Articles

Reducing the Administrative burden

This, the second article in the series looks at a range of administrative burdens facing services and presents ways in which technology can be applied to successfully ease or remove completely their effects.

Paper based Healthcare

Paper based systems have formed the backbone of Sexual Health Services for many years. Paper diaries are used to book and manage patient appointments, record tests taken and match up incoming results. The paper case-notes are not only the medical record for patients, they are combined with strategically placed baskets or mail trays to enable services to manage the patient flow through clinic and handover between staff.

Services have well established paper based systems to deliver sexual health care and are quite rightly protective of these systems, they have been thoughtfully designed and improved over time to address the range of challenges faced in the day to day delivery of care.

Unfortunately no matter how well designed and thought out these systems are, paper based systems inevitably have a range of limitations and failings. Paper based care is resource intensive, inefficient and costly and does not support safe, high quality, consistent, cost effective care. With the introduction of Patient Administration Systems (PAS) to Secondary Care Hospitals, Genitourinary Medicine Services became aware of the advantages technology could bring and in order to protect patient confidentiality invested in their own “PAS” systems. Over time this investment in IT extended to community based family planning services.

Sexual health services are aware of the benefits of using technology to support service delivery and many services already use IT systems in clinic to manage appointments and record activity about the patient attendance. The transition from paper based care to use of technology to deliver services can have immediate advantages, can address some of the resource intensive paper based tasks systems and also address some of the paper based disadvantages.


Appointments & the Paper Diary

Paper diaries have been used to book patients into appointments for years, the neatly ruled pages being carefully divided into columns in the hope that the staff booking the patients will collect all the pertinent bits of information the service requires.

Some services have moved on slightly and use pre-printed templates, removing the labour needed to divide up the diary, yet still the time consuming preparation of these paper based booking systems when combined with their limited effectiveness of delivering care at multiple locations, has proved a driving factor for certain services to invest in technology that addresses this area. Paper systems do not help support patient confidentiality and safety of patient data. Here technology can and is providing improved service delivery in a number of ways.

Improved Access and Reduced DNAs

Clinic and Appointment management and Patient Administration, which is discussed later, forms the core of many of the current IT systems available for Sexual Health services. Good Clinic Management software and Appointment booking tools can bring improvements in efficiency, improved data quality and also offer the ability to address issues such as inappropriately booked appointments, giving services the ability to better control appointments at multiple service delivery locations.

By matching a patient’s requirements to the services available, modern technology can support staff to avoid inappropriate booking. It can also inform the member of staff booking the appointment to any pertinent information they already hold about this patient which may impact on when or where the most suitable place is for this patient to be seen.

The ability to control how appointments are booked and being able to define booking rules are key areas to look out for when choosing technology. The careful choice of the right technology will also enable automated booking solutions, allowing patients to book directly into appointments without the need for costly interaction with staff.

Available in multiple formats and languages, automated booking can be delivered in patient friendly technologies to support patient choice. Patients can book appointments automatically via the telephone, on the internet through online appointment booking and with in-clinic kiosks. All of which can be delivered in a language suitable for each individual patient.

Reducing the number of patients that miss their appointment is another key to improving efficiency. Technology can assist greatly in this area, automatically reminding patients of their appointment via SMS text at a service defined period of time prior to their appointment and even give the patient the ability to confirm or cancel their attendance by responding to the reminder that was sent.

Patient Registration

Our previous article “Speeding up Patient Access” touched on the bottleneck of patients arriving at clinic. The need to register new patients and the importance of updating the details of returning patients is an essential process of any quality service. However, the time this takes and the impact it can have on clinic as a whole when using paper records is a key challenge that services need to look to overcome.

The paper based check in and registration process is incredibly inefficient and full of duplication. The paper flow often goes along the lines of this; a patient arrives at clinic and fills out a registration form that also asks their reason for attendance. The patient hands this back to reception staff who then look for the paper case-notes in the filing system or back office store room if it’s been a while since a patient’s last attendance. Reception staff then manually either update all the changed information received from the patient or create a brand new set of notes, which are then placed in a basket for a nurse or doctor to pick up.

Patient Kiosk Illustration

All that effort gets the patient into the service and in front of a health care professional (HCP). However the only information the HCP has at this point to help them choose an appropriate patient from the waiting room is the patient’s “stated” reason for attendance and a quick review of the case-notes.

This means this HCP may not be able to effectively care for this patient and may end up having to hand the patient over to a more appropriate member of staff. This again is far less efficient than getting the patient in front of the appropriate HCP first time.

With patient-friendly technology and Electronic Patient Record (EPR) systems, patients can Self-Register by providing them with the ability to enter or update their details through a kiosk on attendance. This can be quality checked and then automatically and safely update the patient’s EPR, thereby greatly reducing the workload of the receptionists and improving the quality of data that used to be transcribed by hand.

If we take this a step further we can then introduce patient triage which will transform a patient’s “stated” reason for attendance into a better qualified, realistic identification of what services this patient actually requires. This understanding is essential for getting the patient in front of the most appropriate healthcare professional first time. Triage opens up the possibility for additional efficiency savings, enabling the patient to self-serve where appropriate.

Paper Care Records & Finding the room

Storage is one of the biggest problems paper records create. The volume of patients who visit services mean there are many records all of which need to be systematically filed in an organised and secure manner. Not only does this need to happen at the hub of the service, but also at every venue where care is delivered. The physical task of searching for and finding the case-notes in a paper filing system is expensive, slow and prone to errors. It’s realistic to be able to find a patient record electronically within seconds regardless of how long it’s been since the patient last attended.

Test Results & Data Collection

Services also use paper to record information on tests taken and to record data on clinic activity. Services record every test that is taken in clinic and then match up incoming results to ensure no result is missing. When using paper possibly the most laborious task of all is manual activity data collection.

How can you improve in these areas? Receiving tests and matching them electronically to the patient’s record significantly increases accuracy, patient safety and efficiency and is a great first step. Being able to request tests through a system completes the end to end process and allows you to specify an expected turnaround time, alerting you when an expected result has not been received. The same technology can also be used to automatically alert services to an incoming result that indicates a patient requires attention, be it due to a new positive diagnosis or due to a certain amount of change to a viral load or CD4 count.

Choosing a system that knows who’s in clinic, which patients they saw and what activity occurred is essential for automating the production of activity data and clinic summaries. Utilising technology here can both increase efficiency and provide an improved, timelier and safer service for all patients.

Putting Information at the Heart of Decision Making

One of the greatest advantages of using technology to support the delivery of care is the information that can be extracted from it. It is possible to extract almost instantly the data on service activity which can be transformed into information and through analysis; provide a true understanding of how a service can develop.

Technology can not only greatly reduce the burden of data collection it can increase data quality and facilitate continuous improvement to both service delivery and patient care.

Information at the Heart of Decision making illustration

Communicating with Patients

Patients keep us busy long beyond the hours in which our clinics are open, whether it be on-going care plans requiring action or newly received test results. Any quality sexual health service also understands that patients expect more than a “no news is good news” approach. The increased priority of prevention in sexual healthcare also means more and more patients are being screened for STIs. Without the right technology this large scale increase in screening would be unmanageable.

To manually inform large numbers of patients of test results would be hugely labour intensive and inevitably introduce delays in notification. Technology can and does automatically communicate with patients. The right technology can take account of a patient’s communication preferences and will adapt to any action that needs to be taken, whilst maintaining sensitivity to any test results. In addition, the right technology can enable patients to pick up their results autonomously by telephone and at the same time inform the service that this has happened.

Patient centred care is about choice. By partnering technology and healthcare it is possible to open up access to patients in new ways. By reducing the burden of administration we can increase the efficiency of services delivery while also improving quality. It is essential for services to utilise the right technology in order to make the most of their available resource while also maintaining high quality consistent patient care.

Like to know more?

If you would like to find out in more detail about how INFORM can support services in this area please get in touch.

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