Archive: information and computing
INFORMATION: THE KEY TO EFFECTIVE COMMISSIONING.
October 1996 Andrew Willis King Edward Road Surgery, Northampton
Maximising the contribution of information and information technology to planning and evaluating care for patients within the NHS. A discussion document.
Information: the key to effective commissioning
THE INEQUITY OF COMPUTER REIMBURSEMENTS BETWEEN GP FUNDHOLDERS AND NON-FUNDHOLDERS: A PROBLEM FOR PRIMARY CARE GROUPS.
April 1998 The National Association of Commissioning GPs.
This paper addressed the imbalance between the computer systems of previously fundholding practices and those of others.
The inequity of computer reimbursements
A MANUAL DISEASE AND FOLLOW-UP REGISTER
1981 Billing Road Surgery, Northampton.
Analysing patients by disease group or therapy did not start with computers. An assortment of ingenious manual registers had evolved over the previous 20 years, in large part spearheaded by the Research Department of the RCGP in Birmingham.
However, our practice wanted a register that was based less on a research requirement than on an operational need. We maintained an Age Sex register designed by the RCGP, which we found invaluable for preventive medicine, but we also wanted to know which patients had certain conditions, such as diabetes, asthma or heart disease, or were on long-term steroids, and whether they were attending for follow-up as planned. Disease registers existed but were primarily intended for research, and proved unwieldy for our purposes.
We used edge-punch cards produced by Copeland Chatterson and worked with that company to design the system described in the article linked below.
As far as I know, it was the only such register in the country combining a disease register and follow-up register on a single card register. Keen to extend its opportunities to others, we submitted the linked article below to the RCGP journal, only to be told that manual registers were old hat and that now practices would use computers for such things! In reality it would be another ten years before most practices had a computer at all.
Cope-Chat Register - an edge-punch card disease and follow up register
BUSINESS MODELS IN GENERAL MEDICAL PRACTICE
1992 SI Herbert & A Willis. Healthcare Computing
In 1989 I undertook full-time research at Health Services Management Centre, University of Birmingham, constructing a model of the comprehensive information needs of general practices. In 1991, at the request of the NHS Management Executive, I extended it to include fundholding and other post-NHS Review changes, in order that it could be used to build the General Practice model within the overall Common Basic Specification for the entire NHS.
In this way, my research achieved a far more productive result than I could ever have expected.
This paper describes that exercise.
ADDING A NOTEPAD TO YOUR CONSULTING ROOM COMPUTER
1984 JAR Willis and AW Willis Exact publication uncertain.
Flexibility for the individual user is one of the most appealing characteristics of computers. Ironically, although towards the end of the 1980s computers were becoming more commonplace in consulting rooms, they frequently formed part of complex systems which did not allow independent use. My brother (also a GP and computer early adopter) and I designed a feature of the professionally written general practice computer system I had commissioned two years earlier. The new feature allowed the user to collect information in whatever form he or she liked, to be used subsequently by other programs of the user's choice or construction.
PUTTING PATIENTS RECORDS IN YOUR POCKET
Jan 1997 Mark Willis and Andrew Willis. Issue 12, Newsletter of the EMIS National User Group
When the practice was working for Fellowship of the RCGP we hit a problem concerning medical records. We were required to have them available whenever we saw a patient. (I would question the absolute need for such a pedantic requirement, but those were the rules.) The problem was that we had not used paper records for some years, and while we took a printout of the computer record on a planned visit, clearly that would not work for emergency visits, particularly in the night. But to achieve FRCGP we had to find a solution.
Our answer was to put a summary of all our patients' notes on a Psion palmtop computer, which could be carried by whichever doctor was on duty. As far as I know, this was a first anywhere in the country and was produced by my younger son Mark, who - was, conveniently, studying computer science at university.
We presented Pocket Patients to a somewhat startled annual conference of the EMIS User Group. We passed the Psion round the audience, inviting people to break into the machine, let alone access its encrypted records. Of course, no one could do so. If not the first, then this must have been one of the earliest examples of encrypted medical records within the NHS.
Appointment System Survey 1995 - an example of organised curiosity.
The term "organised curiosity" was coined by Dr. TS Eimerl, one of the founders of research within the college of GPs. It perfectly described the sort of exercise some GPs were doing in the last quarter of the 20th century. Not formal research; they just wanted to know something for their own information. Anything - whatever they were curious about. Usually, there would be no intention to publish the results. They were just curious.
Here is an example - a look at our appointment system. While, in retrospect, the second paragraph of the conclusion appears funny, I remember that as a result of this study we changed our appointment system and recording procedures so that we could indeed adopt the third paragraph. So this was an informal example of the measure, analyse, adapt and remeasure cycle of quality assurance. We just didn't know it was called that.
A LONG TERM WORKLOAD ANALYSIS AUDIT
1974 - 1995
Another example of organised curiosity - this time of my consultations over 2 decades. The data were collected using a manual system in the 70s, and then the Notepad and workload analysis programs described above.
This audit looked at the age and sex of patients consulting, what actions were taken in the consultation - such as hospital referrals, prescriptions, and investigations - and the clinical conditions presented.
The Electronic Transmission of Prescriptions NHS Pilot Project
Despite our practice's heavy involvement in the NHS pilots of the electronic transfer of prescriptions, this is the only remaining note I have about it. It was produced as a summary after the very successful pilot was summarily stopped in its tracks by the Department of Health, much to the displeasure of practices and patients alike. It would be over a decade before the resulting national scheme was rolled out, and in the interim, we returned to steam methods.
The costs of computing for primary care groups
January 1999 Final draft for BMJ editorial
Once the GP Fundholding scheme had been withdrawn by the incoming Labour government, an unfortunate legacy was the disparity between the computer systems of non-fundholders and ex-fundholders. Clearly, they all now had to do the same job.
This draft of an editorial in the British Medical Journal discussed the problem and the necessary remedial action.
A WORKLOAD ANALYSIS PROGRAM: AN EXAMPLE OF USERWARE
1987 (?) Paul Willis and Andrew Willis. Draft of article published in Practice Computing magazine.
This project addressed the same problem as NotePad above, but by now my practice had moved on to a commercial computer program and it was not possible to incorporate the software bridge described above.
So my son's GCSE computer project became that of developing a stand-alone but economically p[riced workload analysis system. Perhaps this was also an example of family-ware. There would be more to follow.
The Information needs of Primary Care Organisations
November 2001 Paper presented at Harrogate NHS IT Conference
A review of progress concerning the national Information for Health 10 year strategy.
The paper followed a Working Group convened by the NHS Alliance.