Do Doctors read letters?

open forum
#1

Of course they do but when?

Also do computer systems normally process letters, store any structured content such as any actions in the letters?

What I suspect happens, if a discharge letter arrives at a gp practice, it gets stored and will be read when the patient next sees the gp. Any actions would be processed then.
However if it is a referral, the referral is actioned and the letter is read when needed.

Does this sound reasonable?

Why I’m asking:

From a technical perspective I can send a discharge notification as two ways: a letter and a notification. The letter contains the notification, so technically I dont need to send a discharge notification, the notification is also in the letter and the letter is a requirement. However if the discharge letter contains an action such as ‘review asthma medication’, should that be in the letter or should it be sent separately?

I think the principle I’m seeing is INFORMATION such as letters shouldn’t be used to pass ACTIONs (notifications?), they would record them. ACTIONS can contain or refer to INFORMATION (letters).
So if an ED sees the need for an asthma review, they send that as an ACTION, the discharge is sent as a NOTIFICATION and these are all sent as part of the discharge letter (INFORMATION).

#2

From interop point of view. The current way of solving the INFORMATION side of this is to use HL7 FHIR Dcouments.
This has origins in a HL7v3 standard called CDA.

The ACTION/Notification side of this is normally HL7v2 (but can be done in FHIR). It’s an old standard but that doesn’t mean its clinical role or purpose isnt required anymore.

#3

Hi Kevin,

I am long out of practice but your assumption is not correct for they way we worked, and I suspect how most GPs work.

A discharge or outpatient letter would be read by at least on of the docs on receipt (or close to receipt) and any actions, system updates required (Meds, allergies, problems) would be done immediately. In most cases the patient may never visit the practice. In many practices, trained admin staff would typically do the data input/coding.

To answer your question, the future IMO needs to be a mix of both - we still need some kind of encapsulated ‘document’ that clearly explains what happened but at least some parts of that document should trigger process support / coordinated / distributed care.

“So if an ED sees the need for an asthma review, they send that as an ACTION, the discharge is sent as a NOTIFICATION and these are all sent as part of the discharge letter (INFORMATION).”

Yes, though there is no particular reason that the discharge letter is physically sent, as long as it is available via the notification - as it is this that triggers the workflow in the practice. In the NHS Scotland National digital platform, I would expect (eventually) that the ‘letter’ would actually stay in the platform, and the GP practice would pull it from there when required.

@pacharanero - what’s your experience?

Ian

#4

Thanks Ian.
I did start with a misleading title :slight_smile:

It is the process I’m interested in. Human behaviour around long docs may factor in (TL;DR).

#5

Does seem to be better working practice to call out actions rather than embedding them in documents (Especially around structured actions)

#6

A lot of practices are now getting a member of the admin team to screen the letters to pull out urgent actions. Med changes etc. The letters then are only read if urgent or when the patient next consults.

Phil

Phil Koc, an

#7

Thanks Phil - that would have been my assumption but I did not have real-world experience to be brave enough to say it!!

#8

Do any of the Gp systems automatically process actions within letters.
I’m thinking not - too risky?
(Plus are structured actions actually being recorded in letters).
P.s. I have a reason for asking these questions. I want to propose an action and information system. Project looks like it’s setup for a fhir document

#9

No processing at all other than a workflow to ensure the domument is viewed so actions within it can be manually flagged. FHIR documents may be useful once the GP systems and interpret the I coming messages.

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#10

yes everything is stored in the vault along with your hospital card
this is done so that after the death of the patient, signs of a particular disease would be brought out from a young age

#11

i don’t think they always do. lol. i wrote a letter to my doctor openly discussing about meds i used and he didn’t even noticed it. maybe not everyone, but mine surely doesn’t read them.