Connected Health

A GP’s Perspective

Dr Declan WoodsNational Healthcare Conference 1st April 2014

Technology & Digital IT Forum-Connected Health

What is General Practice?

• Vast majority of patients are managed within the community by GPs

• The number of patients presenting to general practice is increasing from year to year

• General Practice is the first point of contact with the health services for most patients

• Cradle to grave

Current Technology in General Practice

What technology is working well in General Practice?• GP Software• Healthlink

– NIMIS– Lab Reports– eReferrals – Cancer, Early Arthritis– GP Out-of-Hours Messaging

• PCRS

Caredoc Case Study

• Excellent example of a fully integrated healthcare service with a complete electronic patient record

• Award winning ICT platform developed over the last 15 years

• Interoperable with other healthcare services

The Caredoc Organisation

• GP Cooperative with 670 participating GP members

• Not for profit company• Governed by a Board of Directors and

Management Team, fully indemnified• Collaboration between GPs, HSE and Department

of Health (since 1999)

What is Caredoc?

GP Out of Hours

Service

Community Intervention Team (CIT)

Nurse Remote Patient

Management

Integrated Technology Platform

Joined up and integrated

A focus on patient care needs

Delivers high quality appropriate healthcare services

Easily navigable for patients & staff

ICT Interoperable, scalable & adaptable

Caredoc’s approach

Caredoc patient centric ICT System

• Seamless flow of electronic data through the patient journey• Data precedes the patient• Clinical Decision Support Software • Special Patients Notes / Care plans• IT connectivity to Treatment Centres and Mobile Units• Technology devices: Workstations, Laptops, Tough books and Tablets. • Linked to daytime G.P. Surgery software• Linked to the Acute Hospital Network – SLHK • Deaf/Hard of hearing texting service using 3G/GPRS mobile solution

Complete out-of-hours electronic Patient Record

• Patient demographic details• Call handler notes• Nurse triage notes • Access to previous encounters (if the patient has been seen in the out-of-hours or CIT service)• Doctor consultation notes• Receptionist notes• “Special Patient notes” – important information about a patient (palliative care notes, drug

notes etc – received from patients own GP)• Full auditable files• Event list – who interacted with the patient record• Complete log of all people who have accessed the file (both to add notes but also who viewed

the file)• Nothing deleted from files – all information, even when altered, is available for audit

Implications for clinical practice Visibility & Accuracy

• Information on patient interactions with healthcare services is captured in Electronic Patient Record database.

Seamless flow of electronic data through the patient journey

• Patient information is delivered in a timely and efficient manner.

• Information precedes the patient.• Rules out unnecessary duplication.• Productivity is improved. • Provides clear visibility for the GP on

their patients at all times.

Information precedes the patient at each point of care

Caredoc Network

• Network that covers the South East of Ireland (Carlow, Kilkenny, Waterford, Tipperary, Wexford, South Wicklow) – Approximately 834 system users– 13 Treatment centres– Users: Doctors, Triage Nurses, Clinical Nurses, Nurse Prescribers,

Call Handlers, Receptionists, Administration – Mobile Units (Home Visits & CIT Visits)

• Connectivity with the NEDOC , D-DOC and NoWDOC Out-of-Hours Services

The right care at the right time

CAREDOC operates with The Nightingale Teleguides - an algorithm-based clinical decision support software (CDSS) tool . They are a set of symptom based, age and gender specific clinical algorithms, which enable the right person to reach the right level of care at the right time.

Clinically Safe & Evidence-Based

Improves efficiency of Remote Patient Management

Reduces unnecessary A&E / GP visits

Expert Clinical Decision Support Software

Challenges facing General Practice

• Our aging population • Increasing life expectancy• The rise in complex chronic health

conditions • Finite budget • Limited resources – Manpower • Lack of Individual Health Identifiers

(IHI) for every citizen• Lack of ICT Interoperability and

connectivity

What is required?

• Increased collaboration between healthcare providers

• Need for effective and appropriate care to be delivered by the most appropriate healthcare provider

• Build services in the community

• Integrated technology to support collaboration

Reality of Healthcare Services

No single discipline can practice in isolation or meet all of the changing needs of patients today -- Interoperable ICT systems, collaborative research and healthcare partnerships are critical to avoid silos and improve patient care.

HEALTHCARE PROVIDERS

INDUSTRY RESEARCH & TECHNOLOGY

COLLABORATION

PATIENTS

eReferral &

eDischarge

ePrescribing &

eMedication Management

Research, Predictive Modeling

& Data Mining

Enhanced connectivity

Telehealth

New areas of interoperability and connectivity Sharing of information more effectively Expand the concept of healthcare through new

services to create greater efficiencies Individual Health Identifiers

Examples of technology projects that need to be addressed:

Next steps

eHealth Strategy 2013

• International experiences– Denmark– UK Whole system Demonstrator

• eHealth can deliver better patient care, improved outcome and increased savings

• Change management and collaboration • Investment in healthcare ICT

– 0.85% of total healthcare budget relative to EU 2-3%

Thank you