Paperless or Paperlight?

1. Paperless or Paperlight? That is the question… • Presented by Hélène Somerville

2. September 2013 – initial discussions • - Mobile Working • - Paperless Service. • GPs had been using SystmOne (S1) for several years. • Obvious choice… BUT it was not designed for SLT use! • Initially used for recording SLT face to face contacts and admin contacts. • 3 different geographical areas operating 3 different S1 units. East & North Herts, West Herts and West Essex. • Background

3. Numerous Meetings to map requirements onto S1. • - Business change team • - Senior Manager • - 2 x Clinicians • Processes need to be exact and comprehensive • Capture each step from referral to discharge. • Then replicated onto the system - S1. • Process

4. How will referrals come in? • How to send appointments out? • How to run a clinic? • What letters do we need? • Examples

5. A Light Bulb Moment Paperless vs Paperlight is about way more than writing up the case notes.

6. Referral process

7. Booking • Appointments

8. Protected project time: • - one staff member seconded as full time role. • Experience of the system. • Visit locations to see in action. • Co-ordinate training and going live. • - staff can put learning straight into practice. • Check software requirements and compatibility with any new computers. • Get used to the new vocabulary – semantics. • Top Tips

9. Record and capture data for • Audit: Staff activity, waiting times, • Specialist versus Universal workingResearch: Reportingco-existing diagnosis • Outcomes: Adapted the East Kent Outcome System. Called a Questionnaire just to confuse us...all part of adapting our needs into an existing system. • Clinical vs Non Clinical Contacts

10. Letters circulated from central hubs - three hubs with the relevant admin address and telephone number. • Move to mobile working means many clinics not manned during the day • To avoid messages being left on answerphones, letters only have the admin telephone numbers • Patients can therefore always speak to a person. • Task from S1 (like an email) then sent to therapist with the message. • Less personal approach for letters versus less unanswered calls. • Letters and Reports Come From The Process

11. Text Reminder two days before a clinic/home visit when in electronic ledger/diary. • No text reminder for school visits. • Text can be sent at appointment booking via electronic ledgers/diary. • Possibility of confusion. • Reduces DNAs. • Text Messages

12. Setting Objectives

13. Therapy Blocks

15. Check child’s address and telephone number. • Add ethnicity if not recorded. • Update consent template. • Initial assessment- complete paediatric SLT assess and diagnosis notes. • Therapy/review/Drop in- complete SOAP notes. • Care plan- create or check. • After initial assessment – remove from waiting list, amend caseload and add to intervention list. • Intervention list – amend notes/waiting since and due date. • Checklist for Appointments and/or Admin Time

16. Set new objectives (programme). • Complete outcomes for previous objectives. • Write report. • Task admin group to circulate report, programme and outcomes • Add information to Children’s ongoing diagnosis template if appropriate e.g. type of cleft • Add details to groups and relationships (e.g. family members, professionals) • Add reminder if required e.g. safety issues in home, dog at property. • Checklist for Appointments and/or Admin Time

17. Shared Access to information from involved services(subject to parental agreement). • Access to alerts: Safeguarding issues, domestic abuse etc. • Joined up working with local SLTs - one shared set of notes. • Use of admin staff to deal with all initial queries. • Use of admin for circulation of reports. • Reports and letters templates save time. • Child’s information automatically populates – safer record. • Benefits

18. Drop-in   • - admin can check if child previously known. • - quick access to alerts, HV information. • - Can email advice to parents. • Able to stay in one place to do reports/programmes. • Can complete everything on the day. • Don’t have to go back to clinic to print – task admin. • Benefits

19. Reduces SLT admin time – quicker to send task • Standardised formats/templates across the service • Don’t’ have to carry big files around • Safer transfer of care to colleagues – no case notes in internal post! • Benefits

20. Everything attached to patient record • - Tasks from the patient record can check. • - Assessments scanned on. • - Objectives. • - Outcomes. • Increased Flexibility • - Able to access patient information from any location. • - Flexibility to work from home, school, other base. • Benefits

21. User messaging – • - Can message SLT who is logged onto S1 • - Can see if staff on annual leave • Intervention lists for each team • - Better information sharing and transparency • No need to keep end of the month records as all the information there. • Can see who has breached time constraints as names go red. • Can collect information on conditions e.g. SLI caseload, Down’s Syndrome. • Benefits

22. Reliant on internet access –“dead” spots in the Hertfordshire countryside. • Time taken to “fireup” the laptop and enter the many passwords and security cards to get onto S1. • Speed of typing! • Trying to type and simultaneously keep the child from joining in on the laptop. • Transcription - still allowed to do with pen and paper but difficult to do with lap top open as well for reasons given above. I need another pair of hands! • Challenges

23. Unable to merge the 3 S1 units - I have 3 ledgers! • Took time initially to move all my patients into units. • Only current patients on S1. • Review & cleft clinic only patients discharged & re-registered each time they are seen. • - Extra admin for me. • - Potential for loosing them to follow up. • Can take time for letters, assessments to be scanned on. • Keeping all the information in your head once you are typing in the SOAP notes as can’t get out of this box and in again. • Challenges

24. Maintaining eye contact during consultations whilst typing. • Reading long reports on screen. • These last two do seem to be a bit age specific but not exclusively so….. • Challenges

25. The Clinical Tree

26. Our service is paperlight - much to our relief! • Large documents such as Statements or EHC Plans, Large booklet assessments such as the ACE are NOT scanned in but kept in manila folders • We can also keep a paper copy of the questionnaire (i.e. our current targets) so that we can refer to it during therapy sessions and e.g. for my role copies of the GOS.SP.ASS. • Paperless or Paperlight?

27. Just over 6 months in we are slowly getting used to doing everything via our laptops. • Finding out new things you can do on S1 all the time. • Not sure the typing is getting quicker. • But probably most importantly we wouldn’t go back to paper records. • How are we doing?

28. What about the future? • Looking at the possibility of using Skype as has been trialled by an adult service within our Trust • Using the intervention lists to find children with similar needs and seeing in groups • Closer links with GPs.

29. Any Questions? Thank you for listening.