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healthdirect
Symptom Checker
Dr. Trina GregoryDr. Kieran Le Plastrier
o A not-for-profit organisation funded by the Governments of Australia to provide telephone based and online health information services
o Our aim is simple – to provide Australians with equitable access to safe, trusted health information to enable them to make informed choices about their health
o Our organisation was formed in 2006 as the National Health Call Centre Network (NHCCN) to provide a nurse triage helpline
o In the years since inception our organisation has expanded to deliver a wide range of integrated helplines and online services:
Healthdirect Australia… who are we?
Healthdirect Australia… who are we?
We manage a suite of services which are accessible across the country:
• 24 hours a day, 7 days a week -free helplines and online services point your patients to the right service, at the right time
• We do not diagnose, or provide a substitute for face-to-face care
healthdirect
• A helpline service available 24hrs a day which allows callers to speak with a registered nurse for information and advice
• A website which allows your patients access to trusted health information and hosts the healthdirect Symptom Checker
after hours GP helpline
• Allows callers to the helpline access to a GP during the after hours period, when their local GP may be unavailable
• Particularly relevant for rural and remote patients
Pregnancy, Birth and Baby
• A telephone counselling service offering free, confidential support to pregnant women, their partners, and new parents with a baby up to 12 months of age
• A website with a wealth of information to assist you in supporting your patients
mindhealthconnect
• A web based portal providing mental health information and advice
• Links to trusted content and service providers
My Aged Care
• A website and telephone contact centre providing information and advice for older people and their families to enable them to better navigate the aged care system
Get Healthy
• Free advice and coaching for a healthier lifestyle
National Health Services Directory
• A national database of health services and provider information
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Healthdirect Australia identified the need for a clinically sound online tool to assist consumers in making health choices because:
o Over 80% of Australians are seeking health information online*
o Over 60% of Australians are seeking information and symptoms and disease online*
o Dr Google is not a trusted source of information!
* Market research conducted by Objective Digital in June 2013
Symptom Checker…why build it?
Warm Up
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What do you want to ask?
Why are you asking these questions?
What outcome is appropriate for these callers?
Scenario 1: 50F, calling to ask advice on her 56 year old husband’s nose bleed. Started 10 minutes ago and hasn’t stopped.
Scenario 2: 68M, ESL with accent, In hospital recently for 2 nights with infected right leg on IV anti-b’s, Now on oral anti’s, but worsening pain and redness over 24 hours.
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Stop your patients googling it! Encourage your patients to ‘healthdirect it!’ to find trusted information on symptoms they may be experiencing.
Symptom Checker…a safe alternative
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Clinical Panelists’ Perspectives
An online symptom checker for patients
o Good clinical information that will safely direct patients where they need to go
o User friendly and with assurance that the information they get from the internet is accurate, safe and clinically sound
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Works with the principal of a patient's “medical home”
o Encourages a person to help themselves where appropriate, but also to discuss and involve their "usual GP" where ever possible and appropriate
o Aimed to work with GPs, not as a substitute to GPs
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For all Australians
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Anyplace Anywhere Anytime
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Not a diagnostic tool
Not a replacement for face to face consultation
Does not undermine or compete with relationship a GP has with their patients; aimed at enhancing this.
Not about saving money, un blocking beds or freeing up EDs
Encourages consumers to take responsibility for their health and improve health literacy
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What it is not…
What about after hours?
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o What do patients currently do if they are worried?
o What would you like them to do?
o What is best for everyone?
Background
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o Long time requirement of funding agreement
o Researched various options
o Study tour to UK to review NHS Direct HaSCs
o Licenced – early 2013
o 41 HaSCs
o Undertaking an “English to Australian” translation
o Went live with 20-24 early July
o Remainder over following 9 months
o Spare for pandemics
What we have completed so far:
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Head injury
Chest and back pain
Colds and flu
Diarrhoea and vomiting (adult)
Diarrhoea and vomiting (paeds)
Abdominal pain (adult)
Abdominal (paeds)
Breathing problems
Leg pain
Burns and scalds
Chest injury
Rashes and skin problems
Pregnancy problems
Hay fever and minor allergy
Wounds
Limb injury
Bites and stings
Back injury
Joint pain and swelling
What we are working on:
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o Headacheo Neck paino Swallowed and inhaled
substanceo Foreign bodyo Urinary problemso Rectal bleedingo Eye problemso Earacheo Dizzinesso Confusion
o Collapseo Female health & STI’so Men’s health & STI’so Mental healtho Diabeteso Mouth problemso Dental problemso Nose bleed o Facial injuryo General illness (adults)o General illness (child)o Contraception
Adaptation to Australian Context
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Evidence Review and Gap Analysiso Undertaken by NHS Directo Based on list of Australian authoritative sites;
e.g. NHRMC, NICS, DOHA and Content Partners, eg Cancer Council, Heart Foundation, Professional Colleges
o Focus on guidelines rather than underlying evidence – basis of healthcare professional advice
SimpleMonitor head injured patient for 2 days ‐ UK 1 day ‐ AU
ComplexSignificant research AU standards / guidelines.Significant discussion with UK re inclusions in Gapeg Bites and stings – multiple inclusionseg Mental Health –completely rewritten.
ModerateDifferent care advice to UK.AU research into local guidelines and standards.Discussion with UK re inclusion in Gap and content. eg Hydration advice for adults and infants
Content
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Clinical Assessment Panel Currently 24 members Every panel consists of – ED physician, GP, ED nurse, Pharmacist,
Paediatrician, Ambulance rep. Some panels also include SME’s. Some SME’s include:
Sexual health nurse Midwife Urologist Psychiatrist Obstetrician Mental Health Nurse
Review 5 documents Visio Logic Flow Self Care advice Flow points Change log (changes identified in Gap analysis) Dispositions
• UK review - Some acceptance of risk
Dispositions. More than end points.
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Disposition review
o Dispositions are the end point – the recommendation of appropriate care.
o UK -120
o so far 22 in Australia
o Expect to have more as we progress through to specialist dispositions.
o Reduced due to context of Australian health system
o 9 UK call backs reduced to 1 in AU (ring - healthdirect)
o Speak to your GP
Evaluation and monitoring
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Internal data collectionAnalytics
Questions yet to answer: impact on telephone service; impact on GPs if any; improved appropriateness of attendances at ED and/or GP
We have UK experience as a guide; Australian modelling
Service Improvement and Development Committee (SIDC) –Quality review and improvement
Benchmarking – with UK
Longitudinal prospective study
What do you think?
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Demonstration and discussion
http://www.healthdirect.gov.au/
Example Scenarios for Symptom Checker
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A. School child with gastro symptoms
A. 28F with pleuritic chest pain for 2 days
1. Find the appropriate checker2. Follow the script as shown to find the disposition3. Are you satisfied with the advice?4. What might you do differently, and why?5. What are your views on the end-point summaries as you view
them?
Thank you
Questions?
