Prevention is Better Than Cure – My Journey With NCSR Integration

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Contributed by guest author Dana Tse of Campsie Medical Practice in Campsie, NSW.

When it comes to cervical cancer, Australia is fortunate enough to have the lowest mortality rate, and second lowest incidence rate in the world. While these are encouraging statistics, the success of our cervical screening program is heavily dependent upon the recruitment of women.

Higher rates of participation in cervical screening means that more women with precancerous abnormalities can be detected and treated sooner, which is necessary to achieve lower incidence and mortality from cervical cancer.

Cervical Screening Rates In Your Practice

What are the cervical cancer screening rates in your practice? More importantly, how do they compare to other practices in your PHN or the national average?

What, if any, have you found are the limitations in improving screening rates within your practice? Can you articulate the barriers to cervical screening in your practice? Is it perhaps a lack of patient education around the importance of cervical screening? Are there cultural barriers in place?

Is Preventative Healthcare Part of Your Practice's Workflow?

Nationally, cervical cancer rates are declining. Some drivers behind this include the widely available HPV vaccination, the option for cervical cancer screening self-collection, and the initiative to offer cervical screenings every 5 years. However, even with all the above, our national rate of screening is less than 50%; and I tend to be a glass half empty sort of person!

At our practice in Campsie, less than half of our female population were involved in cervical screening. We averaged approximately 30% for our PHN, compared to the national average of around 40%.

So naturally the question came to mind – what were some of the barriers that our women patients were facing? We decided to embark on a quality improvement activity with NPS MedicineWise Learning to ascertain how we could improve these rates.

The most welcomed upgrade and recently added feature in Bp Premier Saffron was the NCSR integration – or National Cancer Screening Register. Instead of having our nurses call and be on hold with the NCSR, we can now readily access information through Bp Premier. In fact, we’re able to do everything related to cervical screening directly within Bp Premier; from the utilities function, to searching the NCSR hub for most recent screening dates, results and even to check when women were next due, or if they were overdue and required a recall.

We could finally update our database to reflect our true cervical screening rates and actively recall women who were due for screening. This was particularly important post-lockdowns, where ‘less important’ things like screening may not have been front of mind. I believe our cervical screenings rates are now higher than before, due to information previously being missing, incomplete or out of date.

Bp Software provides several SQL queries that have proven useful for us in accomplishing this task.

NCSR Integration - Where To From Here?

Quality improvement is something that exists on a timeline. It can’t be set and forget. As for our practice’s approach:

  • We plan to revisit our cervical screening every 6 months to capture any data that is missing
  • We plan to include cancer screening records for all new patients when they meet with our nurses
  • We would like to tackle bowel screening rates
  • We look forward to the NCSR integration with Breast Screen
  • We would like to see NCSR reminders in Bp Premier generated as a list, without having to enter the reminders ourselves

We are fortunate and privileged to live in a country that offers free screening for prevention of these cancers, most of which have great treatments if identified early.

As the adage goes; prevention is better than cure.

Authored by:

NCSR Integration Article Author Blog Image

Dana Tse
Practice Manager at Campsie Medical Practice

Dana has previously contributed an article to the Bp Newsroom on Effective Practice Management.

The New Generation of Practice Management Systems – From Interoperability to AI

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Early practice management systems (PMS) were born out of the need to provide better continuity of care for patients and more efficient operations for a GP/practice, both of which contribute to the improved quality and safety of care delivery. They have created significant and perhaps intangible benefits to individuals and society over the last several decades.

The new technology enablers, however, make it possible to transform PMS into more federated, better connected, and evidence-based systems by leveraging the emerging interoperability standards and Artificial Intelligence (AI) technologies.  This will make the new generation of PMS even more central to primary care systems within the overall healthcare care continuum.

This will enable future generations of Best Practice Software to bring many new benefits to patients, practitioners, and the community at large – contributing to a ‘more sophisticated and connected community healthcare management’, as mentioned in a recent Wild Health article.

Technology Enablers

The technology enablers include web-based and cloud infrastructure, now being used as the basis for the next generation of Best Practice Software, referred to internally as Titanium.

When used in conjunction with new interoperability standards such as HL7 FHIR®, cloud technology adds new mechanisms to the way various parties in the delivery of healthcare are connected, including support for patient engagement.

Through the cloud, AI solutions can be built leveraging huge amounts of data created by clinicians, including as part of collaboration with other clinicians, and in some cases, generated by medical devices. Such solutions can provide new insights to the clinicians and support new models of clinician-patient collaborations, with added emphasis on preventative and personalized health.

The Added Value of Interoperability

Architecting for interoperability adds dynamic and evolvable aspects to the way health systems of the future are connected, typically using APIs over cloud. This allows constructing and managing flexible event-driven clinical workflows supporting multiple participants, including hospitals, Aged Care facilities, community health centres, and patients.  This is not currently possible using HL7 v2 messaging integration approaches.

The emerging HL7 FHIR® standard provides a common information model for representing digital health data (the so called FHIR Resource entities) and API interfaces, both of which support building interoperable and connected digital health systems, and many international vendors are now embracing it.  In some cases, this is in response to regulatory requirements, such as the US Office of National Coordinator (ONC) cure act Final Rule.  This rule was designed to give patients and their healthcare providers secure access to health information. It also aims to increase innovation and competition by fostering an ecosystem of applications to provide patients with more choices in their healthcare, in part through the standardized API interfaces.

Best Practice Software recognizes the many benefits that the FHIR® standard can bring in the context of cloud technologies and is currently establishing a long term FHIR® adoption roadmap as part of its strategic direction.

The Added Value of AI

In general, AI is a collection of interrelated technologies used to solve problems autonomously and perform tasks to achieve defined objectives without explicit guidance from a human being. AI adds value through automating many tasks typically involving human actions and decision making.

Examples of AI use in healthcare are in the interpretation of medical images, e.g., X-rays and MRI scans, in the personalized treatment of patients based on their medical history and genetics, and in the optimization of clinical workflows.

A key component of AI is machine learning (ML), whereby computers ‘learn’ without being explicitly programmed, making use of the large amount of clinical data collected over time (aka training data) and applying advanced computational reasoning techniques. This can be in the form of:

  1. statistical machine learning searching for a predictive function from the training data
  2. reinforcement learning approaches constructing AI algorithms with “rewards” or “penalties” based on their problem-solving performance, inspired by control theory approaches
  3. deep learning solutions based on the use of artificial neural networks.

Other AI applications are in natural language processing, computer vision, used in many clinical image processing applications, and robotics. Another area of use in health is knowledge representation, particularly used to document clinical knowledge in a computable form such as SNOMED-CT clinical terminology.

Many rule-based Clinical Decision Support (CDS) systems can also be regarded as a form of AI.  Best Practice Software has included since its initial release CDSs aimed at helping clinicians to provide safer and more personalized healthcare. For example, when prescribing, background checks are made for potential allergies, drug interactions, contra-indications etc.  The use of new AI approaches can add another level to CDS, leveraging data-based solutions, contributing to better evidence-based healthcare provision.

Best Practice Software is currently looking at AI technologies for its future products to advance the creation of learning health systems for primary health providers as part of connected health ecosystems. The aim is to support more effective, evidence-based, and personalized clinical care and adaptable clinical workflows, as well as more efficient administrative operations of practices, based on the large volumes of historic data that has been collected. Possibilities include analysis of previous investigations of patients to support predictive clinical actions, text mining of correspondence with specialists, hospitals, and other clinicians, to help better decision making in case of similar future symptoms and so on.

While interoperability delivers more connected and event-driven care, analytics and AI provide augmented decision making for clinicians.

Establishing Trust for Providers and Consumers - Guidance for Developers

An important consideration when discussing AI technologies is to ensure that clinicians trust the decisions that are made as a result of the use of the AI system. This is often referred to as an explainability problem, which requires mechanisms to support clinicians in understanding how AI systems make decisions.

There is a further element of trust, whereby that learning health systems need to ensure that personal and societal confidence in IT systems is preserved in the presence of the data proliferation and sharing. To this end special care needs to be taken to express rules related to privacy, policy and ethics.  These concerns were discussed at more length in the paper delivered by Best Practice Software at the recent AI in Healthcare workshop in Oct 2021, and highlighted next.

One way to create trust is to develop “explainable” AI, where developers can present the underlying basis for decision-making in a way that is understandable to humans and can demonstrate that the system is working as expected by clinicians.

Another part of the guidance for developers is related to the problem of expressing computable expressions of policies, such as obligations, permissions, accountability, responsibility, and delegation. These expressions can be implemented in code as part of any digital health application, including the AI solutions. For example, they can be used to encode rules associated with privacy consent, governing the rules of access to personal healthcare information, or with research consent, governing the rules of clinical research. 

Computable expressions of policies are also important when one needs to express responsibilities associated with passing of healthcare data between providers, taking into account various legal constraints such as data ownership or custodianship or regulatory constraints associated with privacy.

AI brings its own set of policy issues such as how one can go about specifying ‘responsibility’ of AI applications, e.g. in the case of safety concerns, is this a responsibility of the AI developer, the IT staff involved in deploying the system or of the users of the system such as the clinicians.

These are issues which are currently yet to be addressed as part of legal systems, but the computable policy framework should be a required prerequisite when building scalable AI in any healthcare organization.

Co-authored by:

New Generation of Practice Management Systems Author Headshots

Dr Frank Pyefinch
CEO at Best Practice Software
&
Dr Zoran Milosevic
Interoperability and AI Consultant at Best Practice Software

Footnote

The paper presented at the AI in Healthcare Workshop is available upon request. If you would like to obtain a copy, please contact Dr Zoran Milosevic here.

Vaccine Hesitancy – Navigating the Three Cs

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This article was contributed by guest author Tracey Johnson.

Vaccine hesitancy, along with its potential scale and impact, has become a topic of national debate since the middle of 2021.  Fortunately, we saw a rapid take-up of vaccination across the country in the final quarter of last year.  Together with every practice, we are now facing the challenge of those patients whose reluctance to embrace the COVID vaccine jeopardises community safety, health system capacity and our own team’s wellbeing.

What We Know About Vaccine Hesitancy

Vaccine hesitancy is complex.  It varies across time, place and vaccine type.  Many patients who are choosing to delay their COVID vaccination are already vaccinated for many other conditions and illnesses, and often do not consider themselves “anti-vaxxers”.  It is this group who are more likely to be influenced to adopt the jab.  Those whose stance on vaccination is long entrenched and underpinned by deep suspicions of science and institutions will continue to read extremely biased social media content and turn out to protests which only serve to reinforce their views.

So, what do we know about the more malleable and open vaccine hesitant patient?  The ‘Three Cs’ determine to what extent our public health efforts might be successful.

vaccine hesitancy venn diagram

Complacency

With Australia’s closed borders and public health measures such as mask wearing, social distancing and lockdowns, much of the population had not experienced the realities of widespread COVID transmission within the community.  Many believed that lockdowns and economic turmoil were in fact worse than COVID itself.  This is complacency in action.  Images of exhausted healthcare workers in the US, over-run hospitals in India and a mounting death toll from waves of COVID in the UK started to shift the perception by the middle of 2021.  No longer was it easy to dismiss COVID as a disease with limited and acute potential in older populations, and deaths in nursing homes.

A state like Queensland, which has only recently experienced major uncontrolled outbreaks, remained home to many complacent communities.  Late in 2021, when a COVID positive case holidaying in Townsville led to no community transmission, many held a bolstered optimism that COVID was a “city thing”. The variation in vaccination rates between metropolitan locations, and regional and rural areas which have never reported cases is stark. 

Then – COVID arrives in towns like Goondiwindi, or indigenous communities like Wilcannia.  Suddenly, there are frantic calls for vaccination.  Complacency can be overturned when figures near to the community, or with whom the community identify, speak to the ever-present danger of COVID.  Localised campaigns by community leaders in various ethnic communities have shown that complacency can be overcome if knowledge is shared by trusted figures and imminence is emphasised.  We have been working closely with our PHN to share video case studies and engage community leaders.  We even ran a shared medical appointment model involving an interpreter and community leader to kick off our vaccination drive in the Somali community in our South-East QLD suburb of Inala.

Confidence

Confidence should be easy to build in a vaccine launch environment unlike any we have ever seen.

Having worked in drug discovery, I have personally attested to groups of our patients how “drug development as usual” occurs.  Months waiting for grant applications to be reviewed, months more waiting for ethics applications to be approved, study launch hoping to attract a few willing volunteers meeting strict criteria, data analysis and reporting leading to the next grant.  The cycle repeats year after year.  Even when data is great, years are lost waiting for government food and drug agencies to consider new drug registration and reimbursement applications.  The time lost to waiting for money and approvals can easily account for half of the time.  

When it came to developing a vaccine for COVID – money was poured at the problem.  Scientists worked around the clock with growing teams.  They built on drug platforms discovered years before and applied them to COVID.  Governments prioritised consideration of drug registration applications and pre-purchased drugs even before they were fully validated.  With over 3 billion people now vaccinated, speedy adverse event reporting and timely data on deaths from vaccination versus outcomes for the unvaccinated, data is our friend in building confidence in the science. 

vaccine hesitancy quote Tracey Johnson

We keep our COVID resources in a shared clinical drive so that the latest information is at the fingertips of our entire team.  Active discussion on our “teams” channel rapidly disseminates great statistics to combat vaccine hesitancy.  The University of Queensland produced a tool highlighting your chances of getting struck by asteroids, cracking a double yoke egg and all sorts of other meaningful comparisons to highlight the advantages of vaccination.  Such tools are great to use with patients, as they offer a somewhat light-hearted take on the very real statistics that they’re often concerned about.

Convenience

Convenience is the final pillar.  Queensland Health has done, and continues to do a great job in getting access to jabs in schools, Bunnings carparks, on weekends and promoting vaccines available in pharmacies.  Since September of 2021, there has always been a vaccine option available.  Sadly, many in our community do not tap into traditional media, so boosting knowledge around these vaccination options requires our teams’ letting patients know what they can do.  We have used social media, our team encouraging patients to walk into nearby pharmacies and promoting the free sausages available at Bunnings.  This has ensured that our already full vaccine clinics did not create a waiting list amongst patients in our own community.  Given the unattractive remuneration we receive from vaccination, our team did not hesitate to encourage patients to take up other options if it meant getting vaccination earlier.  Where we had spare vaccine doses available on the day, we administered them to vaccine hesitant patients whilst they were still committed.

Our own vaccine clinics ran from 7am until 9am for many months and still operate on Saturday mornings to ensure working and school age patients have access.  With access now so easy, we have scaled back our vaccine delivery to sessions during weekdays so that our nurses are more available to complete chronic disease and preventative health work.

With the QLD borders now open, we look closely at our patient records to assess who still needs a prompt to get vaccinated.  Our region has one of the lowest rates of vaccination in all South-East Queensland, despite our practice being one of Brisbane’s early movers to launch vaccination.  With data extraction tools like Cubiko, we have been able to identify patients whose charts indicate an absence of vaccination.  We continue to use these reports to track vaccination status in our patient population.  In the past we benefitted from Cubiko being able to tell us which patients were eligible for AstraZeneca when vaccination was staged or were no longer eligible when age restrictions were brought in.  This saved our already overwhelmed reception team many hours of searching through lists.

These lists over-sample patients as until recently there was limited capacity to draw down data from the Australian Immunisation Register (AIR).  One of the silver linings of the pandemic is that Medicare Web Services is now working actively with software providers like Best Practice to link AIR History directly to a patient record.  What a boon that will be for vaccination planning, automatic recalls, and practice reminder systems!  Expect this improvement from midway through 2022.

Remain Positive - Remain Committed

Remaining positive throughout the pandemic has been the hardest thing for all healthcare providers.  However, positivity has been shown to have greater impact than just on team morale.  The media has been replete with stories around the often vocal 10% of the population that are staunchly remaining unvaccinated.  Research has shown the community responds far more favourably if the approximately 90% who are vaccinated is celebrated.  Acknowledging how common vaccination is amongst your patients can help push conservative patients over the line.  They will want to join the herd!

Working as a team is important for all healthcare provision.  This is especially important when it comes to requests for exemption from vaccination.  Our doctors and nurses agreed months ago to strictly follow the exemption process to the letter.  With shared commitment it was impossible for patients to short-circuit vaccination by appealing to the compassion of their healthcare team.  Everyone had the one message; vaccinate now.

Language Is Your Ally

In the early days our team were so polite when speaking to patients exhibiting vaccine hesitancy, even charming in the way they explained the risks of the disease and benefits of vaccination.  It did not take long for their language to harden.  We often hear accounts now of doctors telling their elderly, multi-morbid patients with many risk factors that what they know is that it is almost certain they will die if they get COVID.  

Vaccine hesitancy tracey johnson quote 2

Finally, we remain grateful for the stance taken by government that even private healthcare providers need to have all staff vaccinated.  Like many practices, some of our less educated team members were concerned about vaccination.  Highlighting to them that they will be at the front line when COVID becomes endemic ensured most were willing to get vaccinated.  We had one very reluctant team member.  The government edict around healthcare workers finally saw them book Moderna at a pharmacy just in the nick of time to meet the deadline.  Loss of rights to earn, go to restaurants and clubs did the trick!  We have seen a similar cascade amongst our younger patients and those working in sectors with vaccination mandates.

Looking Ahead

In the future, will vaccination rates remain high? 

That really depends upon government edicts and how successfully we continue to address the ‘Three Cs’. We have much we can control at a practice level to support maintenance of vaccination status.  How long key public health messages continue to emphasise the importance of vaccination will be central to our success.  The emerging science on how regularly we need boosters will be important as annual vaccinations might be resisted due to inconvenience.  If the edicts and campaigns melt away, we will probably see vaccination rates via boosters fall to levels similar to those for flu, insufficient to create herd immunity.  That means our practice systems and commitment to public health will need to fill the gap by prompting patients to get vaccinated.

Authored by:

Tracey Johnson Blog Author Image

Tracey Johnson
CEO at Inala Primary Care

Tracey Johnson is CEO of Inala Primary Care, a large general practice serving one of Queensland’s poorest suburb, located in Brisbane’s west.  

COVID-19 Vaccines and Pandemic Planning – A Retrospective

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By the time Christmas 2021 arrives, it will be roughly two years since the first appearance of COVID-19 in Wuhan. For most of us, this has been a very long, frustrating, and unfamiliar two years. But it is a time that our generation should never forget. Change – both planned and spontaneous – is always a challenge.

Many won’t be aware that planning for pandemics has been the focus of many health professionals and governments departments for decades. Way back in 2009, I was part way through my four-year term as the Mayor of Bundaberg Regional Council. While that term was such an incredibly busy time for us, I remember holding regular planning meetings in preparation for the expected arrival of Swine Flu into Australia – and subsequently into the Bundaberg region.

The things we were planning for, even in a small Regional Council in Queensland, included the logistics of setting up testing and vaccination hubs, temporary field hospitals and working out how to staff them, how to limit individuals (perhaps already infected) from entering our community and potentially spreading disease and unfortunately, planning for the inevitable need to quickly open up new cemeteries and crematoriums to accommodate casualties.

Thankfully, Swine Flu dissipated quickly and didn’t really take off in Australia. However, planning work had been going on for years because everyone working in Government Health circles knew that there would one day be another global pandemic – which due to the ubiquity of modern international travel, would spread like wildfire.

It has been fascinating watching how authorities and individuals around the world have responded, in both encouraging ways and otherwise, to this real-life global emergency. Here in Australia, and our cousins across the ditch in NZ, have been incredibly lucky to live in countries surrounded by water – creating a natural barrier to infected travellers – and with access to great technology. We are also fortunate to have universal health care systems run by skilled professions and access to a range of safe and effective COVID-19 vaccines

There continues to be a lot of debate, confusion and in some instances, hesitancy about the emergency roll out of COVID-19 vaccines. One commonly heard objection to receiving COVID-19 vaccines is that they were ‘developed too quickly’. It is important to understand that many of these vaccines have been decades in the making. In fact, some of the new vaccine technology rolled out for COVID-19 was built on research originally done for other Coronaviruses such as SARS in 2003, and MERS in 2012. Since that time, many researchers have been working on developing a more universal Coronavirus vaccine that could quickly be adapted for new variants like COVID-19.

Decisions made around the world to legislate fast-tracked testing and emergency rollout of vaccines in early 2020 would not have been taken lightly and would have been made in response to horrific scenes emerging from countries hit hardest. Tens of thousands of new infections daily, overwhelmed health services, lack of basic supplies and equipment, and the stark reality of exponentially climbing death rates.

In our corner of the world, we had a bit more time up our sleeves because decisions, while sometimes unpopular and inconvenient, were made quickly to isolate us from the potential spread of the virus. But with borders planning to reopen in the next few months, we are still quite vulnerable as vaccination rates in some areas are low.

It is so important to understand that an emergency rollout of a new vaccine does not in any way compromise the testing schedule of these vaccines. Normally, scientists would have to wait for years to secure funding to continue their work. Once COVID-19 hit, massive amounts of funding were diverted to COVID-19 vaccine research. Universities and researchers – who often worked in relative isolation – were freely sharing data, techniques, and findings to push forward their work collectively.

Approval was given to run the normal testing phases testing phases to run concurrently. Instead of waiting for Stage 1 testing to be completed and the results reviewed, approval was given to begin Stage 2 testing BEFORE Stage 1 had ended. If at any time Stage 1 failed, then Stage 2 immediately stopped and work on that particular vaccine candidate would be abandoned. Another important thing to consider is that “normal” testing of vaccines involve a limited, but “sufficient” number of volunteer recipients. At time of writing, nearly 3 billion individuals around the world are now fully vaccinated with two jabs of the most appropriate vaccine available to them, with around 7.15 billion doses administered altogether. This is a far greater number of vaccine recipients than any normal vaccine trial would need to pass the normal testing requirement. If these vaccines carried a risk of widespread and significant side effects, they would have surfaced by now.

Potential side effects are now well documented and while most are relatively minor, if reported early, even the most serious can be effectively treated – leaving recipients with few or no long term issues or concerns.  On the flip side, we are witnessing a significant shift in the number of unvaccinated people who require ICU support, and the long-term impacts of long COVID are yet to be determined.  Time will tell if those suffering long COVID will not only endure a poorer quality of life, but also a shorter life expectancy. The vast majority of COVID-19 patients in ICU today are unvaccinated and unfortunately many will subsequently die. The unvaccinated are more than 10 times more likely to die from COVID-19 (and twenty times more likely to pass it on) than those who have been vaccinated.  Sobering thoughts.

My family and I are all fully vaccinated and my elderly mum will soon be lining up for her booster as soon as she is due – followed closely by the rest of our family – not only to protect ourselves, but to reduce the risk to her and our other older and/or immunosuppressed family members and friends. 

Lorraine Quote Covid-19 Vaccine article

Advice that you receive through social media posts may not necessarily be the information you should be considering when you are weighing up your options in what may be one of the most important decisions for you, your friends and family, and ultimately – your community.

I mentioned earlier that we were incredibly fortunate to be living in Australia and NZ. The challenges we’re facing are first world problems when you compare our situation to countries who do not have the wealth or advanced health systems that we have access to. As COVID-19 continues to circulate in these poor and underprivileged communities, we will continue to see more disease, death and unfortunately the likelihood of new COVID-19 variants – perhaps becoming even more virulent than the current Delta strain. Former NZ Prime Minister Helen Clark has issued a strong statement on the matter.

COVID-19 Vaccines have a relatively short shelf life, and much of the supply we have here in Australia and NZ is starting to expire. It would be a great shame if these precious doses were wasted. So – if or when you do decide to book in and get your jab – please don’t skip the appointment. The last thing we need to see is vaccines being tossed down the sink.

Authored by:

COVID-19 Vaccines Blog Article Lorraine Author Image

Lorraine Pyefinch
Chief Relationship Officer at Best Practice Software

Australia’s ePrescribing Rollout: Lessons Learned

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Contributed by guest author, Tracey Johnson.

It’s been a little over a year since Australia fast tracked its ePrescribing rollout.

Paper referrals, paper scripts, sending faxes between providers…these are all so yesterday!  The Australian Digital Health Agency (ADHA), in collaboration with many stakeholders, spent the last few years designing new, paperless and portable solutions which will make medicine use safer and more transparent.

A core component of this effort was the ePrescribing rollout.  For once, Covid-19 was our friend, accelerating plans for launch to accompany the introduction of telehealth.  Each state Health Department legislated ePrescriptions and the e-tokens behind them as a recognised form of accessing medication in June and July of 2020.  Inala Primary Care saw our first patient use an e-script on the 5th of August, just a few days after ePrescriptions were legal in Queensland.  So twelve months on, what are our reflections on the ePrescribing rollout?

ePrescriptions were one of the simpler workflow changes our doctors made in the last 12 months.  Best Practice Software consulted with our team on the early design of the interface.  The click through options are intuitive and easy to navigate.  Since we launched ePrescriptions we have had four new doctors join our team.  Each has simply received an introduction to ePrescriptions within their orientation to Bp Premier, so no additional induction was required.

Twelve months ago the scenario was very different.  We circulated the fact sheets produced by the ADHA and gave our doctors a patient visit as admin time to read the information.  This occurred in advance of two lunchtime sessions we ran outlining the ePrescription process.  We used videos produced by the ADHA and Best Practice Software to show doctors where ePrescriptions fit within the digital health agenda, and how Bp Premier had been adapted for the ePrescribing rollout. 

In preparation, we spent some weeks liaising with pharmacies nearby.  We were very disappointed by their awareness of ePrescriptions.  The region had been identified as a Community of Interest by the ADHA and additional resources invested in pharmacy readiness in the months prior to launch.  Two of the independent pharmacies were ready and worked with us to test the system.  More than half the pharmacies frequented by our patients took more than two months to get organised.  Within four months all were finally on board!

There were just a couple of issues our end.  Our NASH certificate was coming to an end and had to be updated just as we were about to launch.  We also found the lack of a patient information campaign by the government meant our doctors had to take time to explain the system to each of their patients.  Once information was provided, patients were usually happy to embrace ePrescriptions, even those on S-8 Medications. 

Moving patients from paper scripts to an Active Script List (ASL) is a bigger exercise.  ASL consolidates multiple medications into one list removing the need for multiple tokens associated with the issuing of each script.  It will benefit doctors as they can see what a patient has had dispensed and when.  The patient needs to engage their pharmacist to set up ASL.  Once in place, patients can give consent to any pharmacist to access their ASL to dispense medications.

We still have a large group of older patients who prefer either a printed QR code or a traditional printed script to take to their pharmacy.  They have not used ePrescriptions to engage with e-delivery when lockdowns occur, even with several local pharmacies offering a home delivery service.  Some lack smart phones and confidence in using them.  To address that, we ran a morning tea for a group of our patients aged 65 years and over, and showed them how the system worked.  It helped to boost some confidence.  Others were happy for the outing but have still asked for scripts to be left with reception for collection – even during lockdowns!  Change takes time.

For family members managing the medications of parents, children and loved ones, ePrescriptions have been popular.  It saves holding many pieces of paper and makes dispensing anywhere so much easier.  E-reminders when the next script is due have also been praised.  ePrescriptions will hopefully encourage more patients to build a relationship with a pharmacy.  This should mean better access to education, active monitoring of what they are taking and education about drug interactions.

We have noticed interest in ePrescriptions wax and wane in line with Covid-19 outbreaks.  Over time and with more government and pharmacy education about the benefits, we believe ePrescriptions will be widely embraced.  This will vastly improve the accuracy of dispensing, GP knowledge of medications in use and how compliant patients are with taking medications.  Less time stocking rooms with script paper will be a very welcome outcome of the new world!  We believe medication safety is everyone’s business. ePrescriptions add to our toolkit, and in Covid-19 times have been a boon in terms of keeping our team safe and streamlining workflows.

Best Practice Software’s Training team have developed a comprehensive list of resources which were made available during the ePrescribing rollout, which you can explore here.

Authored by:

Tracey Johnson ePrescribing Rollout Author Image

Tracey Johnson
CEO at Inala Primary Care

Tracey Johnson is CEO of Inala Primary Care, a large general practice serving Queensland’s poorest suburb located in Brisbane’s west.  The practice has a history of digital innovation uploading the first record to the My Health Record system and more recently co-founding Cubiko, a practice dashboard solution which delivers insights to practice teams each day.

R U OK? Day 2021 – A Reflection on Mental Health

R U OK Day 2021 blog image

Each year R U OK? Day reminds us to stay connected, have meaningful conversations and encourage more people to ask R U OK? at work, school and in the community. The website includes suggestions for simple steps that could save a life:

  1. Ask
  2. Listen
  3. Encourage action
  4. Check in

There are conversations tips, videos of how to ask and resources including how to find professional help if needed if the conversation becomes too big for family and friends.

Lifeline provides a directory of free or low cost health and community services available in Australia for areas such as domestic violence, family and children’s services, financial assistance and mental health services at lifeline.serviceseeker.com.au

The BeyondNow suicide safety plan app helps create a safety plan in crisis and distress for those in need, ideally with support us, as health professionals, or someone they trust, to work through when they are experiencing suicidal thoughts, feelings, distress or crisis. The app is available to download and to read further about the app, see beyondblue.org.au

moodGYM is an online self-help program that has been available since 2001, using cognitive behaviour training to develop skills to manage depression and anxiety symptoms. The program allows real-time self monitoring of problem moods, thoughts and behaviours via mobile phone or computer. Those using the programme monitor three symptoms of their choice or three recommended to them by myCompass through answering the profiling questionnaire ( eg stress, depression, confidence, worry, irritability, motivation, diet and medication use) See moodgym.com.au

myCompass is a self-help tool for mental health, providing proven techniques to help manage stress, anxiety and depression.

Here are some of the agencies that offer good support to those in need:

  • Lifeline, 1311 14 for 24/7 crisis support, the Suicide Call Back at 1300 659 467
  • kidshelpline at 1800 55 1800 for counselling to young people under 25 years
  • Griefline on 1300 845 745

Authored by Dr Lisa Surman

How Bp Premier Features Help to Improve Consultation Efficiency

Bp Premier Features Blog Article

Contributed by guest author, Dr Stephen Jelbart.

Haven’t we progressed since the introduction of information technology! We doctors can do everything so much more efficiently nowadays, compared to the old days of pen, ink and card records. That’s what we like to think anyway, but have we actually improved? Have you really advanced and improved your efficiency in parallel with the IT? Are you keeping up? Did you know that Bp Premier features a range of ways in which you can achieve that coveted efficiency?

Your efficiency in generating patient notes, documents, and referrals is determined by your knowledge, understanding and proficiency in the use of the attributes of the software available.

Most people use Microsoft Word or something similar, but few people utilize the full power inherent in Microsoft Word. Templates, Macros, Tables, Nested Tables etc. Similarly with Microsoft Excel. I like to think that I can use a spreadsheet reasonably efficiently, but I was in awe and flabbergasted when I saw my friend, a chartered accountant, generate a business plan in Microsoft Excel within one hour, when is it had taken me the best part of two weeks to generate something that was not nearly as accurate and comprehensive! Figures, formulae and calculations flowed from his fingers with amazing speed. He generated a cash flow analysis with a simple ‘copy and extend’ manoeuvre that was not only amazing, but horrifying when he pointed out the long-term effects of ignoring ‘getting the cash through the door’. But that’s another story, a blog for the entrepreneurs to pursue!

Bp Premier is, without a doubt, the best general practice software available on the market in my opinion. However, I hope further improvements can be adopted (are you listening, development team?).

ACRRM and RACGP demand that we take detailed and comprehensive notes to cover all bases. It is also “best practice” for indemnity purposes to maintain succinct, accurate notes and this is where agile use of IT can help us do so. Let’s just take a quick look at how the layout in Bp Premier lets you do that easily.

  • On the left, at the top corner, you have patient name and address. Double-click up there (or F10) and you access patient demographics. I frequently check to see if all that info is accurate as you don’t want to be sending an SMS, for example, to an incorrect mobile number!
  • Moving down sequentially along the left-hand side of Bp Premier, you have the best guide available for ensuring your logical progression through systematic questioning and examination of the patient.
  • Start at the top and move down:
      • Allergies and Sensitivities
      • Current Notes
      • Past Visits
      • Past History
      • Medications
      • Immunisations (accurate documentation is now legally very important with COVID-19 shots)
      • Family and Social History
      • Etc.

It’s all there and laid out in a logical and sensible manner as a reminder to complete a comprehensive examination and history – all extremely important from the dreaded audit and accreditation point of view. 

Always Consult Previous Visits

I open this up and quickly scan through the most recent visits to ensure I’m on the right page when the patient comes in. Saves a lot of potential embarrassment.

Past History should, if data has been entered correctly, give you an idea of the current maladies. Make sure you use the database provided when adding PH. Don’t add free text to the main diagnosis – you can’t accurately search for free text entries! If your diagnosis or ‘Reason for Visit’ needs more detail, add that in the comments box at the bottom. Demote resolved issues to ‘Inactive’ to keep the current problems succinct and Up to Date. Make sure you enter the date of diagnosis when adding a problem – otherwise a long-standing history of Hypertension might appear to have been diagnosed in 2021!

The same is true with medications! Always review the medications list to ensure only current medications are included – otherwise any referral will likely contain a long list of pills and potions that haven’t been taken for years.

Next Up - Patient Notes!

Always look at your patient, listen to your patient, interact with your patient – taking time to do so is always well spent as you pick up ‘non-verbal’ communication that can hone your overall assessment. Let the patient talk and help tease out the main issues early in the consultation so that you can prioritise to ensure you address the important issues. Doing this early in the consultation helps to develop an early rapport and avoids that “… and just one more thing Doc” at the end of the consultation which can quickly erode the 15-minute consultation time allocated to your next patient. When you know all the issues, you can get your patient to make another appointment to address the less important problems.

You’ve now spent some time listening and you need to adequately document the consultation. You can save yourself heaps of time using ‘Autofill’. Spend the time to populate all your favorite notes into Autofill initially, and once they are in place you will save yourself heaps of time.

Let’s say your new patient has Hypercholesterolaemia and Hypertension and needs new prescriptions. You might just add those meds to the list, print them out and say ‘goodbye’, and ‘next please’ but it’s valuable for audit purposes to actually document that initial brief interaction. You can type that out long-hand (correcting your spelling as you go) or using Autofill and type:

‘Rpts’ (to generate from Autofill);
“Patient presents for repeat prescriptions” for
‘hc’ (to generate “Hypercholesterolaemia”) and
‘ht’ (to generate “Hypertension”) –

That’s just 14 characters typed to generate 70 characters. Very efficient!

Consider the patient with the common presentation of a mild URTI.
I type; ‘Li’ (shorthand for “Little to find”) and Autofill completes the following:

Patient presents with URTI symptoms for the past ? days.

On Examination:
Little to find.
No cough.
Dry cough.
Throat not red.
Throat slightly red.
No Lymphadenopathy.
Small upper cervical glands.
Chest clear.
No rash.

Then all you need to do is delete the bits you don’t want to ensure you leave the appropriate documentation. That’s two characters to enable 34 words! Not bad, eh? It does take a bit of practice to remember the short-cuts but after a week or so, you’re off and running.

Here’s another:

‘Knex’ (shorthand for Knee Examination)
This Autofill serves as a reminder of the elements of a comprehensive knee examination.
Add / Delete or modify after your examination.

Examination of the Knee: LEFT / RIGHT
Normal gait / limp?
Any swelling or deformity / inflammation
Full and free Range of Motion? Active / Passive
Flexion limited by pain / stiffness to …Full extension?
Patella tap – No effusion / Small effusion
Patella crepitus – present / none
Anterior draw test; -ve / +ve
Lachman test; -ve / +ve
McMurray test for integrity of the meniscus
Tender on palpation? Joint line pain?
Varus and valgus stress to assess collateral ligaments
Pivot shift for ACL; -ve / +ve

So, there are a few ideas with some Bp Premier features to get you started if you haven’t already established a repertoire in Autofill.

Given that many GPs move around a lot nowadays, particularly the Registrars, it would be very handy (once again, development team take note!) to have the ability to download Autofill to a flash card to make all your hard work on developing software efficiency with Autofill, portable for your next Registrar assignment!

Authored by:

Stephen Jelbart Author Image

Dr Stephen Jelbart
Guest Blog Contributor for Best Practice Software

Dr Stephen Jelbart is currently practising at Plaza Medical Centre in Kalgoorlie, WA.

The Rise of Healthcare Consumerism

Healthcare Consumerism Blog Image

Healthcare consumerism is a concept that has existed for some time, but only recently has it really taken hold and started to significantly impact primary care.

There is perhaps no common understanding as to what constitutes healthcare consumerism, and discussions with providers and patients will likely yield two different sets of responses as to what it actually means.

Ask any provider that has had to contend with correcting the misconceptions of a patient’s self-diagnosis and treatment plan (often courtesy of Dr Google, WebMD or the Mayo Clinic) within the constraints of a few-minutes long consult, and you may be confronted by a somewhat less than flattering take on the subject.

However, as a patient, notions of patient empowerment through clinics and a shift towards patient centricity will likely feature very favourably.

Regardless of your individual view on this, in a consumer-centric society, consumerism was always going to find its way into the healthcare sector, and this will influence the sector in many predictable, but also some unexpected ways. The rate of this change has been accelerating as a result of the general societal changes brought about by COVID-19.

Broadly, consumerism itself has many defining features, but fundamental to it is the principle that the consumer is in control (though subject to marketing, social engineering influences and manipulation). They are in control of what they consume, and their patterns of consumption drive the choices that providers of products and services make about what gets produced and how it is produced. In theory, the more informed consumers are, the more their decisions are driven by knowledge.

It is, then, reasonable to conclude that patterns of consumer behaviour and expectations are responsible for the kind of product and service innovations that organisations like Amazon, Uber and Apple have brought about in their respective industries.

Given the level of disruption that has been brought about by the aformentioned powerhouses in their respective industries, one can only speculate about how much of an impact they would have if they turned their attention to serving the needs of the patient in an era of healthcare consumerism. Even if they don’t – they, and others like them have reset long-held, more traditional consumer expectations.

To compete in this environment, and to compete with the concept of healthcare consumerism itself, provider organisations will have to re-assess their entire value streams, and re-image how to leverage their people, processes and technologies in response to this consumer-centric landscape. 

Competing with Healthcare Consumerism

To develop an approach and response, one has to consider some of the behavioural changes brought about by this trend. It does, in essence, come down to the fact that patients’ expectations of care delivery have changed, and that they are taking an increasingly active role through a range of actions.

Patients are, of course, not a homogenous group, so their expectations and their responses to this will differ from one group to another. According to the Pew Research Centre, millennials now make up a larger portion of the population than baby boomers, and the long-term transformations of healthcare will be driven primarily by their needs. This generation has grown up in a technology-rich, consumer focused environment where transparency, rapid delivery and convenience is the norm.

A recent study into healthcare consumer expectations resulted in some startling findings:

Healthcare Consumerism Stats Infographic

As evidenced by the rise in social media, consumers have proven to be willing to share increasing levels of personal information for the sake of convenience across platforms – as a trend in consumer behaviour, this will likely apply in the context of healthcare as well.

It would be reasonable to expect that patients will want to share information between providers (evidencing a willingness to share), will want to have tools to aid this sharing of information (evidencing the importance placed on convenience), but will in all likelihood require more sophisticated consent and sharing models than what is the norm with some non-health related personal data.

Some of the other actions that patients are taking to meet their expectations include:

  • Shopping around, evaluating their options and generally expecting more from providers
  • Doing their own research about health issues, treatment options and providers
  • Taking deliberate steps to monitor and improve their health. The proliferation and increasing sophistication of wearable and home monitoring devices bears witness to this
  • Co-operating with providers to make treatment decisions and more freely sharing information with care providers
  • Taking cost and quality aspects into consideration in their decision making
  • Using technology for appointments, telehealth consults, online payments, prescription renewals and a host of other services

If we consider the expectations and consider the actions patients are taking to meet their expectations, a few things immediately become clear:

  • Patient loyalty will continue to decrease as millennials make up an increasing percentage of healthcare consumers
  • Providers will face new challenges in attracting and retaining patients, with less loyal patients being more likely to switch providers, and being enabled to do so with the ease provided by technology
  • This will have ramifications for health outcomes given the impact on continuity of care

So what’s the message in all of this?

The most logical outcome is that due to the rise of healthcare consumerism, it’s in the industry’s best interest to meet the demands of healthcare consumers by designing products and services that meet current and emerging patient needs.

Here at Best Practice Software, we are developing the next generation of healthcare systems that will not only meet the demands of our provider customers, but software that will deliver the tools and meaningful interactions with patients and other stakeholders to address the needs of future healthcare consumers.

Authored by:

Andre Broodryk Author Image

Andre Broodryk
Product Manager at Best Practice Software

8 Tips for Improving Workplace Communication in Your Practice

Improving Workplace Communication Blog Post Image

Working on improving workplace communication is paramount for any business, and Medical Practices are no exception.

As a Practice leader, you know that success in your role is dependent on your ability to effectively communicate. But just as important as the quality and value of your own words is the cultural commitment you make to internal communication within your Practice as a busy, high-profile workplace. So how do you make it part of everyday business, and embed it within Practice business strategy to make it “part of what we do around here”?

I recommend promoting the benefits of good workplace communication within your team by outwardly recognising that good communication is fundamental to the success of your Practice as a business. By making communication one of your ‘people pillars’, you’ll ensure less misunderstanding within your team – including Practitioners, Reception, Practice Management, and IT/business support team –, an increased commitment to change, a reinforced role of supervisor as leader, and more active participation in the Practice and its mission.

Think about adopting some shared communication principles within your Practice team, like:

  • Embedding in your team mission your commitment to open, honest, and meaningful internal communication – at all costs, including the potential to damage fragile egos. Embrace the concept that, as leader, you’ll set the highest standard in being transparent and authentic in your communication with the team and invite members to (respectfully) challenge you anytime they think you miss the mark.

  • Embrace face-to-face communication foremost while still recognising e-mail and intranet bulletins as a convenient, but ultimately more impersonal, workplace tool. Sunrise (before clinic) and Sunset (after clinic) personal team or individual briefings will always be more valued when they’re localised, purpose-driven, two-way, … and brief.

  • Utilise the communication tools already built into your business software/systems for instant messaging when you need to raise attention to an urgent or immediate matter – especially between Practitioner and Reception team. There is a great internal messaging feature built in to Bp Premier that many doctors and their Practice team use, providing a useful instant on-screen message if ever required.

  • Value meaningful two-way engagement with your Practice team, ensuring the team knows you will provide (and you welcome back) genuine and constructive feedback on team achievement towards individual and shared goals. Improving workplace communication is a lot easier when your team knows they’re being listened to.

  • Recognise the frontline role your Practitioners and Practice leadership team plays in team engagement – and let your Practice leaders know you expect they will make team communication the first and foremost part of their role as leader and use language which is familiar to and understood by their work group.

  • Ensure your Practice team knows they will be briefed face-to-face on matters which affect their job, and you’ll set that standard yourself. If each employee can’t be consulted and involved in decision-making regarding their job before any major change occurs, they should at least be briefed in person on important matters which change what they do, or how you expect them to do it.

  • Preference communication that promotes action within your team and Practice. We’ve all sat in a meeting that should have been an email, so ensure any team assemblies have a clear and concise purpose (agenda), don’t linger longer than is necessary, and you note and distribute a summary of key action items and accountabilities before anybody leaves.

  • Outline to the team your minimum engagement opportunities. Perhaps make a commitment that, for instance, you’ll host supervisor briefings at least monthly, and supervisor-to-Practice team briefings every second day, and informal ‘toolbox’ chats on health and safety matters or reception/patient matters each Friday morning at 7:30am. This helps ‘lock in’ your time together, and shows you’re wholly committed to these engagements, even if you don’t have much news to share.

While these tips provide a good starting point on the topic, improving workplace communication needs and deserves follow through and actions that match your words, from the senior-most level to the people greeting and treating your patients. By sharing team news early and consistently you’ll help ensure your preferred (rather than speculative) message is heard by every member of your team.

Authored by:

Craig Hodges
Chief Corporate Officer at Best Practice Software

Why is my Baby Irritable? – Six Points to Understanding Infant Sleep

Irritable Baby Article Baby Sleeping next to Clouds

A common problem in primary care is to be asked for guidance on the care of an irritable baby. In this article I describe non-medical problems which, in my experience, actually dominate over medical problems.

As a GP I have focused on the care of mothers and babies for about 40 years and have seen well over 10,000 families. For the rest of this article, let’s assume that the irritable baby in question is less than 12 weeks old.

To oversimplify the situation, my experience is that in this age group two problems dominate – fatigue and hunger.

So, if you are faced with an overtired mother and an irritable baby who seems to cry excessively, a very simple algorithm is as follows. Exclude poor weight gain and take a simple sleep history.

In this article I am going to focus on fatigue, but in terms of ensuring adequate nutrition it is easy to measure weight, to calculate weight gain per day and percentiles.  For children under 12 weeks, I recommend measuring and graphing these three variables at every visit.

Weight or Hunger

Unfortunately, hunger is very common in our culture.  If weight gain per day is less than 30 gm per day, if percentiles are dropping, if the baby is irritable at the end of the feed, if feeding times are prolonged i.e., more than a total of 20-30 minutes then a feeding review is needed.  Do whatever is needed to ensure that the baby finishes all their feeds fully satisfied.  I can address hunger and feeding in more detail in a later article. Today, we are focused on sleep.

Sleep, Fatigue or Over-tiredness

Total sleep volume that is needed to be well in the first few months is almost always more than 16 hours per day. This varies with weight but only a little.  Heavier babies can cope with a little less sleep and light babies need more.  To put that point in its reverse, lighter babies become over-tired more rapidly and need shorter waking times.

I teach six main points which give a useful and practical understanding of infant sleep.

  1. Sleep is Cyclical
  • During a block of sleep it is normal and healthy to awaken and resettle multiple times.
  • For a newborn baby, these cycles are about 45 minutes long. The waking events will last generally 30-90 seconds. The majority should be silent, and you will be unaware that they occur.
  • In overtired babies they may waken at the 45-minute point and have trouble getting back to sleep. Thus, if your baby is calling for assistance every 45 minutes it may be a sign of fatigue.
  • In very overtired babies, sleep cycles can ‘break down’ to 20-minute cat naps.
  • In a block of sleep, a baby awakens and returns to sleep multiple times. What forces drive a return to sleep? To simplify very complex events, I identify two things:  Tiredness and ‘cues of sleep’.
  1. Cues of Sleep
  • It is useful to think of the sleep achievement event as being driven by a combination of tiredness and external cues of sleep i.e., the things which are going on around the baby at the time.
  • Again, to simplify these cues can be divided into parent dependent and parent independent.
  • When a baby or child is put to bed at the beginning of a block of sleep tiredness dominates. Cues of sleep achievement are outweighed by tiredness and they are more likely to achieve sleep efficiently.
  • As a block of sleep progresses tiredness reduces and cues of sleep become more important in achieving a return to sleep.
  • If a baby is put to sleep using parent dependent cues i.e., holding, rocking, patting, feeding then there is an increased chance that the baby will request those cues be repeated later in that block of sleep.
  • Cues of sleep which are parent independent are more useful. I use a term ‘parent-lite settling’.  So, we prepare a baby for sleep, but the final transition is achieved by the baby alone as often as is possible.
  1. Cues of Sleep are Learned
  • To make this point I use adult experience. Learning to sleep with a partner. Moving to a new suburb or street with different noises outside the home. Buying a new bed.  We have all had these experiences.
  • So, cues of sleep can be changed and relearned.
  • Babies actually do this very efficiently.
  1. Sleep Achievement and Sleep Maintenance are Usefully Regarded as Learned Skills
  • By combining two points i.e., sleep is in part cue dependent and cues are learned I develop a very important point.
  • Going to sleep and maintaining sleep are usefully considered learned skills.
  1. Fatigue Interferes With the Learned Skill of Sleep Achievement
  • This point may seem counter-intuitive but almost every single mother that you care for will agree that she has had a personal experience of becoming so tired that while she is desperate to get sleep her mind will not turn off. This is critically important for children.
  • Therefore, it is important to ensure the child does not become over tired.
  • A newborn can become overtired in 10 – 15 minutes.
  • Low weight babies are more prone to fatigue and heavier babies a little more resistant.
  • For the age group under discussion waking times need to be fairly short i.e., 20-30 minutes over-night and something like 45 minutes during day light. This time includes feeding, changing, cuddles and any social time.
  • To put it another way in the first month of life my ambitions for a baby are simply feed, sleep, and grow.
  1. Cues of Sleep Achievement That are Parent Independent are the Most Useful for Family Life
  • A baby who achieves sleep with parental care is preordained to request that care again at some point in the block of sleep. Minimise sleep transitions which involve parental assistance and allow a child to achieve sleep alone.
  • Adopt a ‘parent-lite’ approach to sleep achievement. Be there and be supportive but keep it minimal rather than the reverse. The baby needs to feel parental love and support but when it is time to be asleep leave them alone to finalise the last steps in sleep achievement.
  • A parent has a major and positive role to play when the baby is awake and maybe even when sleepy but once the baby is ready to be finally asleep these events are best managed by the baby alone. This is true from the time of birth.

Conclusion to Assessing an Irritable Baby of Less Than 12 Weeks

  • Take steps to check that a baby is being well fed by whatever technique ensures adequate growth.
  • Avoid over-tiredness and the following points assist understanding.
    • Sleep is cyclical with blocks of sleep which include multiple short episodes of arousal followed by a return to sleep
    • Sleep achievement is in part cue dependent
    • Cues of sleep are learned can be altered and relearned
    • Sleep achievement and sleep maintenance are usefully regarded as learned skills
    • Avoid children becoming over tired as this interferes with the learned skill of sleep achievement
    • Minimise cues of sleep achievement that are parent dependent. Take a ‘parent lite’ approach.
  • It is my experience that ensuring complete feeding and avoiding over-tiredness linked to the learning of parent-lite cues of sleep will resolve that large majority of events where the presentation is an irritable infant aged 12 weeks or below.
Dr Brian Symon
This article was contributed by Dr Brian Symon. He has more than 30 years’ experience working with parents and babies experiencing problems of sleep, feeding, growth and behaviour. You can find out more about Dr Symon’s work at his website – The Babysleep Doctor.