Carryduff: The Paperless Practice Use of Computers in General Practice Stewart Paul Jonathan Reaney

Introduction Where? Carryduff Surgery, Hillsbourgh Rd, Carryduff Who? Dr J Browne and 3 other partners, 1 doctor part time, 1 registrar 4 nurses Practice manager, fund administrator and 8 receptionists

Introduction What? Fundholding General Practice Practice population approximately 8000 When? Started 1978 Moved to new premises 1989

EMIS GP Computing System Invented 1982 by doctors in Leeds Installed in Carryduff Surgery 1991 System cost: £ NHS paid for 75% of system as part of initiative to increase use of computers in General Practice

Security Encryption Passwords Usernames Firewall

Dr Paper vs. Dr PC Appointments Dr Paper One book patients on hold while looking up book 6/10 Dr PC Appointment book on computer Instant access from any terminal 9/10

Prescriptions Dr Paper Time - have to search notes Mistakes 3/10 Dr PC Computers warns of overdoses, allergic reactions 9/10

Referral Letters Dr Paper Letters handwritten, stamped and posted 5/10 Dr PC Pilot scheme with City and some departments in Ulster referrals and replies Time saved in deciphering doctors handwriting 7/10

Hospital Letters, Lab Results, X- rays Dr Paper Time searching through file Client on hold 5/10 Dr PC Scanned into computer Doctor input Filed after scanning Instant access on screen Doctors notes with item on screen 8/10

Power Cut Dr Paper Can operate close to normal Paper notes only require light 8/10 Dr PC Can still operate at very basic level Delay repeat scripts Handwrite new scripts 1/10

Fire Dr Paper Lose everything 0/10 Dr PC Everything backed up daily at 1am and tape put into fireproof safe Backed up weekly off site on tape Occasionally burn information onto CD 10/10

Drug scare or recall Dr Paper Impossible to search through notes for 8000 people 0/10 Dr PC Type drug name into computer Computer searches Results in 1 second 10/10

Overall doctor scores Dr paper 21/60 Only scored higher in one- power cut Dr PC 45/60 Two perfect scores- fire and drug recall.

Training Self training Balance between computer and patient

Web Site Patients can order repeat scripts on line Out of hours information View test results News

Voice Dictation “Thank you for seeing this lady” “Hank is for leaving the Navy”

Drugs Order Changing dose Intelligent system

Scripts Print out Doctor just has to check and sign Legible

Records Looked up anywhere Time saving Doctor must update information

Links Books Documents Leaflets Societies Websites

Further Features of EMIS Macros – shortcuts for common phrases Access to pictures, video and audio to get second opinion Can type in drug and see any interactions Electronic BNF Can print out patient information leaflets Can access details of self-help organisations

Development GPs all linked up Voice dictation Increase security