the I’s have it!!! <ul><li>Innovation </li></ul><ul><li>Information </li></ul><ul><li>Infrastructure </li></ul><ul><li>Investment (time,resources) </li></ul><ul><li>Integration </li></ul><ul><li>Imagination </li></ul><ul><li>Interoperability </li></ul><ul><li>Improvement (there’s always a better way) </li></ul>