We explore the advancements in digital record keeping and discover what methods three aesthetic practitioners are using to store patient notes safely and securely
As technology increasingly seeps into every aspect of our lives, from digital apps that monitor our sleeping pattern to faceless banking conducted via smart phones, aesthetic record keeping is also evolving in light of the digital revolution.
Electronic record keeping has gained traction within the industry over the past decade. By 2015, practitioners are now utilising technology in a way that many would have never considered possible before the turn of the 21st century.
And it seems there are countless benefits to these digital systems. Dr Askari Townshend, advanced trainer and aesthetic practitioner, agrees. “There are all sorts of ways that these technologies can help us minimise emissions and deviations of protocol. They can enable practitioners to run reports to ensure your auditing is robust, you are following protocols, or identify staff or staff groups that are not adhering to certain protocols.” He continues, “Being able to flag all of that up at the touch of a button is invaluable, and it should help drive standards in everything that we do.”Upon opening his aesthetic practice in May, Dr Townshend intends to ‘go paperless’ immediately, and is currently working with Customer Relationship Management (CRM) developers Pabau to create a personalised record keeping system. “I think the software and technology is up to standards that we can manage [ourselves] usefully,” he says. “The real value in using technology lies in making sure that processes are improved, and where things are going wrong they can be highlighted.”
With a variety of systems currently available, founder of iConsult Richard Crawford Small explains why he believes his technology was a front runner in developing electronic record keeping systems. “iConsult was designed initially around the needs of the peripatetic, or mobile injector, who would need to carry patient medical records around from site to site. We gave them a database, and a simple way to capture patient notes, images and consent,” he says.Crawford Small hoped that this would also aid insurance issues, where keeping track of thousands of individual pieces of paper can be challenging. “I have been told many times that the majority of malpractice cases are settled before liability is even established, because of incomplete or missing paperwork,” he says. Consultant plastic surgeon Mr Taimur Shoaib reiterates this aspect of legality. As a medicolegal expert, he emphasises that standards of record keeping are set by our fellow colleagues and peers, and when a practitioner is under investigation for a malpractice case, he says, “If that peer doesn’t feel that the standard of record keeping was as comprehensive as it could have been, then there is a higher chance of a successful medical negligence claim.”
Managing director of clinic management software company e-clinic, Mark Lainchbury, believes that electronic record keeping systems, including e-clinic, are versatile not just from a medical and legal perspective, but also for business needs. “Some clients are very focused on the clinical data aspects, whereas others are more focused on the very powerful business tools such as marketing and reporting,” says Lainchbury. “I think the most important facet of e-clinic is that it offers a much broader range of features that generally go deeper than most of the other systems which are available.” e-clinic allows users to design their own clinical workflows, scan records, save images and keep patient information online through a patient management system that allows you to text and email patients directly. However, Lainchbury says, “The downside of such a rich feature-set is you sacrifice a degree of simplicity, which is why we introduced a less sophisticated version, e-clinic Standard, last year.”
Though incorporating an electronic record keeping system for the very first time in your clinic could seem daunting, those using these digital systems contend that it creates better efficiency long-term. “This is what technology is made for,” emphasises Dr Townshend. “To make life easier, to keep things more precise, to make sure people are accountable – that’s really what we should be doing.” He believes that using digital systems is a logical progression, noting that the ability to read medical notes is an on-going clinical issue. He exempli es the problem, saying, “I sometimes pick up notes that I wrote in a rush when I was tired at the end of the day and I’m not quite sure what one or two of the words say – how on earth is anyone else going to read it if I can’t?” Mr Shoaib opened his clinic nine years ago and immediately downloaded several 30-day trials of record keeping systems to decipher what would be the most effective system for his new clinic. He now uses a system called ClinicOffice. “It turned out to be the most versatile of a lot of packages because it comes with different modules,” he says, explaining that its multiple facets enabled him to use its document module for scanning and saving documents, store records in its financial section, log demographic information and patient contact details, as well as providing a function to allow patients to log in and book their own appointments.
Although his record-keeping methods haven’t changed drastically since his clinic opened, Mr Shoaib finds that his staff now use ClinicOffice to its potential better than they did initially; making use of its online diaries and automatic texts/emails to patients. With its differing functionality, this kind of software is flexible to the user’s needs. Users also have different levels of access depending on their job role. One issue he has discovered, however, is the hindrance of a slower internet connection when sending out information, due to the volume of practitioners using the software in clinic, therefore causing it to slow it down. This, he says though, is down to his own broadband speed, which could be improved with a different internet provider. So what is the real crux of effective record keeping? In light of his experience of having to record very precise, detailed notes as a consultant in the NHS, with the resources to record them, Mr Shoaib considers the effects of electronic systems being thrust upon a practitioner not previously familiar with them. “Most hospital consultants are used to dictation systems because we learnt how to use them in the NHS,” he says. “Hospital consultants, I think, are in a privileged position. For the regular aesthetic practitioner, this is not going to be the case, but that doesn’t mean to say that medical record keeping can fall below the standards that we expect from the standard that is set.” He highlights that it is crucial that medical records reach a high standard, whether digitally or on paper. “You cannot compromise on any particular aspects of the medical record keeping process,” says Mr Shoaib. “Even if the medical record keeping process is done with paper it has to be stored for seven years,1 and if it is done electronically, then there is no reason to ever delete them.” Dr Townshend agrees, stating that if a digital system is effectively designed, there is no excuse for producing low standard medical records. Of the different systems available, he says, “If you have a great idea, but you implement it and design it poorly, it’s not going to help you and it can actually make it worse,” adding, “You have to get it right so people can understand what the benefits are.”
One of the key concerns that may cross the mind of those undecided on adopting an electronic record keeping system is security. Many systems use the Cloud, a system of servers that store and back up information with secure access. “Our Cloud platform [for e-clinic] is very secure with robust data backup and replication across two UK data centres. That infrastructure does come at a cost but I think most people understand the need for that level of security and resilience,” says Lainchbury.
Online security in this way also means more accessibility. “With iConsult, all of the records are stored securely online, ready for access either through the iConsult app, or the website,” says Crawford Small. Mr Shoaib adds, “Security is of course exceedingly important and there are BSI standards for security, and all clinics who used any form of electronic storage need to register themselves with the Data Protection Act.”2 He continues, “The Data Protection Act also states that we have to back-up the data and, ideally, the information should be stored offline as well. This is to ensure that if there is a physical catastrophe in the clinic, our patient’s notes are still accessible.”3
Toby Makmel, co-founder of patient management system Clinicminds, is confident that the future of medical record keeping is digital. Though his own system is yet to incorporate the function of medical records into its own software, Makmel believes this will change as the Dutch-based company becomes more popular in other countries and is required to follow country specific protocols. “I think the future is a very clean desk – a tablet with a keypad
and a stylus [pen-like device for touch screen electronic devices] is all that’s needed. I think working on the Cloud will be the future because you don’t want to have the trouble of continuously getting out your work – you want full mobility,” he says, adding that this will be a crucial factor for growing clinics who hope to make a mark in the aesthetics world.
Dr Townshend agrees, “The negative points that are made will come from the kind of people who don’t want change. I don’t say that in an insulting way – Lots of people don’t want change because things that are new are sometimes difficult, you have to learn new things – but if we fast forward five years or 10 years, there is no way on earth we’re going to have little scraps of paper floating around that people can lose, damage, take home, or leave on the train.”
DH/Digital Information Policy, Records Management: NHS Code of Practice (2nd Edition) (UK: gov.uk, 2009) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200139/Records_Management_-_NHS_Code_of_Practice_Part_2_second_edition.pdf p. 4
Information Commissioner’s Office, Register of data controllers (UK: Information Commissioner’s Office, 2015) https://ico.org.uk/about-the-ico/what-we-do/register-of-data-controllers/
Information Commissioner’s Office, Information security (UK: Information Commissioner’s Office, 2015) https://ico.org.uk/for-organisations/guide-to-data-protection/principle-7-security/