Sussex Health Informatics Service provide a benefits analysis of Docman and EDT at Victoria Road Surgery.
The aim of this project was to investigate different methods of delivering clinical correspondence from an acute trust to the GP workflow and to identify the benefits that can be realised from this process. Victoria Road Surgery serves approximately 11,000 patients and has 5 partners with 1 salaried GP.
Victoria Road Surgery was one of five practices to participate changing how they receive their clinical correspondence as part of the “First of Type” project. Of these, Victoria Road was the first to change their processes over to receiving correspondence via Docman EDT and is the first to report benefits after two and a half months live operation.
Approximately 110-120 pieces of clinical correspondence are received daily, over 100 on paper and 20-25 are via email.
Sources of Correspondence
The Surgery can receive correspondence from many sources these include:
- West Sussex Healthcare Trust which includes St Richards Hospital and Worthing and Southlands.
- Other acute trusts in the Sussex area
- Specialist Hospitals: e.g Royal Marsden, St Georges Hospital Tooting.
- Private Hospitals: Nuffield Hospital, Gorring Hall
Correspondence received
Clinical correspondence includes
- Clinical letters
- Discharge letters
- Private correspondence from Nuffield, Gorring Hall
- Radiology reports
- Histology results
- Faxes
- Results from: Child development Centre, Mental Health Team, Cancer screening, bowel, breast, Diabetic retinal screening and Smears
- Pharmacy medication reviews
- A&E letters
- Physio discharge letters
- Patient letters
- Patient questionnaires
Current paper process
Mail arrives in the department, each individual document is date stamped by the administrator. The documents are then sorted in preparation for scanning. The administrator opens Docman and the document is converted to a TIFF file and is assigned to the patient and is then allocated to the GP and sent to the GP workflow. The GP will enter Docman and look at their workflow and look at the scanned document in the patient’s record. The GP will underline the relevant areas for coding and may request some specific actions dependent on the content of the letter e.g a clinical appointment, blood test etc. The letter is then sent back to the Read Coder who will code the areas highlighted and pick up information for QOF. Once completed this is sent to the Receptionist in the generic workflow, who will select actions and then complete the requested actions.
The administrator spends 2 hours in the afternoon to process all the post of which there is approximately 100 letters.
Current email process
Emails go into a generic NHS mailbox, the email is opened in outlook and the attachment is opened. For all radiology results received this way a read receipt must be sent. The document is converted to a ‘TIFF’ file and is saved to a dedicated hospitals folder. The email is then moved to a batch folder (according to month) within the inbox and saved for 3 months until EMIS verify the backup tape when it is deleted. The administrator will then enter “Batch manager” of Docman and import the entire “Hospitals folder” into Docman. With the first document open in “batch manager” the administrator will search for the patient. The letter is then assigned to the patient in Docman – this includes some data entry. On selecting “File document” the GP (to whom the patient is registered or covering for annual leave) is then chosen, this is then sent to the relevant GP workflow. The GP will enter Docman and look at the workflow, look at the scanned document in the patient’s record. It takes approximately 30 seconds to process a document attached to an email.
Future process
Following the adoption of Docman EDT to deliver correspondence, all clinical documentation will arrive into the Batch Manager where the practice will process as detailed in the Process map below. It takes 10 seconds to process a document and place it in the GP workflow once it has arrived in EMIS Batch manager. The Map identifies that the new process has reduced the steps involved by 10 when compared with the current email process and 11 with the current paper process.
Benefits
It is perceived that approximately 2 hours (throughout the day) of administrative time will be made available when all clinical correspondence from the acute trusts within Sussex are sent electronically and are automatically matched with the patient record as with the pathology results. This will equate to 10 hrs per week.
Immediate benefits
- Improved Information Governance and Data Protection Issues.
- Information less likely to be lost in transit.
- Improved speed of access to information thus assuring patient safety in particular when relating to prescribing.
- Improved liaison between secondary and primary care reducing risk of readmission.
- Improved patient experience as it reduces the time the patient has to wait for the result once they have undergone the procedure so alleviating unnecessary stress.
Long Term Benefits
Increased administrative capacity:
Will enable reassignment of administrators to run audits and make contact with patients for example: Enhanced Service support; with QOF targets and new government initiative “Health Checks”. This is a new government initiative that patients > 40yrs are invited in for a health check. The requirement is for 250 per year. All of these will generate income to the surgery.
Will free up clinical staff to address and make the relevant changes required as a result of completed audits.
Staff satisfaction: (quote from the practice manager)
The team at Victoria Road were very pleased to be invited to pilot this system. We are already benefiting from a valuable time saving that is made by some of the correspondence being received electronically; albeit quite small due to the limited departments in secondary care that are processing in this way. We would definitely not want to revert back and hope that the process will only increase and see 100% of correspondence sent this way in the not too distant future.