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How can we make IT work for us?

Elaine Campbell
BSc(Hons) RGN DipN(Lond) NDN Cert NP
Practice Nurse/Practice Nurse Mentor
Hampshire

Practice nurses cannot have failed to notice the changes occurring in working practice because of the information technology (IT) revolution. The massive investment in new computer technology for Y2K resulted in many practices upgrading their systems. The benefits of embracing the new technology are ­enormous, impacting on our working environment, education, professional development and communication with others. But how many of us feel truly comfortable using the new technology?
There was a time (only recently for most) when prescriptions were written by hand (with all the errors in interpretation that incurred), item of service (IOS) claims were filled in monthly and sent by post, and audit required a manual search through patients' notes. The new technology allows information to be recorded and retrieved quickly and reliably - National Service Frameworks (NSFs) and clinical governance have increased the need for this when auditing standards of care. Nurses can now access databases with search ­facilities to aid research for their studies or find evidence supporting their working practice.
The next stage in the modernising process in primary care relies upon the use of electronic links and the information superhighway. The substantial investment in IT promised in The NHS Plan(1) is linked with the government's strategy document Information for health.(2) Targets have been set to link all practices to the NHSnet by 2002, with the ability to request and receive test results and book hospital appointments electronically. Patient records can now be kept in electronic form (the electronic patient record: EPR) without storing paper copies. These will form a key component of a patient's electronic health record (EHR) - a record of care from cradle to grave, which can be accessed from anywhere in the country 24 hours a day, whether in a hospital outpatient clinic, accident and emergency department or GP out-of-hours cooperative. 
Software packages, like those developed for NHS Direct, will be used in general practice and walk-in ­clinics by nurses performing triage, or as a tool to guide ­consultations. Telemedicine will be used to aid diagnosis and choose treatment options. The National Electronic Library for Health will provide access to latest evidence-based interventions, and training packages will be provided online so that students can study in a ­convenient location at a time suitable to them.(3) 
There are many obstacles in the way of this vision, not least the problems with incompatibility between different systems, but however long it takes it will be the future. A bigger challenge perhaps is that of getting users to understand and use the systems ­effectively, something that will require a substantial investment in training.

The internet
The main benefit of the internet is the tremendous scope it offers to access the wealth of information now published, as well as aiding communication with ­others. Practice nurses are a traditionally isolated group, sometimes working without a supportive ­management structure, and often geographically removed from sources of reference such as libraries. The internet has the advantage of being accessible from home - a big consideration for practice nurses, many of whom still don't have access to the NHSnet at work or else work for employers who are reluctant to allow either the time or facilities to access it at work. However, the huge volume of material now published makes finding your way around the internet a daunting prospect for those new to this medium. "Search engines" help with this process, as do dedicated ­nursing sites (see Resources). It is important to retain a touch of caution when dealing with information on the internet - remember anyone can post anything.

Email
This is the communication tool of the internet, and becoming familiar with its use opens up new ways of communicating with others. Major benefits include:

  • Being a way to contact people at a time ­convenient to both parties - messages are stored until the recipient is ready to retrieve them. This is ­particularly useful for nurses who cannot interrupt consultations to take phone calls, for contacting people in different time zones or at unsocial hours.
  • Documents can be sent as attachments - ideal for any written information you wish another individual to receive, such as minutes of meetings, draft copies of articles for comments, or updates of publications.
  • Communication can be made with people you would otherwise not have been able to contact directly. There is a degree of anonymity with email as your "address" gives few personal details.
  • Large numbers of people can be contacted ­together - the same information can be circulated to all it concerns.
  • Speed - messages sent electronically can arrive within seconds.

People will start to communicate with you via email once they are sure you will receive it. A good way of encouraging you to log on to retrieve your email is to join an egroup discussion forum. The practice nurse egroup is very active (see Resources).

The practice nursing website
The practice nursing website (www.practicenursing. co.uk) was set up by myself in response to the need for practice nurses to have a vehicle to communicate and share ideas and dilemmas. The "community" pages provide an active discussion forum where all topics relating to practice nursing are discussed. The "links" page is a crucial element of the site, providing easy access to sources of information of relevance to ­practice nurses and their patients. Students visiting the site can find answers relating to our role, ­responsibilities and working environments, and ­nurses ­wishing to pursue a career in practice nursing can get ­guidance on how to go about it. The site attracts many visitors from overseas and therefore has the function of demonstrating what the issues ­relevant to practice nurses in the UK are, allowing us to open channels of communication. The site is ­constantly evolving and relies upon the contributions of many interested nurses.

What part of the website do they visit?
The website is divided into a number of areas. The homepage is the usual first point of entry. However, the discussion forum (the community page) is the most accessed part of the website (see Figure 1). Links to other websites, general information and documents posted by other nurses are also heavily used. There is also a jobpage and guestbook, but these are not used as frequently.

[[NIP01_fig1_75]]

The future
A vision of the future shows a vast wealth of up-to-date information including electronic patient records, ­policies, guidelines, ­protocols, local and national ­contacts and databases, all available at the touch of a button. Communication will be enhanced by use of electronic links, and "paperless" practices may become a reality. Time ­currently spent on administrative duties will be more effectively used to deliver care. Taking advantage of training opportunities now will ease the transition into the new ways of working.

[[NIP01_pp_75]]

References

  1. Department of Health. The NHS Plan. London: HMSO; 2000.
  2. Department of Health. Information for health.London: HMSO; 1998.
  3. Ward R. Students net the benefits of technology. Nursing Standard 2000;14(46):28-9.

Resources
Practice nursing website
W:www.practicenursing.co.uk
Practice Nurse egroup
W:www.groups.yahoo.com/group/practicenurse
Internet resources in Nursing, Midwifery and Allied Health Professions (NMAP)
W:www.nmap.ac.uk
Primary Care Online
W:www.primarycareonline.co.uk

Further reading
Ward R. Internet skills for nurses. Nursing Standard 2001;15(21):47-53.
Lyons J, Khot A. Managing ­information ­overload: ­developing an ­electronic directory. BMJ 2000;320:160