My Morning Routine
Every morning when I get into work, the first thing I do is go through all the patients for the day using Topbar. It takes hours- probably 2 hours (that is for 10 doctors) if I am honest, depending on how many doctors are working. A good day is 1 hour (when about 5 doctors are working). And this is after 18 months of doing this daily so I am pretty fast! I have worked out it takes me about 15 minutes per doctor to do through their patient list for the entire day. So why do I torture myself with this tedious task every morning? Well, in short, it is amazing! And it is FREE through your local PHN!
Here’s a video that explains Topbar:
Do I use Cat4?
Pencs offer another popular tool amongst General Practice called Cat 4 (previously called Pencat). Now I really only use this to send deidentified data to PHN or do find a specific set of patients. I don’t find Cat 4 to be as useful as Topbar. However, for the recently released PIP Quality Improvement will definitely require the use of Cat 4. Topbar is an excellent tool for identifying data gaps on particular patients and MBS opportunities. Every practice is different, and I am just sharing what works for us.
Our opportunistic strategy works
The reason our practice loves Topbar is that we don’t find recalling patients (which you can do either on the phone or letter) for routine health assessments to be very effective. Honestly it becomes an extremely laborious process with a low response rate.
We prefer to do these opportunistically on the day they came in to see the doctor about something else. Obviously the nurse will ensure the doctor and patient agree to having their health assessment (for example) before they get started. If it doesn’t suit the patient, we schedule the assessment for a day it does suit. However, we find 8 out of 10 patients are happy to have it done on the day.
If the patient would prefer to do it another time, we reschedule for their next visit. Or we put a note in Pracsoft in the messages section and a recall in our clinical software. But in summary, the spontaneous approach works for us. Even though it takes a lot of time for me I think doing Topbar daily works out as much better effort = extra billing = improved patient care.
The Topbar Process
So every day I start at the beginning of the book and open up each patient chart’s in our clinical software with MD open. I don’t really focus on the demographic information that is missing and I let reception worry about checking this when the patient arrives.
The Opportunities we focus on
Topbar identifies lots of opportunities but I look for the following specific opportunities:
Patients who need their chart update
Patients who need their chart updated, must be missing multiple areas i.e. height, weight, BP, allergies I try to select patients with 4+ areas before I flag it for the nurse to update. The reason why I say multiple areas is that I see little value to update their waist circumference when everything else is up to date.
This can be fixed at a later date when the other measurements are out of date. Obviously there is no financial benefit to simply updating charts but as we are accredited with AGPAL we need to hit certain minimum thresholds. So I mark them up and the recently introduction of the Quality Improvement PIP has made this even more important.
I use the blood pressure symbol to mark these up as the nursing team know that means it is non essential task to do if they have time. 99% of the time they still get to these but they know if something urgent comes in, it doesn’t have to be done.
For essential tasks for nurses, we use different symbols. Also if it is a slow afternoon, we have one nurse sitting in a consultation room with Topbar open. The nurse just calls in patients who need their chart updated and does this all afternoon. We find that works well too.
The nurses really like Topbar as it provides a visual prompt to remind them of the areas they know they should be updating but sometimes forget when they are busy.
Patients who need a Health Assessment
Patients who are due to have their 75+ or 45-49yo Health Assessments, I mark these up with a Fasting symbol. There are limited symbols in Pracsoft it is Control F if anyone was wondering. If an over 75+ wants their Drivers License done, we will always do their Health Assessment on the same day. This is because it covers a lot of areas that the GP find useful in making their assessment for the patient to continue driving (i.e. mini-mental state exam). For the 45-49yo Health Assessments, I make a note of why they are eligible (i.e. high cholesterol) which Topbar also tells me which is fantastic. I just make sure to check the patient is seeing their regular GP that day before I mark them up for a Health Assessment.
My Health for Life
Topbar also recently released a feature which identifies patients who can participate in My Health for Life which is great. One feature I would really like to see is patients who should have a 10997 and also those who can have a Healthy Heart Check (item 699).
Topbar increases Practice Revenue
Using Topbar has definitely increased our practice’s income and more importantly delivers better care to our patients!
I highly recommend just one staff member (could be a nurse, practice manager or senior receptionist) goes through this every day at the beginning of the day. This way the other staff can have Topbar open during the day, but you know the important items (like HAs) have already been marked up so the nurses can plan their day.
Highly worthwhile tasks and the added bonus is that it teaches you more about Medicare item numbers.
Other important actions
Patient Privacy & using PEN CS
Practices should be advising their patients either by a poster or on their new patient information sheet, or privacy brochure that the practice may be obligated to provide patient data de-identified or identified. This could occur for a number of reasons other than sending data to PHN. For example: solicitor requests, subpoena, prevention of a serious threat to life etc. The RACGP guidelines on privacy of health information includes links to templates for practices to adapt around privacy of data, collection, use and disclosure.
Here is a poster that you can put in your waiting room:
Topbar doesn’t share any patient information and it is stored on your network. But this is an important consideration when using PEN CS generally, especially with the new QI PIP requirements.
Let me know if you have any questions about Topbar! I hope this helped!