Collecting data to improve quality

We are a husband and wife team working from several locations in Cumbria – I have been in practice since 1987.

For 20 years we have been using our own home-built software to help us collect data for purposes of clinical audit. Data is based on online and written patient questionnaires, which help us to identify areas needing evaluation or improvement.

For everyday use, we use written case histories in clinic, and then we simply record patients’ names and details in our Software programme – http://www.crystalsolutions.org – when we get home at night, and click the accounts tab, to input financials (which we use at year end). This only takes a few minutes once you are ‘au fait’ with the software. When we wish to audit — we input more details for each patient for a given timespan (two months, six months, one year — your choice).

The benefit of using software (in addition to paper case histories) is that one can search for criteria other than alphabetical names (the only real sort option available with written notes), as well as combining searches, and grouping conditions and/or treatments, age groups etc. So it is possible to search female patients of certain age groups with neck symptoms and assess results, or search for RTI. The choice is vast, as the programme can store more than 100 different fields of information per patient, which is all well and good, but for the time it takes to input.

This is why we have been developing and evolving the software for some 20 years, to provide quick input; the programme uses drop and tick boxes and already edited fields, to auto paste common descriptives, all to allow for quick entry. For example, telephone codes — three of our local codes are set up so that one button inserts the code, and all we need to do is to type in the number. The same is used for many fields of information such as practice locations and conditions that can be chosen from editable drop down menus.

When I have been asked about the software in the past, I have often begun with extolling the magic new re-discovery of the product you can put behind your ear, the one which works upside down with no battery and can also erase text. However, the use of a 50 pence pencil/biro is unbeatable in practice and we use pre-printed A4 case history sheets, customised to remind us of what is required for good case history taking and treatment recording (we have recently added “Consent? are you happy for us to continue” as an aide memoire to continue to seek this throughout the consultation).

Years ago I tried inputting data in the clinic direct onto the computer/tablet, but was unhappy that I was having to look away from the patient — it really is a distraction as far as I am concerned, and I loathe the GP eyeing their screen all the time — so that experiment lasted only a few days.

It was then that we really evolved our software to be able to quickly input details, when we got home in the evening – albeit tired. We also had several practices at the time, and it was useful to be able to sort out the different practices. Typically we can input data in under 5-10 minutes. The programme can also then be used at home to find a phone number of a patient at a different practice for example.

If an audit is undertaken, and we find a group we wish to examine closer, we can then refer to the definitive relevant hand written case histories in the practice, if we hadn’t inputted sufficient data on the computer. If the required data has been inputted then the task is even easier and we can then ascertain that say 70%+ of the sample female neck group with whiplash symptoms, derived 60% or more improvement in symptoms. We might then look at the 30% who didn’t get any benefit and see if there were any common signs or omissions or treatment failures — i.e. where we might update and improve our skills in this area.

If you already have practice software, you will probably be able to use it like this (i.e. in conjunction with written notes) to complete an audit on say treatment approaches and outcomes. If you haven’t, you are welcome to try our software, which is free to download and allows for 35 records to be used, before requiring purchase (you can even delete those records if you wish and trial another 35).

If you have any difficulty using the software we can help you over the phone or Skype if needed. At present the last version is probably six or seven years’ old, works on windows and mac desktop machines, but not so well on tablets and phones (only apple  IOS) — I keep meaning to bring out a dedicated IOS version but time … ;

Without doubt collecting such data has improved how we treat out patients, not only helping us to learn about our strengths and weaknesses, but identifying areas of focus for our CPD.

You can email me at: jol@crystalsolutions.org