Surgery CARES: Implementing Instant Medical History 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 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.

Solution underway

Patients 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 and remotely. 

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 traffic. 

●     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

●       Improved waiting time for patients contacting the surgery by phone. 

●       Improved quality of service.

●    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. 

●       Fewer 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 professional

●       80% of patients able to sign themselves in using the kiosk

●       Patients signing up for online services via the kiosk

●       A way forward can be determined to introduce further workflow changes to positively impact our access issues

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.  

I 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.

It delivers 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

Dr 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

“Found 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 Richard 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

●       Dr Richard Sills , Glen Griffiths (IMH UK Ltd) / Wiggly-Amps (GP system supplier) 

●       Reception staff / Management / Patient Participation Group / Clinicians at Haughton Thornley Medical Centres

The project has been funded by NHS North-West Innovation and further details can be found by seeing Final evaluation of project and case study findings