[log in to unmask],Net writes:

>Why computerised records?
0.  Readable records.  Or does that mean easily accessible?
>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).
3.5  (at least the opportunity) to assist correct decisions on eg
prescribing.
      	 Parenthetically, it is interesting the way in which many
systems conceal the 
	allergies, avoids, and ADR hitory while one tries to write a
prescription, only 
	leaping upon one with a cry of glee when a demonstrably incorrect
choice
	is made...  Displaying the don't prescribe this box beside the FP10
image seems a 
	good idea.
	
>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.

You have made the correct choice on that.
Among the functions that should surely be added is some intellisense in
the free text/narrative entry process.  For instance sieving the typed
input for 
"BP" followed by {2 or 3 digits} "/" and {2 or 3 digits} and asking
respectfully if this is a BP and if one might place it in the BP table,
automatically, while adding a little bit of value by displaying the
previous few BPs should be accpetable to most of us.
Caveats:
	it should be a non-modal popup, IE one must be able to simply carry on
typing
	ideally, it should just float around on screen until answered yes/no,
or even go 
	away of its own accord after half an hour or so when it becomesa
pparent the user 
	doesn't want to know.

However, you have a clear benefit from your recording of 45% acceptable
BPs, in that you only have to look at 55% of the hypertensives to see
if you can trawl out a BP entered freely, instead of 100%.

> surely we must record screening and morbidity
>information in a standardised way so we can audit ourselves. 
Or require our IT designers to provide sufficient ways to record that
each of us can usually find a congenial way - reducing the number of GP
system interfaces to 3 would be a disaster in that respect.
Or require them to provide means of automating or speeding the trawl
for irregularly recorded notes.

>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!!)
Um...why do you take the correct decision on going to a single system
for the notes, and then saddle yourself with having to remember and
then find a paper to hand out for advice.
THe self manage,ment plan should be printed semi-automatically, with as
much information already held already filled in or custom calculated,
and it should seek permission to update and reprint itself whenever it
is due.

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

Start off in medical schools.  Students are still being taught to make
notes on paper.
Continue in hospitals, the hospital medical record is an appalling and
expensive mess, as are the letters coming out of it from specialists,
for whom there may be some excuse, and GP Registrars working below
grade as SHOs there, for whom the tutors should be leaning hard on the
hospitals to prvide record systems able to teach good practice.

Unfortunately most of the tutors were early adopters of IT, and
therefore still have Vamp Medical and cannot be expected to understand
good record or use of IT.

>Regards
And to you, also, regards and felicitations.


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