Why can't we access patient records on home visits?

Originally published in GP magazine .

Written for GP magazine around 2008. This is the version I submitted - the published article may have been edited.

For the subject of this month’s column I thought I would revisit a topic that I touched on in a previous one, namely mobile computing - or, more specifically, access to patient records while out on home visits.

Why is this important? Don’t the majority of consultations happen in the surgery? Aren’t GPs forever trying to get patients to come down? Well, home visits tend to be to the most ill and most vulnerable. Patients visited are often post-operation, very elderly, infirm or dying. Not only do visits occur in patients’ homes, but we also visit lots of nursing homes, elderly people’s homes and other institutions like bail hostels, children’s homes and homes for the long-term care of individuals with a variety of chronic conditions, e.g. head injuries, learning disabilities.

Why is it then that, with all the billions spent on IT, we haven’t a good workable solution to deliver good healthcare to these most vulnerable of patients? There is no access to lab results, prescribing records, hospital letters or old notes - most of us only take a summary printout if we know about the visit beforehand, and nothing if we get called to an emergency or asked to see an extra while there seeing someone else. We all carry mobile phones and bags full of stuff - why not something that allows us to look at the records or even input them? Let’s not forget the IMT DES and good clinical practice, as well as the lawyers, would have us record full, accurate notes contemporaneously. How many of us can say that for home visits? I constantly get reminded by reception to add them on - I’m convinced they think I don’t go. My normally brief consultations are usually even briefer, and luckily I have never been caught out.

I have therefore found it quite funny that, having repeatedly refused or at least not agreed to purchase a laptop for me for home visits, my PCT was more than happy for me to have one to do my PEC work. Although I understand it comes from a different budget, and there are only a few of us on the PEC compared to the hundreds of GPs and 53 practices, it just feels odd to the clinician in me that we are prioritising management over clinical care.

To be fair, over the years the IT department has tried various solutions, and I trialled at one stage a Panasonic Toughbook - never quite sure leafy Cheshire really needed its ruggedness. We used a mobile card and VPN to gain access to the PCT’s network and then to my practice. It was a 3G card that worked well when there was a signal, but when it dropped down to GPRS it was dreadful. It was also a nightmare if you went from home to home, as you had to go through the whole log-in scenario every time, and trying to explain to the patients the benefits got a bit tiring. It also worked particularly badly inside nursing homes and old buildings converted into EPHs.

A relatively cheap broadband link into each residential home, with a correctly set-up and secure wireless access point, would cost relatively little and surely give big gains to patient care. Why can’t it just be made part of the accreditation process for homes? It would soon get implemented.

EMIS, my clinical supplier, have never really sorted it either. They originally had a portable solution that downloaded to a laptop, then they moved to a PDA version that just wasn’t good enough; now they seem back on a portable download-to-laptop solution, which again is fine if you know who you are going to see beforehand, but not for emergencies. It could do with an over-the-air download facility to combine the wireless functionality but prevent you needing a constant signal. Also, at the moment it doesn’t seem to work with Docman, one of their partners.

Size is an issue. PDAs and BlackBerrys always seem too small. The laptop lent to me is quite large and would be difficult to use for visits. Recently our AD for primary care requested a small portable laptop for his work; requests were apparently denied, until it was pointed out they were the machines all the IT department used.

I have heard, though never had confirmed, that there is already a whole-of-Cheshire private wireless network for social services.