Using Paperless Medical Records

By Dr Brian Franks / 06 Feb 2018

Aesthetic practitioner Dr Brian Franks details how to transition from paper medical records to digital

Around 2,500 years ago, ancient Greek physician Hippocrates used pen and papyrus to record medical records.1 Whilst medicine and technology has advanced considerably since then, it is remarkable that for many of us, the practice of recording, filing and retrieving patient information has not. Although there are excellent alternatives to the mighty pen, it is understandable why some practitioners are hesitant to embrace new technology. However, to meet the needs of an increasingly demanding world, with time becoming ever-more precious and, regulations requiring more transparency and increasing competition – it is necessary to change our behaviour and adapt to more efficient, effective and economic ways of running clinics.

This move towards the paperless office started half a century ago with the advent of the first commercial computers, built by manufacturing company IBM in the 1950s, with hospitals as key customers.2 Yet, more than 50 years later, most clinics are still yet to wean themselves off paper completely.

In order to leave our comfort zone, there has to be very compelling reasons to change. Fortunately, the speed of technological development means that there are now some remarkable digital systems available for the aesthetic medical practitioner. These digital systems have functions that include the ability to run a clinic’s entire operation and management, covering all areas from patient scheduling, medical questionnaires, consultations, consent forms, before and after treatment plans, patient aftercare notes, stock management, invoicing and reporting.

Digital systems

Using a digital system has the potential to completely change how your clinic runs. It removes the hours filing and retrieving paper records, the stressful hunting for misplaced records, and printing out consent forms when you have run out. It also reduces the considerable time in clinic, long after the last patient has left, writing up notes and filing before and after photographs on a potentially unsecure office computer. A comprehensive digital system will reduce the administrative burden enormously, freeing up practitioners’ time to see more patients. The front-of-house staff and other support staff will also have more time to answer calls and focus on patients. 

There are digital systems that will group questionnaires, consent forms, photos and medical notes in one location that can be filed securely and easily retrieved. Some systems even provide prepopulated medical notes for frequently occurring consultations, which are more comprehensive than quickly scribbled notes jotted down in a busy clinic. All of this assists in increasing patients’ satisfaction with the clinic’s services. Thus, when the practitioner’s consultation is over, the administration is also over and spare resources can be set free to work on operations that increase patients’ experience and building long-term patient relationships. In turn, this could lead to increased patient retention and spend, all helping to improve the financial performance of the business.

One major advantage of cloud-based digital systems – where data and programmes are stored and accessed over the internet instead of a computer hard drive – as opposed to systems with local data storage, is the remote accessibility of clinic notes. This means that practitioners are able to view and add to the clinic note away from the office, if necessary. Finally, coming in May next year there is requirement under General Data Protection Regulations (GDPR), which among other things, will mean practitioners must know where all their patient records are at all times.3 This is possible with a tightly managed paper system, but it is considerably easier to comply when using a high-quality medical digital platform.

From paper to digital

So, how do you move to the digital space? Firstly, you need to decide which system to use, as there is a plethora of choice for clinics and practitioners.

Stage 1: Suitability of software

The practitioner and the front of house staff must both be involved in the purchase process so the best system is acquired, to suit both practitioner and clinic staff.

The most important criteria are:

  • Software that meets both the needs of the administrator and the practitioner.
  • Software that is highly secure.I suggest finding out if the provider is International Organisation for Standardisation (ISO) accredited; has robust data monitoring; undergoes regular third party penetration testing by a recognised security company (also known as ethical hacking); has hourly back-up; 256 bit AES encryption (a specification for the encryption of electronic data approved by the US National Security Agency for top secret information); an Incident Response Plan (IRP) if there is a data breach, such as the recent attack from a leading London plastic surgery clinic; and does the provider have cyber insurance?
  • Can medical data be easily retrieved when migrating from one computer system to a new computer system?

Stage 2: Time vs. cost

You should consider the amount of time you are currently spending on paperwork and what the cost of your time and the time of your support team adds up to. Even your ‘free time’ such as your evenings, if spent working, equates to a cost. With more available time, how much better would your customer service and revenue be? How much space is required for filing and what is the cost of printing? Most importantly, what is the cost of a lost medical record? When it comes to choosing a digital system, pricing varies from a free solution, such as Google Docs, to more expensive products.

Stage 3: Support

Support is critical and should be an important consideration. This could be to learn how to use a new feature or to fix a bug that you’ve come across. You need to find out what Service Level Obligations (SLO) the vendor offers and how critical issues are dealt with out of hours. In addition to technical support, does the vendor provide any support to help improve business performance? For example, in what ways can the software help you save time or grow your sales?

Stage 4: Contractual terms

What are the contractual terms for support, such as working hours of the support team, contract duration, i.e. can you cancel at any time or is there a minimum period or a cancellation period? What support is there for set up, training/coaching, product development and costs of data migration from an existing database?

The choice of supplier is a critical business decision and is a long-term commitment so needs careful consideration. The software is a core element of your business and will help greatly to market your business for sale at some point in the future. It will be an essential component of your future wealth and needs to be treated accordingly.

The transition

When the system and supplier is selected, the most important task is installation. I found that this is best achieved with small steps. Many systems provide a range of features that the user needs to become familiar with over a period of months, as opposed to a few days. But in a few hours of training, the user should have a very good grasp of the essentials of the system. Most clinics already use computers for diary management or invoicing and it is essential to keep both systems running in parallel for at least a month to ensure a smooth transition. Some ways of working will inevitably be different and will take some adjustment. But the big change is in the management of paper. A useful check is to take the patient challenge. Simply take the first few patients on any given day (I find 10 is useful) and carry out the full patient pathway using the digital system and see how this compares to your tried and tested paper system. The benefits should become immediately apparent.

My personal advice is to keep existing paper records. It is too time consuming to digitise these records. When seeing one of your existing patients, you will need to have their paper records to hand, but ask them to complete the medical forms on the new system and gradually, the paper record should, for most cases, only be needed one more time. Over the course of a year, the clinic will be able to transition fully to a digital system.

2,500 years further on; the four humours of Hippocratic medicine are no longer considered the best theory of the human body and, for an increasing number of aesthetic clinicians, pen and paper is also no longer the best technology.


Disclosure: Dr Brian Franks is the key opinion leader for the Consentz digital record keeping system.

References

  1. Richard F. Gillum, From Papyrus to the Electronic Tablet: A Brief History of the Clinical Medical Record with Lessons for the Digital Age, The American Journal of Medicine, <http://www.amjmed. com/article/S0002-9343(13)00398-7/fulltext>
  2. IBM 100, The IBM 700 Series, Icons of Progress <http://www-03.ibm.com/ibm/history/ibm100/us/ en/icons/ibm700series/>
  3. Martin Swann, ‘Getting Ready for GDPR’, Aesthetics journal, July 2017. <https://aestheticsjournal. com/feature/getting-ready-for-gdpr>


Comments

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