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RECORDS, DATA & DOCUMENTS
Letter to GP within five days – unrealistic or unacceptable?
James Kippenberger, MD of BigHand Healthcare, explores the source of delays in getting correspondence between secondary and primary care providers.
N
ot that long ago, it was not uncommon to speak to NHS trusts that were taking more
than a month to deliver a letter to a GP. With people’s health as the subject of those letters, that is undoubtedly an extremely long time.
On occasions the result of such a delay was scarily negative for the patient. New targets have pushed this turnaround time to five days – quite a dramatic decrease. Those trusts now achieving this are, and should be, proud of the advancements they have made to enable this, either in process, technology or both.
That is to be commended, but equally when timing is critical (either in the eyes of the patient or against the reality of the condition) a full working week is still a long time.
There are five notable places where bottlenecks can occur. Technologies and process changes introduced to smooth the overall workflow need to tackle each one distinctly, but track progress along the entire chain.
The first introduction of delay occurs between the patient being seen and the dictation being generated; a balance of practicality meets memory retention. Dictating immediately after the appointment (or while the patient is in the room) ensures the most accurate record, but introduces a delay to the clinic (adding cost elsewhere). Delaying the dictation means the clinic runs smoothly, but makes recalling the specifics of every appointment difficult. A delay of a week between clinic and dictation
64 | national health executive Nov/Dec 14
renders achieving targets or recalling what was discussed impossible.
The second, more targeted, delay is the gap between dictation and transcription. With old analogue tapes, waste was at its peak. Workflow, priorities and visibility from digital systems resolved that overnight but technology can only offer itself as a tool. Resourcing (not just quantity but structure) has a critical role to play here. Outsourcing the transcription or pushing the voice file through speech recognition adds efficiencies, as both options work out-of-hours when internal secretaries have gone home, and do so at less cost.
Next along the path is turning that initial transcription into a final edited version. Particularly in the case of externally typed work (by man or machine), there is a need for editing and review. The role of the medical secretary remains critical, bringing real medical and human knowledge to ensure quality. Unnecessary delays can appear, as too much time evaporates on manual formatting and the obsession with producing an aesthetically pleasing letter (neither GPs nor patients rank attractiveness above timely receipt). Solutions should eradicate not accentuate this issue.
The fourth potential blockage occurs after the final version is ready. It needs clinician approval. A pile of papers on the desk was easy to flick through and sign. The advent of electronic documents means access to a PC, or increasingly a tablet, is required for sign-off. A
renewed focus on this phase will reap tangible rewards, with remote access another focus where technology should aid and not inhibit.
Lastly, the document needs to be sent to, and received by, the GP. Postal services had their own impact on trusts’ ability to deliver documents rapidly, and still do at an alarming number of sites. A logical and well-defined interface between the clinic letter production system, a trust integration engine and a distribution technology can ensure receipt is timely and guaranteed.
So in summary, if a trust has to get documents to GPs in five days, it cannot afford more than one day on each step outlined above. Viewing it in this way can allow trusts not just to achieve the new target, but also to identify what the real (or perceived) barriers are to improving beyond that.
Arguably, the ‘holy grail’ is client-side speech recognition. It presents an option to remove steps two to four. A letter can be dictated and generated directly in clinic. It could be immediately with the GP electronically and the patient could leave clinic clutching a freshly printed copy.
The only real barrier is finding sufficient time for the clinician to perfect the use of such a technology.
FOR MORE INFORMATION W:
www.bighand.com
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