A system to follow up patients after emergency treatment?

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sun, 08 Apr 2018 16:41:59 GMT

[quote user="Michael Woodhouse"]Give me 1 single example of how ^{this could ever happen (and the animal and owner details are known)? I call bollocks.[/quote]}

^{Only way, I suppose, is to wait and see. Diabetic coma?? Addisonian?? "Ascites" [but following a FUS "cathetisation"....] certainly others will quote better hyperthetical advantages.}

^{What, exactly, are the clinical disadvantages; I can't think of any!}

PMSs are password protected which could be issued to OOH vets?

Must be better to have a recent history with pretty well any animal presented, even routinely , which I suppose, is the reason for any recording of any case notes ever?

RE: A system to follow up patients after emergency treatment?

Michael Woodhouse — Sun, 08 Apr 2018 15:47:33 GMT

[quote user="Anthony Todd"]No doubt they are but, sooner or later, there will be an incident where, because the animal's history isn't known and the presented animal is in dire straits the sensible treatment, without the history, results in a death people will hopefully realise that ways around vital data access should be found.[/quote]

Give me 1 single example of how this could ever happen (and the animal and owner details are known)? I call bollocks.

How many people die from ambulance and A&E treatment without a full history from the GP, even if patient found unconscious and unidentifiable?

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sun, 08 Apr 2018 15:40:40 GMT

[quote user="Martin Atkinson"] The penalties for allowing someone's date being let loose into the wrong hands are stratospheric.[/quote]

No doubt they are but, sooner or later, there will be an incident where, because the animal's history isn't known and the presented animal is in dire straits the sensible treatment, without the history, results in a death people will hopefully realise that ways around vital data access should be found.

A MRCVS is hardly a wrong-un and would he or she risk a career for an illegal data access?

But, hey-ho, these days common sense and obvious solutions are always trumped by theoretical illegality!

RE: A system to follow up patients after emergency treatment?

mariette asselbergs — Sat, 07 Apr 2018 19:23:28 GMT

Yes Martin, allowing your date being let loose in someone else's hands is probably a scary idea

RE: A system to follow up patients after emergency treatment?

Martin Atkinson — Fri, 23 Mar 2018 13:12:13 GMT

In reply to the OP, I've never been asked and hadn't considered sending follow up histories to OOH providers.

In reply to Anthony, besides giving third parties access to you PMS being an exceedingly high risk strategy, it will become even more problematic when GDPR regulations become active in May. The penalties for allowing someone's date being let loose into the wrong hands are stratospheric.

RE: A system to follow up patients after emergency treatment?

Julie Innes — Fri, 23 Mar 2018 12:59:43 GMT

I would be happy to do that, Mariette! It wouldn't take a lot to save some follow up history and send it, and I think it's a great idea! It would allow our OOH providers to see outcomes and improve their service accordingly as it would allow you to get more of a "feel" for different practices.

RE: A system to follow up patients after emergency treatment?

Gillian Mostyn — Fri, 23 Mar 2018 06:53:59 GMT

[quote user="Anthony Todd"]Yeah, but you take the time to send them your history of their patients so the least they can do etc. etc.![/quote]

Which they will be paid well to do. OOH services are not provided FOC to user practices.

I would be happy to email over any specific histories to an OOH vet..they could just email us a request. I wouldn't really want staff having to sit down to go through all cases seen OOH to pick out which ones have actually needed further treatment and then email them onwards. I suspect most of those emails would just end up in trash anyway?

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Thu, 22 Mar 2018 23:36:44 GMT

[quote user="mariette asselbergs"]Both of the above involve quite a bit of personal time and effort[/quote]

Yeah, but you take the time to send them your history of their patients so the least they can do etc. etc.!

RE: A system to follow up patients after emergency treatment?

mariette asselbergs — Thu, 22 Mar 2018 23:27:19 GMT

Thanks everybody for your contributions.

Anthony we had a computersharing option with one (group) of practices. It was called "teamviewer" and it worked for voyager (Jupiter). It was brilliant because not only did it give us access to the case's previous history when presenting, it also gave me the option of checking what happened in the following 4 weeks after they saw us. However, I think we had it on a guest/trial basis and I think it turned out to be an expensive option for the userpractice to continue with it.

The telephone option is of course there, but that is only so for the odd exceptional case, for the simple reason that my working hours do not coincide with the working hours of the user practice. I would have to phone in the daytime when I have no access to our practice computer. In large practices there is the additional problem of not knowing who would be best to talk to about the outcome of a case seen.

Both of the above involve quite a bit of personal time and effort for each individual case. (Which I don't mind at all for particular interesting cases).

What I was looking for is a system where this would be (almost) automatic, so that we could audit the outcomes of the cases we see. For EBVM (Evidence based vet medicine) this is a basic requirement. I can imagine something like us sending a list of cases to each userpractice once a month, on which we would like to have follow up clinical history. And what I was hoping to get from this forum was an idea about the willingness of userpractices to spend the extra time doing that. I have at least got two opposite answers: Bob who seems to be happy to do it, and Michael who would not want to spend the time except for exceptional individual cases. So I suppose my next step will be to contact all of our userpractices and see how far they would want to accomodate.

Mariette

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sun, 18 Mar 2018 09:35:25 GMT

[quote user="robloxley"]What do you think OOH services currently send their client practices??[/quote]

Er. sorry, got carried away with senility and recent memory loss.

RE: A system to follow up patients after emergency treatment?

Rob Loxley — Sat, 17 Mar 2018 18:20:33 GMT

[quote user="Anthony Todd"]I suppose even easier for the OOH service would be just to write the notes in an email which could be easily copied and pasted into the pet's notes the next morning[/quote]

What do you think OOH services currently send their client practices??

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sat, 17 Mar 2018 16:46:39 GMT

Sorry, I was thinking about getting a occasionaally vital history late at night from the usual practice, not retrospective notes or outcome, which I agree, can be done easily wih a phonecall.

I suppose even easier for the OOH service would be just to write the notes in an email which could be easily copied and pasted into the pet's notes the next morning [or even the complete page from the OOH's PMS?]

RE: A system to follow up patients after emergency treatment?

Michael Woodhouse — Sat, 17 Mar 2018 16:16:49 GMT

To an extent the lack of follow up has to be something you live with if you decide to work in one of these OOH service providers. If following up patients is really your thing then find a job in a practice doing its own OOH work.

I really don't see remote access as a solution, especially when we consider all the data protection laws. My personal view is that histories are vastly over-rated in their usefulness by the profession and if I know current meds I will almost always base a plan (in an emergency situation) on the condition and investigation of the animal in front of me. The NHS seem quite happy treating people by the ambulance service and in A&E without the date of the last booster and details of the nail bed infection from 2006.....

I wouldn't really have the time, nor the inclination to keep providing feedback on cases to an OOH service provider, other than in pretty exceptional circumstances. There are better things to spend my day doing, especially if I chose an easy life and contracted that work out to a 3rd party.

RE: A system to follow up patients after emergency treatment?

Marie Kubiak — Sat, 17 Mar 2018 16:05:10 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]I think setting up remote access to a computer would be a really bad idea as you wouldn't just be giving access to the practice management system, but to everything on the computer.[/quote]

I would be very surprised if the remote access wouldn't, or couldn't, be limited to the PMS which would, at the most, only allow access to the clients financial record.

All the OOH vet would have to do is get permission from the client to have the ability to access the client's financial record [which may be helpful, if you think about bad debtors...]

The advantages of having the actual verbatim animal history, pictures of X-rays lab results etc. etc. must outway the hypothetical danger of access to the financial details of the client.

Gee, everyone thinks of reasons not to do things these days!!

[/quote]

This is not what the OP was looking for - she wanted feedback on cases AFTER seeing them, not medical histories.

Following your tangent though, although I agree it would be lovely to have all the information immediately at your fingertips when seeing an OOH case, it isn't practicable. When you consider the plethora of PMS out there and the individual software required for each one, not to mention that some aren't compatible with some computer systems, individual licenses are often needed for each computer running the program... and that an error by an unfamiliar user may mess up data/finances/client details for the primary practice there could be some spectacular fallouts! When in practice I recall sending clinical histories over to the OOH service if there was a current patient that was at a higher risk of needing to be seen, for other unpredictable emergencies clinical history becomes less pertinent as they likely won't have been seen for the emergency condition before.

Marie

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sat, 17 Mar 2018 15:14:04 GMT

I would be very surprised if the remote access wouldn't, or couldn't, be limited to the PMS which would, at the most, only allow access to the clients financial record.

All the OOH vet would have to do is get permission from the client to have the ability to access the client's financial record [which may be helpful, if you think about bad debtors...]

The advantages of having the actual verbatim animal history, pictures of X-rays lab results etc. etc. must outway the hypothetical danger of access to the financial details of the client.

Gee, everyone thinks of reasons not to do things these days!!

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sat, 17 Mar 2018 14:31:11 GMT

Sorry to turbo but we did it with the branches, mainly for the manager to sort out the banking [addition is a problem for some] but also to look at every aspect of the branch computer and the notes if needed.

I can't believe that there won't be an easy way for OOH services to be given a password to the PMS, log on and look at vital histories and write vital notes.

Got to be the most effective way to get and receive [critical] patient information.

We certainly did it with NO linked connection or central server mainly because when the main server goes down the whole practice is down, so no nothing!

TESCO's main server failed in Hemel Hempstead and the chaos had to be experienced to be believed....

As I said, search "remote access"....

Also oral information transfer could be flakey, and certainly wouldn't stand up to litigation ["I told them I had already given X units of long acting insulin. The vet was operating so I told the nurse, no I didn't get her name"]

RE: A system to follow up patients after emergency treatment?

Clare Tapsfield-Wright — Sat, 17 Mar 2018 12:22:51 GMT

[quote user="Anthony Todd"]

[quote user="Clare Tapsfield-Wright"]In the olden days[/quote]

Back then there'd be sweet FA chance of getting the vet, and even now, not many vets, I wager, will be at their practice waiting to answer a call from anyone.

They won't remember the details of some pet they didn't see after the booster last year....

Google has 15million links and loads of programs to do it.

PS [even better] the "night vet" could even write his/her notes straight onto the animal's notes on the actual computer of record......

PPS The night vet would have access to the patient's notes so a vague "history" would become crystal clear!

[/quote] Well the OP was referring to cases they had just seen and treated overnight or weekend as an emergency, and they would not be asking if they were not significantly interested in knowing the outcomes. I accept times have changed but would still argue that more information would be exchanged in a quick verbal case discussion between colleagues than permission to access a clients records at another practice which would be a legal and logistical minefield I suspect.

Named vets at both ends would be a good idea to ease communication and discussion which would also count as reflective CPD I would have thought. I assume this is about complex cases, not just the odd bout of diarrhoea or a cat bite.

RE: A system to follow up patients after emergency treatment?

Thomas Johnson — Sat, 17 Mar 2018 11:32:01 GMT

[quote user="Anthony Todd"]

Allow remote access to you referee's computer systems?? eg

Google:"how to remotely access another computer over the internet".

We had it so the manager could access the PMS at the branches and navigate to the clients records.

[/quote]

I think setting up remote access to a computer would be a really bad idea as you wouldn't just be giving access to the practice management system, but to everything on the computer. I wonder if in the future as more practices move to cloud based practice management systems it might be easier to give out of hours centres access to limited information, i.e. enough client information to identify the patient, clinical notes, but not financial information or full client details.

RE: A system to follow up patients after emergency treatment?

Bob Russell — Sat, 17 Mar 2018 11:31:05 GMT

We keep our referral practices updated with progress wherever possible. I assume they like to know the progress of cases just as I want to know how things are going while referred.

More difficult with OOH services as we don't actually know the clinicians particularly well but would happily keep them informed if they request it.

I would be happy to allow access to notes from a particular OOH provider as long as this is secure and limited to read only for patient history.

I am sure it will come eventually but cannot see it happening any time soon. Perhaps the owners will end up in control of the notes if the regulations keep getting tighter and tighter on data protection. That will not be a good day IMO!

I also agree that it is rare that an OOH clinician cannot work out what has been given but I make sure that owners know as much as possible within their level of comprehension. Some will be told antibiotics and a non-steroidal antiinflammatory. Others may know more specifics.

Not really answered the OP but perhaps include contact details with any report and ask to be kept updated. I would be delighted to see this level of interest!

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Sat, 17 Mar 2018 10:52:19 GMT

[quote user="Clare Tapsfield-Wright"]In the olden days[/quote]

Back then there'd be sweet FA chance of getting the vet, and even now, not many vets, I wager, will be at their practice waiting to answer a call from anyone.

They won't remember the details of some pet they didn't see after the booster last year....

Google has 15million links and loads of programs to do it.

PS [even better] the "night vet" could even write his/her notes straight onto the animal's notes on the actual computer of record......

PPS The night vet would have access to the patient's notes so a vague "history" would become crystal clear!

RE: A system to follow up patients after emergency treatment?

Clare Tapsfield-Wright — Fri, 16 Mar 2018 20:42:43 GMT

In the olden days we would lift a strange thing called a telephone and ring and ask to speak to the vet who we referred the case to or vice versa they would ring us to see how the case recovered post referral . It worked quite well and we learned a lot . I will always be grateful to Andy TorringtOn and David Habin in particular because they were so generous with their time and knowledge and never made you feel small .

RE: A system to follow up patients after emergency treatment?

Rob Loxley — Fri, 16 Mar 2018 19:54:20 GMT

[quote user="grumpyoldman"]Not sure how that sits with data protection ?[/quote]

If your pet records are purely pet records then do they come under data protection legislation.

We did look a while ago at providing our OOH service with a remote login to our system giving read-only access to only pet clinical history.

Maybe the answer is to give the client remote access to their own pet's records?

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Fri, 16 Mar 2018 19:47:45 GMT

Why, oh why,do people always think of the downsides, or the ridiculously hypothetical, in a possibly emergency situation.

Does it matter that the owner paid £x for a booster 9 months ago!!??

You're faced with a collapsed animal, at midnight, with only the neighbour or a history ignorant relative presenting a collapsed animal that's "been to the vet a lot" and someone is worried about data *ucking protection!!

Just follow it through to see whether any vital information iwould be, actually, on the referring vet's computer.....

Someone with common sense should realise this, surely!

Meanwhile, just supportive treatment or vague [no history] tests until the practice opens at [often at 7 past 9am.....

RE: A system to follow up patients after emergency treatment?

grumpyoldman — Fri, 16 Mar 2018 17:39:14 GMT

Not sure how that sits with data protection ? Frankly not comfortable with none specified 3rd parties having access to our financial data unless there was a method to restrict access to clinical information only. If someone was wanting case histories for casebook follow ups etc they could just ring and ask while the suns out.

RE: A system to follow up patients after emergency treatment?

Anthony Todd — Fri, 16 Mar 2018 17:33:40 GMT

Allow remote access to you referee's computer systems?? eg

Google:"how to remotely access another computer over the internet".

We had it so the manager could access the PMS at the branches and navigate to the clients records.