[log in to unmask],Net writes:
"Less"

Moving records onto the individual machine of the doctor responsible
then has some attractions for you.  Granted that not all the records
wil be on the machine, and the narrative will be on paper on shelves.

Interesting to see you would like to use th emachine for help with
diagnosis.
THis implies some entry of data for that purpose, even if it is
transient and evanescent, unless the machine is used purely as a fount
of knowledge.  (a very reasonable use in itself, of course)
Having entered the data to aid a diagnosis of Appendicitis for
instance, ther emust be some temptation to retain it, in case some of
it otherwise requires re-entry in the future.
If oe already has a registration system, then it becomes tempting to
use an extension of that and so on.

> It is inevitable that they must print on one side of A4
It is entirely feasible to print out onto FP7 cards.  A bit of a hassle
though, and the A4 notes users may find it inconvenient.  A4
handwritten notes of course tend to be single column, with lo=ts of
whitespace to the right.  I think they work better though, and being
difficult to carry is less important now we do less visiting.

> with acres of blank paper.  
If you drop the outgoing report of a patient's notes into WOrd  (Write
won't do it conveniently)  rather than onto the printer, and have a
macro which sets it up into 2 columns of 9 point  proportional spaced
type, you can drastically reduce the paper used.
Running three columns in landscape gives sections of similar dimensions
to FP7 cards...

>Get that right (the one-side is at this stage, I assume, an
>impossibility to correct) 
NEC SilentWriter 610Plus comes with good manual duplex printing
software, and scales pages as well.  The HP6 Laserjet has duplxing in
its enhanced printer driver.  Last week on the Palm Med list some
Americans were talking about true duplex printing (IE both sides of he
paper at once from a double barrellled laser printer, or a printer with
a paper path that includes a half roll and two passes over the roller -
using the infra-red port on their Palm PCs.  THey didn't have it sorted
out, yet.
But closer to home, either turning over a page and duplexing the other
side, or else buying a duplex laser is not outside the realms of
possibility.

>and something useful will have been achieved.  
This is of course a political problem, and one which the GMSC/GPC could
well take on.
The essence of the problem is whether we care about the notes we pass
on to somebody else.  If we care then we should be reasonably content
with centrally co-ordinated actions intended to persuade us (or enable
us) to turn out a neat printout in minimum volume of paper, using
enahncements to our RFA approved software, or else additions made out
of industry standard components like Word.
If we don't care of course....
However, as we grow closer in PCGs, a process GMSC could aid by
negotiating simplification and de-emphasis on capitation in our
payments, we are likely to consider our local colleagues more kindly
than we do at present, and we might well agree upon a general format
for paper printouts of computer notes, even if we don't get to the
transportable electronic record just yet.

Narrative printout should be filed in sequence in the FP7 cards,
summary printout should be on or replacing the manual summary card,
repeat prescribing detaisl should be split into where they go in the
receiving practice.
THis makes it difficult for the sending practice to know what would be
ideal to have on the backside of any particular page except the
narrative pages, so only narrative should be duplexed.

The WorkRound
-------------------
Photocopy the incoming printouts.
Reduce them onto half size double sided A4, and guillotine it into A5
or A6
File it, throw out the original.
THink before replying - if it isn't worth th etrouble of copying into
the format you want, it can't be that much trouble to you at the moment.

>Med Schools must reteach the skill of
>concisiveness.  (He says, rambling on!)  ;->

Political matter, again.
I was very impressed by an SR, now consultant anaesthetist, who held
that notes should be written in good English, he was right.  THey take
less time to read, and tell the stoiry better than cryptic abbreviated
comments.  He studied law as the 3rd year at Oxbridge, which may have
influneced that.


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