Another view: Neil Paul

Yesterday I had an interesting chat with one of my patients, a solicitor. He had spent the morning filling in a form online and it had crashed, forcing him to start again from scratch.

I sympathised, but he wasn’t that bothered as he said he would include the extra time in the bill he presented to his client.

This made me remember that our accountants now file our tax returns online and that I recently paid my car tax online. The car tax site even checked my insurance and MOT automatically.

Then I looked at my desk, which iscovered in requests for reports, mainly insurance reports and DWP forms. All had come in paper form and, no matter how clever we get our note summarisers and admin staff to be, most require me to get out a pen and hand write stuff on them at some point.

Reeking of paper

Recently, I also spoke to a doctor who works as a medical advisor to a fostering agency. She said that part of her role was to read medicals that the GPs of applicants had filled out.

Most of them, she said, were illegible, incomplete or not specific enough. So it’s not just the people filling them in that find the forms annoying; the people reading them do, too. Surely there has to be a better way?

Insurance reports in particular are burdensome. No two companies seem to use the same layout – most practices I know ignore the form completely and create a so-called customised summary printout that tries to answer the questions asked.

This is essentially a form letter that inserts what we think are the relevant data onto a paper report that we print out and send back. User group meetings and magazines often publish tutorials on how to do this.

However, we still have to summarise the notes first, check the status given to problems, remove references to third parties and answer any specific questions the company has.

Most companies have learned not to complain – but still send their form. I’m convinced there is a business opportunity here for a web-based solution that talks to my computer system.

A standard data extract could be developed that populated the online form with the relevant data. Intelligent rules could be built in so the report couldn’t be posted unless all the questions were answered.

We get lots of follow-up questions from companies when we haven’t answered the questions or where something we have entered that the patient hasn’t mentioned generates further questions. This could be done on entry.

Better still the whole process could be managed so that, as a practice, we know how many we have waiting, who is doing them, who isn’t, and so on. If the system handled the payments and invoicing too that would be useful.

Computers and pitfalls

Now, would the insurance companies fund this? Perhaps, although I’m sure that some sort of form submitting service could sell its middleman services to other companies or departments that had forms that need filling in.

I even wonder if this could be part of an insurance brokerage service, where your basic medical details get sent to as many insurers as possible to get you the best deal.

Would GPs use it? Well I for one would much rather go online and have the patients summary and current medication automatically added to the appropriate place on the form than have me hand write it out.

Clever stats could even be added. Most forms ask when the patient was last seen, but all dates could be included. Or counts of attendances could be added in with different grades - nursing appointments and so forth.

These might be useful in assessing a person’s fitness. Now we have access to SUS data, those attendances could be included as well.

Having said that, you have to be really careful with the law of unintended consequences. It was recently brought to my attention that there is a possible quirk in the prescribing module of Emis that could lead to patient safety issues.

One of its features is to allow you to develop custom prescribing directions using shortened text. Basically you type in something like “bdwf” and it then asks you what you mean.

You type in “twice a day with food” and it then always puts that on the prescription - while on screen it shows bdwf. Now imagine a scenario where someone maliciously or accidentally puts “bdwf” but types “take four times a day with food”.

On screen you see one instruction, one the prescription the other. Now, at a lot of surgeries repeat prescriptions are printed off and signed on-mass at break time. There is every chance you might sign a script for four times a day if that was a reasonable dose.

Hopefully the signer and the chemist would notice if it was an abnormal dose. But even at a normal dose there is a real possibility of overdose or toxicity. It probably just needs to show both on screen to cut the potential problem.