Occupational health and IT

Is IT boosting your efficiency as an OH professional? Technology has had a dramatic impact on the way that many OH staff carry out their role, helping streamline workloads as well as recording and providing evidence of the effectiveness of the occupational health function within an organisation. Key areas IT can help with are data capture for absence management, and boosting efficiency, consistency and productivity by automating OH processes such as generating reports. But getting to this point is not easy – and introducing a paperless IT system can be challenging in itself.

For some organisations, the answer is to develop an in-house system which is exactly tailored to their needs. Axa Healthcare PPP went down this route in 2003, when it developed the Workflow system for all its OH nurses and professionals. Minor improvements have been made over the past five years, including modifications to screen design and ease of access when reading and retrieving documents, but overall the system has worked well, says managing director Dr Mark Simpson.

If IT is to make OH staff more efficient, organisations need to be clarifying their needs as well researching the market and looking at the latest innovations. The size of the organisation, range of locations and number of staff involved all need to be taken into account,” Simpson says.

“The way that organisations use IT for their OH departments varies widely,” he says. “Some systems may be fine for the OH department of an organisation, but far less useful for the commercial provider of OH services.”

Once in situ, a system like this can act as an automatic ‘clinical audit’, because the organisation is recording all routine transactions, making it easier to compare the performance of OH staff and set benchmarks. This is not about becoming a ‘Big Brother’ organisation, Simpson points out, but about developing consistent systems and helping staff improve with training and support.

“For example, we have a large number of employees who work from home, and we use our system as a platform for this. Staff can be reached via the same switchboard, wherever they are.

“Using our IT system, we can look at how long it takes staff members to sort out each case. If it takes three phone calls to make an appointment with one employee, the system will record this. And we can see how long different staff are taking to sort out a GP report. It’s all about making sure that clinicians are behaving consistently.”

Challenging move

Making the transition to IT can be challenging. All new documentation at Axa PPP is ‘imaged’ and held on the computer system. The company threw out 80 filing cabinets when the system was introduced, and staff are encouraged not to print out documents unless it is really necessary – when dealing with a particularly complex case, for instance. For most cases, holding information on computer can make collaboration and sharing expertise much easier – clinicians can look at the same case on different PC screens, for instance, and confer about the best approach to take.

The paperless approach has transformed the way that Axa PPP works, says Simpson. “It has made the offices more pleasant to work in, increased our capacity, led to a quantum leap in management reporting, and made our systems more efficient. We can’t close a case until we have filed an invoice, for instance.”

For Jo Henderson, solutions consultant with Tempus Software, small changes such as incorporating raising an invoice into closing a case can make a huge difference to the efficiency of OH staff.

New developments available from Tempus include virtual reception functions, which enable staff to log themselves into the system, so they automatically know that they are waiting to be seen, and text messaging services which remind employees to attend OH appointments – hopefully cutting down on the number of DNAs (Did Not Attends), who are a continual drain on the productivity of OH.

Tempus supplies Cohort, a system used by a number of NHS trusts as well as National Air Traffic Control and British Nuclear Fuels. Its features include the automation of health surveillance recalls, a diary function which enables OH staff to look at a number of diaries simultaneously, and also tracking staff with more than one job or who work part-time on one part of the system. Cohort is one of the oldest systems available, and is based on the Sandwell System, which was originally introduced 20 years ago.

One user of the system is Imperial College NHS Trust which was set up last year following the merger of St Mary’s NHS Trust, Hammersmith Hospitals and Imperial College London Faculty of Medicine, and is now the largest trust in the country.

The trust uses technology for booking routine appointments, recording immunisations, pre-employment health clearance status and other basic service data, as well as monitoring the clinical outcomes of assessments such as the disease/system and work-relatedness of conditions, the duration and appointment range of those refereed by managers, clinical care pathways and assessment questionnaires.

“We also use IT to monitor key performance data such as the turnaround of health questionnaires and appointments following referral, and to produce periodic reports to show compliance with these key indicators,” says clinical health leader Paul D’Arcy.

“And we use the system for clinical audits such as monitoring compliance with immunity checks for healthcare workers or deviation from care pathways.”

Easy access

As well as boosting efficiency by recording data and helping provide ongoing information about absence, systems like this can be linked to the company intranet. This makes it easier for staff to access health-related information. D’Arcy says this is a useful feature of the system used by the trust.

“We have a well-established intranet site for trust employees and managers, which is intended as a one-stop source of advice and includes policies, procedures and toolkits on a broad range of OH issues, and also includes downloads of the latest information leaflets and forms,” he says.

“Some OH data is shared with HR staff, using a shared drive which gives HR near-live information about pre-employment screening outcomes. And many of its forms have been designed for electronic completion and return.

“The IT systems are a valuable tool for monitoring our performance and getting evidence of the clinical effectiveness of the OH team,” D’Arcy adds. “Some of the assessment tools and forms are valuable in ensuring that certain conditions are assessed in particular ways – this is because we aim to create these tools using recognised clinical evidence to back them up.

“Also, by moving to a paper light model of service delivery we are trying to ensure that most (hopefully soon all) patient information is in one place.”

But no system has so far relieved OH professionals of all their routine chores, as D’Arcy points out. “We’ve often asked ourselves how IT can address some of the very real and boring problems of everyday life in an OH service and how it can save our team time for other tasks,” he says. “The systems are often time-consuming to set up and rely heavily upon the IT know-how of a small number of people. However, once set up, they are often very simple to use.”

He believes the key is to be clear about what you need, and not to be persuaded by whizzy innovations.

“Don’t be afraid to experiment,” he says. “Try using dummy patients to see if systems are effective. And I think that OH professionals should choose their own IT system after deciding well in advance what functionality they require, rather than settling for the cheapest or glossiest-looking product that may not fit their needs.”

To get the most out of IT, OH staff need to be clear about the nature of their organisation and the range of activities carried out, as well as the exact functions they are looking for to do their work more effectively.

Robert Dunn, senior occupational health adviser/operations manager at the University of Oxford Health Service, has switched from using the Cohort system to the Opus system supplied by Warwick Systems. He says that while both have their strong points, it’s essential to do an organisational audit before deciding on any IT system.

Flexibility and adaptability are vital, says Dunn, and he welcomes the fact that the system he is now using can to some extent be customised by OH staff to suit their needs.

“Our system works on the principle of episodes and events,” says Dunn. “You can break down an OH function into different events and record each one, which goes to make up a sequence. This means you have a very precise overview of what OH staff are doing, and of your organisational needs in terms of OH.”

The context in which OH staff are working is as important as the role that they are carrying out, stresses Dunn. Some systems may be more suitable for NHS hospitals and trusts which carry out a specific number of specialised functions, whereas large academic institutions carry out a huge array of diverse activities, and may need to add to these at short notice. Oxford University employs some 20,000 people altogether, including around 8,000 post-doctorate researchers, working across a number of sites.

“For an organisation with such various needs, the system has to be dynamic,” says Dunn. “And accuracy is the name of the game. If you can’t prove what difference an IT system has made to your activities, then you can’t demonstrate the difference you have made. Also, you need to have these statistics at all levels – departmental, managerial, supervisory and so on.”

This is more than simple “data capture”, Dunn believes. “The system has to be capable of regurgitating data in statistical form. Data capture is important for clinical governance, decisions made and outcomes of treatment. But this is not just a matter of capturing data – it’s about manipulating data and providing meaningful information based on that data.”

Technological advances

Having used its in-house system for five years, Axa PPP is now looking at introducing a totally new system. This need has arisen partly because Axa PPP has recently acquired employee assistance programme (EAP) provider Icas. “We need to bring a totally integrated healthcare provider to the market,” says Simpson. “And we need to have more security on this system, as EAP counsellors are very sensitive about issues of confidentiality, but we still want to record our other interactions.”

So what will the new system offer to the company? Simpson wants a more intuitive approach and greater ease of use for clinicians. “One point is that we want a system that requires fewer clicks of the mouse.”

And the organisation has learned a lot from its experience. Not least that getting OH staff to use IT effectively takes effort and time – and that teething problems are inevitable.

“If the problem for your organisation is that OH staff are operating in silos, then bringing in an IT system to sort that out is the worst thing you can do. Communication needs to be good before you make a switch to IT, because the first three months will bring a lot of challenges,” Simpson says.

“For example, when we first introduced our system, we had problems because the information we had imaged was not being filed in the right place. You need to be able to tough out any problems. If your organisation isn’t ready, then a new platform will not make you more efficient – it will accentuate the difficulties, particularly in the early stages.”

IT advantages

As well as helping OH professionals to perform their role more effectively, IT is also being used to help communicate the wellbeing message to staff. Arguably, this will remove another chore from the OH ‘to do’ list. If wellbeing programmes are accessible using IT, they are less likely to be added to the workload of OH staff.

One such platform is Bupa’s Positive Health tool, launched last summer. Marco Bannerman, head of intermediary sales, Bupa UK health insurance, says: “Employees complete free online assessments to determine their current level of health and wellbeing. The assessments consider the four key health and wellbeing areas known to impact performance at work – namely, nutrition, fitness, sleep and stress.

“They can then develop a plan to help them achieve their personal health aspirations. Information and e-mail updates are provided as support to help ensure staff achieve their goals.”

Bannerman believes that technology can not only take the hassle out of employee health promotion, but also make healthy working more accessible. “For example, Bupa Positive Health gives employees of all shapes and sizes access to online health and wellbeing assessments, together with information and advice on work-related and general health issues.

“Other key advantages from this technology are that employees can access the system 24/7, at home or at work, with a guarantee that their individual information will remain confidential – factors we believe encourage individuals to take more responsibility for their health.”

The health assessment tool offers free online health assessments to existing users of its services, plus information and advice on work-related and general health issues. The technology behind the service is provided by health and wellbeing consultancy Vielife.

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