Best surgeon in the world. Best patient care. Able, affable and available. Everything in your practice may be 'gold standard', but if you've not got the right administrative and I.T. back-up then it's likely that you're either going to fail, or you'll be incredibly stressed, or quite probably both.

Increasingly, doctors are forming 'groups', in the form of Chambers, Companies or Limited Liability Partnerships. In these situations, the ability to keep an accurate and reliable check on who is seeing who, who is booked for what, what work has been done, what has been invoiced for and what payments have been received is crucial. One of the main benefits of a group practice is the potential cost savings from economies of scale, and for this to exist efficiency is key in order to keep staffing costs to a minimum.

Several software products are available on the market to support the running of private medical practices. Making the correct choice of software supplier is a critical decision, and should encompass the following imperatives:-

  • the program must fulfil all the functions required for the running of the practice
  • the appropriate hardware must be available to run the software, the software supplier must be an established firm with a proven track record
  • there must be an excellent level of software and hardware backup and support, and
  • there must be the capacity for the system to grow and evolve as the practice develops.

I, personally, am fortunate enough to work in a group practice - 'The Northwood Orthopaedic Clinic', encompassing 'The Northwood Orthopaedic Clinic' and 'The Northwood Anaesthetic Practice'. When choosing our software and hardware suppliers, we identified the following processes that needed to be supported:-

  • a 'real time' diary and booking system,
  • full electronic patient records,
  • digital dictation facilities,
  • invoicing and accounting facilities, and
  • a detailed information management system.

With the partners in our practice working from at least four different hospitals / clinics, it was essential that we had fully functional remote access to the system for all partners from all potential geographical sites, with centralised secretarial support.

After extensive investigation of the various products available on the market in the UK at this time, The Northwood Orthopaedic Clinic opted for DGL IT's 'Practice Manager' Clinic Version, run on a server kept in our company office, with remote broadband access to all users.

Our experience to-date of this system has been excellent. There have, as expected, been some initial hurdles to overcome, although these have been largely due to other parties being slow to catch up or match the current 'technological revolution'! First, it is essential that wherever a consultant is practising, there should be easy, direct and reliable access to a broadband connection, for accessing the system.

Our biggest surprise in setting up and rolling out our I.T. system was in the seeming lack of I.T. infrastructure within some of our local private hospitals who, at the time, were unable to offer broadband access, let alone wireless networks. In some of these hospitals this problem remains, and has actually led to significant operational difficulties where some of our consultants have simply had to revert to the 'old fashioned' (labour intensive, inefficient and annoying) practice of printing off patient lists and details onto paper and dictating onto traditional tapes. The difficulty here is that one cannot then rely on electronic transfer of information, thus requiring time and effort to be wasted in support staff having to travel to physically pick up and drop off notes, letters, tapes etc.

However, in those clinical settings where broadband has been available, the system really has come into its own. The electronic diary and bookings system allows one to check all clinic and theatre slots real time, at any time. The 'patient correspondence' and 'electronic patient records' sections give complete access to all patient information, including scanned-in referral letters, progress reports and investigation reports, all previous GP correspondence and operation records, including imagery such as arthroscopy pictures.

Of particular benefit has been the ability to perform digital dictations. Using this facility, the consultant can dictate a letter in clinic immediately after seeing the patient. The electronic dictation file is downloaded directly into the Practice Manager system. A pop-up then informs the secretary in her office that a digital dictation is ready for transcription. The letter can then by typed and be ready for posting before the patient has even arrived home from their appointment.

From an administrative and managerial perspective, the system readily gives easy and direct access to full details regarding invoicing statuses, how many patients were referred from which sources, how much work each partner in the practice has done, and what the breakdown of that work is, in terms of medicolegal reports, clinic work, outpatient procedures, anaesthetics and inpatient surgical procedures. With a minimal number of clicks the system allows production of clear monthly reports on what work each consultant has done, what has been invoiced, what invoices have been paid to-date and what payments remain outstanding.

One of the fundamental, though less directly apparent, benefits of a robust I.T. infrastructure is the ability to prepare full accounts, which saves considerably on end-of-year company accounting fees.

Reliable support and back-up is essential. There is nothing more irritating that having to sit in front of an expensive shiny gadget that's not actually working and which isn't readily fixable. When choosing a software company it is vital that they are able to provide rapid access to expert advice. However, far from only offering just telephone advice, DGL provide a service whereby they can log-on remotely to your computer and deal with any problems themselves, directly. It's an interesting sight to see one's computer appearing to do lots of very clever things very quickly, with the mouse arrow darting around all over the place whilst sitting back comfortably in your chair watching. The I.T. support that we have received to-date from our software company has been exemplary and this should always be a key factor in one's choice of software firm.

Finally, no system is ever perfect or indefinitely ideal. I.T. requirements will change and evolve with time, as one's practice develops and as one adapts the functional day-to-day processes that underpin good practice. It is therefore crucial that whichever I.T. system you choose, with which to build the administrative and information management infrastructure of your practice, it must have the capacity to grow in harmony with your practice.

A number of the requirements that we have had for our system have been new and relatively unique to our group, due to the somewhat innovative structure that we have built our group upon. DGL has been keen and enthusiastic to actively assist in developing their product in close conjunction with some of our requirements, as there are clear benefits for both parties.

And what does the future hold? It is our vision that in the short term, the consultants in our group will be moving from digital dictation to reliable and accurate voice recognition software, thus reducing secretarial workload. Perhaps patients will soon even be leaving clinic with a copy of their clinic letter in their hand?! Integration of booking systems into website-based services is an area of considerable potential interest. As we move ever closer to Dr McCoy's practices (from Star Trek!), it would be nice to be able to do one's ward rounds with a tablet / slate PC, linked in fully to the system via wireless internet connections.

I strongly suspect that it will not be the technology nor the I.T. capabilities that will be the rate limiting factors!

Mr Ian McDermott MB BS, MS, FRCS(Tr&Orth) is a Consultant Orthopaedic Surgeon and Honorary Professor Associate, Brunel University School of Sport & Education. His contact details are:

The Northwood Orthopaedic Clinic, Bishops Wood Hospital, Rickmansworth Road, Northwood, Middlesex, HA6 2JW, UK

Tel + fax: 01923 678333