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IT and the contract ­ how to win no matter which way vote goes

If the vote is Yes, GPs want as much IT capacity as possible. If it's No, they don't want to have wasted their money. Dr Nigel Watson explains.

n the late 1980s computerisation of medical records was an interesting option to many GPs. Clinical systems have evolved and been developed to an agenda partially driven by GPs but also by the needs of the NHS. As the NHS moves further into the 21st century, GPs' dependence on electronic patient records (EPR) will increase significantly.

The new GMS contract, if accepted, will deliver 30-50 per cent of practice income via quality payments, and 55 per cent of these will be clinical. This will mean clinical quality payments will account for between 17 and 28 per cent of practices' income. Practices will need to show what quality level they have reached to secure payment. It will be impossible to measure the quality levels without entering data on the EPR.

The contract relies heavily on investment in IT and also ensuring practices use it to the greater benefit of the patients and practice.

A question commonly asked is whether practices should await the outcome of the ballot before deciding what action to take on the use of IT. The simple answer is, do not wait. However we vote, the advice given below is practical and will ensure practices will improve the quality of their data and be in a better position for the future.

Practical advice

 · Ensure all GPs record clinical data during consultations

Clinical systems have become much more 'user friendly' in terms of adding clinical data. Some GPs have been resistant to turning their computers on, let alone recording useful clinical data. The choice is now simple; use the computer to record clinical data or the practice is set to lose financially, by a significant amount. Whatever the outcome on the contract, encouraging GPs to use EPRs will happen.

 · Use pathology links with the hospital

A significant number of quality standards involve either having performed certain blood tests in a set timescale and/or achieving recorded level below a defined measurement, for example cholesterol and HbA1C. This can be achieved by practices entering data manually on the EPR, but a more efficient way is to use pathology links.

 · Encourage all clinical staff to enter clinical data on the EPR

Other clinicians within the primary health care team carry out clinical tasks that are required for the care of the patient, such as blood pressure, weights, BMIs. Ensure the practice nurses, community nurses and health visitors have access to the EPRs and encourage them to enter this data and action any abnormality.

 · Ensure all relevant clinical information from hospitals and so on is entered

If practices are fortunate, letters and discharge summaries from hospitals may contain useful clinical data, so ensure this is added to the EPRs ­ for example, echocardiogram results and blood results. Many hospital diabetic clinics are now giving GPs full results of tests carried out in the outpatient department, including blood tests, blood pressure, BMI, retinal screening, foot pulses and neuropathy testing. Practices do not necessarily need to repeat these, just ensure they are recorded in the EPRs.

 · Ensure all clinical entries are coded

This is essential ­ remember 'rubbish in rubbish out'. If the data GPs enter in the EPR is Read coded it is easy to identify using standard reports. Entries that are incorrectly coded or added in 'free text' are not detected by standard reports.

 · Differentiate between diagnostic and symptom codes

If a patient is seen with chest pain and the GP thinks the diagnosis may be angina pectoris, this should be recorded as 'chest pain' and then free text ?? Angina.

Appropriate investigations need to be carried out and if the diagnosis is confirmed then a new entry is made of angina pectoris. The danger of entering 'angina pectoris'?? as an initial entry is that subsequent computerised disease registers will include this patient who turned out to have indigestion.

The patient is labelled with an incorrect diagnosis and subsequent quality data will show this patient has not had required care, such as blood pressure, cholesterol, a statin, aspirin and a ?-blocker.

 · Make use of projects such as PRIMIS

Many PCOs are involved with this national project. This uses a tool called MIQUEST, which will interrogate the practice clinical system and help improve its data quality.

 · Develop a practice-based plan for the data required for the new contract

There are 10 areas of quality in clinical areas. Look at each area specifically, go through each quality marker and assess how the practice can deliver that marker, how that information is currently recorded on the EPR and develop an action plan to implement any changes required.

General practice has in the past been judged on many aspects, which have little to do with the quality of care provided. Some would argue that the clinical quality markers do not reflect quality of patient care. All the clinical quality markers are evidence-based and many GPs would argue that this is the good-quality care they aspire to give.

Whether the new contract is introduced soon or not it is worth reviewing your use of IT and the advantages this could bring to patients and GPs.

 · Ensure all GPs record clinical data during consultations

 · Use pathology links with the hospital

 · Encourage all clinical staff to enter clinical data on the EPR

 · Differentiate between diagnostic and symptom codes

 · Ensure all relevant clinical information from hospitals etc is entered on the EPR

 · Ensure all clinical entries are coded

 · Make use of projects such as PRIMIS

 · Develop a practice-based plan for the data required for the new contract

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