“Do Once and Share”

Feedback from the Renal Team

B Stribling, K Harris, A Keogh, J Medcalf

Aims

• Identify the potential for using the National Programme for IT to improve the efficiency of care processes

• Reduce unknowing duplication• Promote national consistency• Reduce the waste of professional & patient time• Ensure a common input to the Technical Office

(central IT)

Why do it?

Have at least one National Document e.g. NICE , NSF

Have an active professional community of practice comprising both professional and patient organisations.

Have already had systems development work undertaken by the Modernisation agency

Scope - I

• Provide baseline information on the current standard clinical practice, and likely changes to clinical pathways

• Identify training implications• Produce Guidelines for primary care on the

implementation of the project• Outputs for SNOMED required

• Describe existing renal IT systems, and the expectations of the wider renal community for future systems

• Describe any finished, or pilot projects in progress

• Develop communication plan between National renal community and NPfIT

• Report to stakeholders on progress to date• Produce timely reports as required

Scope - II

Out of scope

• Comprehensive engagement with social care• Comprehensive evaluation of needs of private

care providers• Comprehensive evaluation of the requirement for

the care of children with renal disease• Comprehensive training manual to include

recommendations for delivery

Patient unknown to have renal diseaseIdentified by• Coincidental Investigation• GP system identifies “at risk” (CVD, DM, ↑BP)• Other clinic• Pharmacy screening program• Formal screening program (if became technically simple• Symptoms of CKD (least likely)• Previous acute renal failure

Assessment and stage of CKD•Repeat Creatinine•Creatinine:age:sex:race = MDRD or other GFR estimate•BP•Urinalysis for blood and protein, protein:creatinine ratio•Screen for other disease eg DM•Drug / PMH / Lifestyle history

Clinical Advice SystemNELH

Map of Medicine

Local Referral Guideline

Assessment

Nephrology Advice“Virtual Nephrologist” orOther method of communication

NephrologyOutpatients

Choose and bookTemplates

Access to all previous dataPMH, FH, DH, BP,GFR,Urinalysis, Imaging etc †

X-ray

Pathology

Doctor

Specialist Nurse

Dietician

Pharmacist & electronicPrescribing supportNELH

Stable CKD *•Return GP CDMP with•Tailored management plan based on standard templates•All test results•Re-referral advice

Progressive CKD•Shared primary / secondary care

Other Renal Disease requiring specialist advice•Shared primary / secondary care

Patient info throughoutTailored to CKD stage and individual patientLanguagePaper as well as IT

CKD initial assessment

Pharmacist reviewMedicinesmanagement Guidelines / policies etc

Advice and supportPharmacy/Others

“One Stop”

Referral to other specialitye.g. Urology

Guideline

Primary care

Stable CKD *Chronic DiseaseManagementProgram (CDMP)Renal or other

† consider possibility that patient might prevent this

Patient unknown to have renal diseaseIdentified by• Coincidental Investigation• GP system identifies “at risk” (CVD, DM, ↑BP)• Other clinic• Pharmacy screening program• Formal screening program (if became technically simple• Symptoms of CKD (least likely)• Previous acute renal failure

Assessment and stage of CKD•Repeat Creatinine•Creatinine:age:sex:race = MDRD or other GFR estimate•BP•Urinalysis for blood and protein, protein:creatinine ratio•Screen for other disease eg DM•Drug / PMH / Lifestyle history

Clinical Advice SystemNELH

Map of Medicine

Local Referral Guideline

Assessment

Nephrology Advice“Virtual Nephrologist” orOther method of communication

NephrologyOutpatients

Choose and bookTemplates

Access to all previous dataPMH, FH, DH, BP,GFR,Urinalysis, Imaging etc †

X-ray

Pathology

Doctor

Specialist Nurse

Dietician

Pharmacist & electronicPrescribing supportNELH

Stable CKD *•Return GP CDMP with•Tailored management plan based on standard templates•All test results•Re-referral advice

Progressive CKD•Shared primary / secondary care

Other Renal Disease requiring specialist advice•Shared primary / secondary care

Patient info throughoutTailored to CKD stage and individual patientLanguagePaper as well as IT

Pharmacist reviewMedicinesmanagement Guidelines / policies etc

Advice and supportPharmacy/Others

“One Stop”

Referral to other specialitye.g. Urology

Guideline

Primary care

Stable CKD *Chronic DiseaseManagementProgram (CDMP)Renal or other

† consider possibility that patient might prevent this

CKD initial assessment

Assessment of CKD

Assessment of CKD

Local Referral guidelines

• Commissioned by Renal Information Exchange Group (RIXG)

• Provides web-based information to Renal patients about diagnosis, treatment, test results, clinical correspondence, Transplant suitability

Renal PatientView

Existing Functionality

• Majority of Renal units already have a well developed clinical computer system

• Functional, locally managed and flexible

• Contains many of the key elements of an Electronic patient record

• Able to share information, but until now not been a high priority

• 31 of 52 English & Welsh units (as defined by Renal Registry 2004 report as having IT systems) responded.

• 6 of 7 Scottish units with IT systems responded. (+ One with no IT system)

• 2 Northern Ireland units responded• 3 Paediatric units responded

42 units total

Existing Functionality

Risks/Issues

• NELH – not complete within this project timescale

• Implications of SNOMED

• Map of Medicine– not complete within this project timescale

• Renal Dataset ready 2007

Conclusion

• Described a reproducible framework on which to hang IT to support CKD

• Described existing functionality (what we have to protect)

• Promoted Renal as an IT literate “can-do” speciality

• Identified “easy” opportunities for further innovation and road-testing existing ideas