[log in to unmask],Net writes:
>It's you who has to convince me.  Yours is the new, highly expensive
>technology.

I don't have to convince you of anything.
You do however, or soon will, have to convince the other members of
your PCG, your professional colleagues, and the citizens at large, that
you are spending their money effectively and obtaining the benefits
that they should expect.

The idea that we spend a lot of time entering unnecessary data in
computers is bizarre.  Is everything you enter in your paper notes
useful?  Hand on anything?
	"Then why waste it entering a great deal of unnecessary data in
computers
	all the time?   Hand on heart, is everything entered useful?"

As you said, some of it turns out to be very useful in later years for
legal purposes.
Why would you either enter more, or less on a computer than you would
write?
We are all in control of what we enter into our notes, whether thay are
paper or electronic - if you find that your computer system makes you
enter somethign you don't want to enter, change computer systems, or
tell th eprogrammers.  Even better, if it is a result of RFA imposed
upon us, get the GMSC going to negotiate it out of our requirements.

Are paper notes cheaper than electronic ones?
The cost of storage of our records electronically is less than the cost
of buying new shelves to keep them on if they were paper.

The cost of pulling paper records in hospitals was estimated by the
Audit Commission (experts on expensiveness) at £6 per go.  Ours are
closer and therefore cheaper, but does anyone have an estimate of the
costs of paper records?  The Audit commission concluded that paper
medical records were disorganised and did not serve their purpose
effectively.

The Medical Sickness Society determined that they would make large
savings by converting paper records to images, stored and retrieved
electronically, at the earliest point they could*.

The areas of Health Service computing where there is widespread
agreement that money has been well spent are in primary care, and in
some individual hospitals or groups of hospitals.
The individual uses and solutions that have been introduced have been
those which have suited people there, and have been introduced for
clinical ends, under control of clinicians, and the projects which have
failed spectacularly, or which have succeeded but after excessive time
and cost are predominantly those were they were centrally directed and
controlled, where delay after delay was introduced while clinicians
called for support urgently.
Examples of projects of that nature include NHS Net, and of course
successful networking of primary care is demonstrated in various small,
local projects.  One could even adduce GP-UK as a successful project in
electronic democracy, feedback and liason with ones' representatives,
and point to the individual expenditure on PCs we have made in order to
use it as an example of effective spending.

Audit using paper records is very expensive, and to return to one of
the earlier points, if it involves people looking at records it means
that every patients' record is read by people who are not directly
treating them.  (if they are actually able to read the handwriting,
that is)
I prefer to set up systems which only result in the patients who are
outside the parameters set having attention paid to their notes.

The NHS with the assistance of a large proportion of GMSC have produced
perverse systems of paying for staff and IT, which may mean that the
direct cost to GPs is less for staff rushing around carrying paper is
less than that for electronics - although even that is in some doubt,
given the increasing cost of staff over reimbursement and the
decreasing cost of computers, but if this is a factor then allowing
those of us who can make savings through the same techniques of record
handling as various other areas of industry and commerce have
introduced to vire staff money to IT seems a sensible aim.

PCGs of course are likely to have the opportunities to rearrange things
in this way.

Appointments are not something I have much to do with, but I am aware
that making them by using staff on the telephone is a large expense,
and that it is often difficult to make an appointment.  I would wish to
take up a suitable system of centralising appointments, with booking
via a conveniently open line at any time that is useful to the patient,
if it became available.
I found it very convenient to e-mail my GP at 0300 to ask to be seen
later that morning, and to be called across the road at 1100.  Using
the telephone is less convenient.
If a small percentage of voice contacts in the first hour of the
morning become asynchronous then the load on our staff will be usefully
reduced, and this may well be translated into reduced costs, or
increased benefits at the same cost.

THe most relevant exerience there seems to be that of United Parcels in
the US, who interfaced their parcel tracking system to their website,
thus relieving several clerks of holding a phone in one hand, keying in
a number with the other, and reading off the location of a parcel to a
customer.

As to Ahmad's nihilism, it seems sensible to check what we do know
about the people who have not been seen for a long time or ever, to see
if anything is outstanding, and to see if any money can be made from
them.  It can make a difference.
Other examples of tasks convenient with electronic records and near
impossible with paper ones is to review all BPs in the records,
highlighting those patients who are very high but not recently seen or
due to be seen soon, and those who do not have but could usefuly have a
BP recorded.  I have had the opportunity to observe in detail the
problems of an assumption that everything can be caught up on when the
patient does attend, and I don't want to go back to it.




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* and also represented the view of the Insurance industry (rather good
at estimating risks) that their chances of loss due to images and ascii
files not being sufficient to defend a court case were much less than
their chance of making an expensive mistake through not having the
paper notes to hand.


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