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10 points on using email and the Web in the Practice

By Adrian Midgley. First serial rights.

1 Computers are cheap

This year the capital allowance on IT equipment is 100%. Buy them with a network card installed, and preferably set up ready to go on your network, to reduce the hidden cost of your (practice's) time in setting it up.
Consider using an old PC in the waiting room as a public terminal.

2 Bring email into the routine you manage paper mail and telephone calls with.

If you accept email with any clinical significance then you must ensure it is handled. The same person who opens the paper post should deal initially with email to the Practice. eMail to individuals should go to their desks, or their secretaries' desks, and if they are on holiday should be checked in the same way their paper mail is checked. All common email client software (Pegasus, Ameol2, Outlook Express) allows an automatic response "Dr Midgley is away for a while, your email awaits his return, if it requires immediate action please resend it to admin@homefieldsurgery.freeserve.co.uk or telephone 01392 214151". Choose phrasing that doesn't matter to much if you forget to remove the autoresponse until a day or two after you return. VPOP3 and other post-office software such as the expensive and complicated Microsoft Exchange allow you to divert or monitor mail in ways more centralised within the Practice. If anyone offers to do it outside the Practice consider their track-record up to now in running IT.

3 Encrypt. eMail is postcards.

Make sure patients know this before entering into detailed correspondence with them, and get the program PGP (Pretty Good Privacy) installed. Unlike secret systems such as Red Pike, PGP is free of charge and has been inspected by the world's cryptographers and is believed to be secure. I installed it on several networks without trouble, but paying somebody to do it for you is sensible. PGP integrates with the email programs above, and can also be used to encrypt your hard drive, you might consider this for laptops with clinical information on them.

4 Put something back.

I propose a new professional obligation for GPs who are aware of the Web and equipped to use it. We should contribute. When I pursue information about a condition a patient has, if I am not satisfied by what I find on the Web - because it is absent, or hard to find, or poor quality information - and I find what I want in other ways, asking other doctors or looking in books or papers, I place my notes on the Practice website. This is a service to the next colleague who has the same question to ask, and is a signpost to my own patients who can either find what they should know on my site, or be pointed on from there to other resources I regard as credible. Stopping sites we do not agree with is neither feasible nor desirable. It is sensible to point our patients where we have found it worth going.

5 Read "Weaving the Web" by Tim Berners-Lee.

He is the Englishman who invented the Web and still heads the consortium that guides its development. The book is very readable, not technical, and in the same mould as "The Double Helix" by Watson and Crick and "The Blind Watchmaker" by Dawkins. Where Berners-Lee writes "CERN" mentally substitute "The NHS" to understand much about how IT policy _should_ be done. I bought my copy on a station bookstall, but you might like to use an on-line bookstore like http://www.bookshop.co.uk/ for yours. I prefer you not to buy from amazon.com as I disapprove of their un-web-like behaviour in attempting to patent trivial bits of web design and prevent others from using them for the benefit of all consumers. If you have a Doctors.Net account, going from there to that bookshop saves you a few percent.

Read "The Cathedral and the Bazaar" at http://www.tuxedo.org/~esr/writings/cathedral-bazaar/cathedral-bazaar.html to see how to ensure we have good general practice software.

6 Manage your boundary.

I use a program called NearSite from a Southampton firm to give quick and cheap access to the Web to all machines on the network. It cost £30 and is available like all good software for a month's free trial. Novell and Microsoft both produce much heavier-duty "proxy-caching" software. The ultimate in this is a Cobalt Qube, a very pretty blue computer which sits on your network and does all your mail and web work, it runs a proper operating system, Linux. Any of these approaches give you a quicker response when you ask for a web page. Although ISDN is much faster to start than a modem, some border caching is a good idea. Without it several GPs sharing a single ISDN line could find it slow at coffee time.

7 Appreciate the Penguin, and the Gnu.

- FSF

Open Source software is more reliable than secret source, this is why most of the Internet actually runs on Linux and Unix not on Windows. Keep it that way.

8 eMail and Web pages work together.

Discourage people from sending big documents to everyone, instead have them send a one paragraph email saying what the document is ("The Locality Implementation Strategy draft is now available for comment, this should give you an idea of what the NHS' five year plan for IT is for the next six months") and including the URL where the document itself is so that anyone who wants to read it can do so. The Government is moving rapidly this way having announced that Health Service Circulars will now be placed on the Department of Health website (www.doh.gov.uk/ ) and Chief Executives will receive a short email...
It is also worth registering certain Web pages with a robot which alerts you when they change.

9 Opera is a better web-browser than Internet Explorer or Netscape and particularly suitable for working doctors.

10 House page.

Have a home page on your own desktop, or on the Practice's internal web-server, which has your most commonly used sites and correspondents on it. This saves time. Mine has the BBC and Dilbert on it as well as Cochrane.

VPOP3 is a British program favoured by the digerati and a trial version can be downloaded from www.pscs.co.uk It far more closely approaches most practice and home needs than does MS Exchange Server.