Devising a document store for your practice
Dozens of pieces of paper arrive in GPs' in-trays every day, as well as 'virtual' paper-piles in the form of e-mails. If we're busy, we often put them aside to read later and/or file. Then when we actually need that vital document, we can't find it.
The consequences of information chaos include:
We hit the wall a couple of years ago. We were paper-light in terms of records, but swamped by other forms of paper.
We were all being sent individual copies of PCT, hospital and other NHS circulars; if we didn't, someone would obligingly copy them round. Ditto printouts of faxes and e-mails, or documents generated within the practice. Referral proformas were a particular problem; every department in every hospital seems to produce its own version.
For 'convenience' we each kept a full set of copies, which required storage, restocking and replacing with updated versions. Other forms were kept in the upstairs office, the downstairs office, behind reception.
We realised that our practice computer would provide the solution. We currently have two servers – our central C drive, which acts as a platform for EMIS, and a separate server for scanning and linking in patients' clinical letters. Both can be accessed from any terminal, and we have at least one linked PC in every office and consulting room.
We created a folder on the C drive called 'Practice Information' which we use to store documents that can be saved in Word or Excel format. These include documents created in-house, downloaded e-mail attachments and uploadable files – for example many referral proformas are sent to us on disk or electronically.
Anyone with computer access can use the folder, but confidential documents (for example for partner-use only) can be password-protected.
We have created subfolders which in turn have their own subfolders, allowing us to store documents logically so that they can be accessed quickly.
For example, the Doctors' folder contains an Appraisal folder, which is subdivided by year; in this we store whole-practice information such as significant event analyses, audits, prescribing and referral data, patient feedback, records of learning events, new services introduced and so on.
We can then download
relevant documents for our personal portfolios, avoiding the end-of-year scramble for documentation.
The scanning software/storage server has a similar 'Non-Patient Filing' folder which can also be customised. We use this to scan in and store circulars, guidelines, magazine articles, and other information which arrives in paper form, but is unsuitable for OCR scanning and conversion to a Word file.
Both folders can be completely customised for our own use, and reorganised as our needs change. This does require some thought, however, and some documents must be saved as read-only to prevent accidental editing. The documents we store include:
• referral guidelines proformas (two-week cancer, DEXA scans, direct access spirometry, ECHO etc) – these can be completed electronically or printed off in the consulting room and completed by hand
• forms for use in the consultation (Depression Questionnaire PHQ-9, mini-mental state examination and so on) – ditto
• practice stationery (headed notepaper, private sicknotes, invoices) – ditto
• reception and administrative protocols
• clinical protocols – chronic disease management, prescribing, diagnostic criteria
• Department of Health, NICE and PCT circulars – for example on avian flu
• Performance monitoring – audits, statistics and so on
• appraisal documentation
• business information – minutes of meetings, financial updates
• practice-based commissioning information
• GP training – forms, tutorials, circulars
• Information for locums (who can also access the main folders)
One of the receptionists is responsible for maintaining the system. When any document is added, an e-mail is sent to everyone in the building, telling them what it is, and where to find it.
Now any of us can access the information we need whenever we want. This makes life a lot less stressful, especially when hot-desking.
Melanie Wynne-Jones is a GP in Marple, Cheshire