I’m sure that 2013 will go down as ‘the year of overload’. GPs will have so much more to do – and for considerably less money.
But something else is also threatening to engulf us: information overload.
It starts with patient-related information. In the past paper notes were kept within the geographical confines of hospital or practice, with the occasional letter or shared record crossing the gap. But in this increasingly interconnected world we are beginning to share our information more effectively, and in more detail.
Hospital letters, once a paragraph in length, now stretch to many pages – though many are little more than copies of entries made in the hospital notes. Nevertheless, GPs have to read the entire document to avoid missing something they are being asked to do. So wouldn’t it helpful if hospital doctors could be encouraged to write GP action points in bold?
Keeping up with medical developments
The second source of overload is medical knowledge itself. Approximately 20% of medical knowledge changes every five years – and that presents a real challenge, because unlearning knowledge is much more stressful than learning it from scratch. There is always uncertainty: in any particular area how can I be sure my knowledge really is up to date?
Keeping up with NHS policies
But probably the biggest source of information overload is keeping up with NHS policies and local information. The amount of data involved can be huge: regulations from the DH; letters from the CMO; changes to clinical pathways; revised versions of QOF, QIPP and local incentive schemes.
There are legal documents from the CCG; redesigned locality pathways; local formularies and prescribing incentives; changes in individual clinics’ referral parameters (different for each of the five local hospitals, of course), special referral forms… The list goes on and on. Keeping up is a full-time occupation.
This is where the work of your CCG’s informaticians will be vital. Contrary to conventional wisdom, informatics is as much about sending information out as it is about gathering data in.
The more that CCGs can make local information concisely and readily available to its clinicians, the less time those clinicians will have to waste searching for it. The best CCGs will recognise both the size and significance of the problem, and deliver simple solutions.
Without doubt, the wrong solution is ‘death by IT’ – where information is distributed using email attachments such as spreadsheets, Word documents, PDFs and PowerPoint presentations.
True, the information is distributed in large amounts, but without any overall structure, and with no easy way of searching for the latest version. Most healthcare workers have no time to read these complex documents, never mind remember their contents. Indeed, delivering complex information in an unstructured form like this will increase the sense of information overload, not reduce it.
How the CCG can help
So how can the CCG disseminate this information more helpfully? It may be better to ask the obverse question: how can healthcare workers most easily gain access to specific up-to-date information at the time they need it? The secret is to structure the layout of information.
A popular solution will undoubtedly be using a password-protected part of the CCG’s website. It will be up to the CCG to ensure that the information presented is both easy to locate using menus, internal links and search engines, and invariably up to date.
Obeying the ‘Rule of One’ also helps greatly: have just one place to store each piece of information (e.g. ‘local GP formulary’). Now there is just one place to look it up, and one place to amend it, with no chance of users accessing an out-of-date document.
The next principle is not to send round changes to documents as email attachments: instead, send links to the original document on the website (and update this single document, as appropriate). By following the links users will invariably get the latest version of the document, rather than an out-of-date version attached to an old email.
It may even be worth your CCG starting a wiki. A wiki is a collection of information, self-assembled by its users, each of whom is free to add new information and edit existing articles. Wikipedia is the best known, but there are many others.
What if your CCG were to use free software to set up a wiki of local NHS information? The more it was used then the more comprehensive, the more accurate, the more up-to date and the more helpful it would become.
2013 will be a year of pressure. If your CCG can improve access to accurate local information it will save clinicians’ time, and increase their availability for other activities without lengthening their working day.
And that is something which is well worth doing.
- Dr John Lockley is a GP in Ampthill, Bedfordshire; clinical lead for informatics at Bedfordshire CCG; and clinical co-ordinator of the Midlands and East MedeAnalytics project.