More morbid thoughts!

I am still trying to "get my head round" the main reasons for
computerised disciplined morbidity recording, and have been a little
disappointed at the responses (although fully understanding the reasons
behind them :^):


>>unless these disciplines are forced upon them ... [snip before and
after]
>I am outta here,  mun,  the whole thing stinks!
>All I wanna do is do no harm to my patients and make a living ...

and
>>variation). We need to be urging as many GP's as possible to collect and
>>record "morbidity data" from all consultations - and this needs to begin
>>ASAP!
>
>
>So apart from "urging",  what renumeration and incentives do you offer for
>this laborious data collection exercise, as I have not seen the requirement
>to do it within the TOS? yet? :-(

More thoughts:

Why computerised records?
1. Easily accessible structured records
2. Rapid searching for common features
3. Warnings/alerts to decrease likelihood of prescribing errors (eg drug
sensitivities and interactions).
4. Audit, both outcomes and the delivery of care (we recently took part
in a county audit on secondary prevention of IHD/risk factor recording
and we are definitely nowhere near as good as we think we are!!)

Taking point #4, my partners continue to argue that the figures are
wrong.  They argue that the number of patients on aspirin excludes a
large number taking it OTC, inspite of a code in the IHd template
reminding us to ask. Similar arguements on BP recording, and we only got
45% of the most recent recording <160/95  "I don't put all the
recordings on the computer"........or put it on as free text....."BUt we
are now "paperless" in the consulting room at least.. to avoid
duplication.

When does the use of computerised templates/protocols become good
practice.... and the random haphazard risk screening unacceptable? I am
certainly not arguing for the imposition of dictates from anyone outside
the practice, but surely we must record screening and morbidity
information in a standardised way so we can audit ourselves. Seeing a
patient with an ongoing complaint and either choosing three different
codes, or saying three different episodes occured (getting the episode
typing wrong) completely wrecks the audit. You (or your nurses) either
spend hours going into each consultation record and trawling the data
manually (free text searches are only a very poor partial answer) or
your audits have such large confidence intervals that they loose most of
their potential to initiate change.

At the very least we ought to be TEACHING and disseminating good
practice - as the more computer literate of our collegues. Either don't
use codes (cholelithiasis etc) until we are certain (RUQ pain will do
here) or ensure we go back and alter it afterwards. (i know read 3 has
afix for this but we need to get recording better NOW). 
We should be thinking quality of care, what are the important things I
need to record for patient X with condition Y..... if we remember to ask
we should record it (and templates etc are the quickest way to do
this).... we have had asthma self management plans since 1989, but only
when i put "asthma management plan?" in the template did I remember to
photocopy some more and issue them (I must have been 6 months without!!)

we need to continually help our collegues/registrars to come to grips
with the principles of good records.....any ideas how?


Regards

>
>
>Huw Thomas
>GP Minehead
>[log in to unmask]
>http://www.irnham.demon.co.uk
>
>Internet Links Page
>

-- 
Huw Thomas


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