implementing Instant Medical HistoryTM in General Practice
Introduction to the challenge we wish to solve
Patients want and deserve to have access to their GP on a timely basis. Demand for appointments however continues to outstrip supply and the telephone is continually engaged with patients often having to wait for long periods before the call is answered.
Receptionists are busy booking patients into clinics and dealing with paper requests for prescriptions. The doctors are busy taking histories over the phone or face to face with patients and determining management plans. It is becoming increasingly difficult to accommodate all the patients who wish to get advice.
Patients continue to call the surgery for minor ailments, to request medications, check blood test results or to enquire on the progress of letters that are due back from the hospital or for issues that in some cases could be better dealt with by others. Doctors always take time to ask for recent medical history for common conditions - 17% of our patients already have access to their GP electronic health records but it is felt that based on experience so far that many more patients could reap benefit from the service.
An increasing majority of patients now have access to the internet but on the whole are not fully utilising Practice online services available to them via the practice based web portalwww.htmc.co.uk. The practice feels that from the positive experience gained so far in online service delivery that through further innovation, we may be able to deliver a more responsive service utilising additional solutions where appropriate to better manage the throughput of patients whilst maintaining and striving to improve upon the high quality personal service we wish to deliver. We recognised that a change in workflow was required to achieve this.
who have contacted the surgery for advice by telephone will be encouraged to
complete an Instant Medical History
(an electronic questionnaire application for patient’s direct use) that can be
completed by the patient in their own time and at their own pace – once
completed and submitted securely online, the comprehensive medical histories
which are derived from the questionnaire responses (including any skipped
questions) can be reviewed by clinicians to safely assess patients more quickly
Initially patients requested to attend the Practice in person by
doctors will be asked to complete a relevant Instant Medical History for the GP to have available at the time of
the face to face consultation. Later we hope to enable patients to complete an Instant
Medical History online at the tie of the enquiry for clinicians to respond to
based on our capacity to deal with them allowing Doctors to choose whether to
handle over the phone or face to face in the surgery or a home visit.
Building on the new approach
● A waiting room
kiosk will allow patients to book themselves in for appointment whilst at the
same time informing them about any new developments at the Practice.
● Patients will be
invited to sign up for additional transactional services using the same kiosk.
Patients requiring access to lab results etc. will be encouraged to do this on
line. As a result, receptionist time
will be alleviated from this task so that they can deal with more phone
● We aim to improve
the workflow with possible triage of problems prior to any face to face or
telephone engagement, however the time scale of the project will not allow this
to be fully implemented in the first phase and we therefore hope to build this
into a further phase.
Key Benefits we plan to achieve
time for patients contacting the surgery by phone.
● Improved patient
and clinician satisfaction. Clinicians spending less time taking a history and
more time managing the patient or improved ability to deal with more patients.
advised to go to alternative services eg Walk-In Centre.
Criteria for Success
● Patients able to
complete Instant Medical Histories prior to engagement with a Health Care
80% of patients
able to sign themselves in using the kiosk
up for online services via the kiosk
A way forward can
be determined to introduce further workflow changes to positively impact our
So what do patients think?
"Having used the Medical
History Questionnaire process for the first time today, I am most impressed
with it and found
it very straightforward and comprehensive.
am keen to continue using this approach, which clearly provides tangible
benefits to both the patient and the General Practitioner. The system appears
safe and secure in use and was very easy to access online.
time saving benefits, which in turn frees up the GP's time from basic
data gathering, enabling the Doctor to spend the available consultation
time delivering an enhanced quality of patient care. I
highly recommend this system for wider roll-out”. Jane C Webster – Patient at Haughton Thornley Medical Centres
The questionnaire is a ground breaking way to speed up GP to Patient contact times. The information gained from answering a few simple questions means that the GP has lots of extra information before the patient enters the surgery doors. Haughton Thornley Medical Centres are always in the forefront for helping the connection between modern technologies & lifestyles to medical information. We were one of the first families to sign up for on-line access to our medical records & electronic prescription repeats so it made perfect sense to us to make good use of the electronic questionnaire. (Family at Haughton Thornley Medical Centres - all 3 members completed an Instant Medical History)
The implementation team visits the Practice
Amir Hannan, Dr
Richard Sills, Glen
Griffiths, Dr Prashant Ramaswamy, Jon Witte and Dr
Sharifah Ullah (trainee doctor) during a visit by the implementation and delivery team to Haughton Thornley Medical Centres in February 2013
The reaction from our Doctors has been tremendous
"Fantastic! I could not get such a
detailed history in the 10 minutes I have to see the patient. Asks all the
relevant questions and presents it in a quick easy to read format which can be
part of your consultation…Brilliant.” Dr Nadeem Ahmed - GP
it very useful and helped me form an initial impression of the problem even though
I am not seeing the patient until tomorrow. That helps me to have a
differential diagnosis in mind though acne remains his main complaint. It
helped me to understand the impact of the symptoms on the patient as the
software seems to be able to tease out quite a good level of history taking
which I probably may not have.
Equally I feel sometimes predictive software of
this sort maybe be useful if helping elicit more detail which may not always be
possible in the 10 minutes patient is likely to have with me. If we can make
the process of obtaining the IMH seamless and quick with our current computer
systems then it has the potential to help both patients and GPs a great deal.” Dr Prashant Ramaswamy - GP
Here is a video of the touchscreen at Haughton Vale when patients present to the surgery, You can also see the printer that produces the little ticket for the patient to collect when they have signed in, which integrates with the way we organise our appointment / room booking. It also informs patients that they can sign up for GP Online Services as well as patient access to the GP electronic health records too.
"It has been a pleasure working with Dr
Sills, Glen Griffiths and the team at Wiggly Amps who have demonstrated
their understanding to implement this ‘Game Changer’ technology which enhances
the services the practice is offering to its patients. It is incorporated into
the workflow of the practice and has seamlessly integrated into the practice IT
system (EMIS Web). We still have some way to go to develop this further and
gain further useful insights into how best to capitalise on the opportunity
this presents. The early signs are very promising and we all would like to
thank NHS NW for assisting us to take this first step” (Dr Amir Hannan)
Partnerships and Delivery Team
Richard Sills , Glen Griffiths (IMH UK Ltd) / Wiggly-Amps
(GP system supplier)
Reception staff / Management /
Patient Participation Group / Clinicians at Haughton Thornley Medical Centres
project has been funded by NHS North-West Innovation and further details can be
found by going to http://www.advancingqualityalliance.nhs.uk/innovation
Final evaluation of project and case study findings