Transcript Vision for the Future

Outcomes Manager – Unplanned
Admissions DES
Unplanned Admissions DES
Personalised Care Plan Manager
• A dynamic template based on
the example within the DES
Documentation.
• Backed up by relevant patient
alerts and practice reports that
enable the personalised care
plan to remain up to date and
relevant.
Risk Stratification and Register
Manager
• 2 Versions
– Qadmissions Risk
Stratification
– Non-Validated Risk
Stratification
• Both contain a 2% Monitor
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Personalised Care Plan Manager
• “A Record
within a
Record.”
• More than an
electronic
version of the
DES template.
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Personalised Care Plan Manager
• Clinical
Information
presented in a
Clinically
Relevant way.
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Personalised Care Plan Manager
• Simple data
entry to be
able to track
processes.
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Personalised Care Plan Manager
• Useful clinical
alerts to help
identify
potential
increased risk
of admission
when in a
patient record.
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Personalised Care Plan Manager
• Clear Care Plan
Summary Tab
for Quick
Reference
• Action plan
documentation
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Personalised Care Plan Manager
• Electronic version populates the fields
within a printable version for patient.
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Personalised Care Plan Manager
• Practice Reports allow
efficient management
of patients on the
register
• Excel files can be
generated to build up
evidence in support of
payment claims.
• Outstanding tasks to
fulfil DES targets is
listed.
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Personalised Care Manager –
Additional Functionality
•
Consent/Capacity prompt and check
•
Anticipatory Care – thorough documentation and planning
•
Home Visit Logging and alerts
•
Adverse drug reaction monitoring and alerts
•
Blood results trend and absolute value alerts
•
Centralised Dashboard Reporting – adaptable to local needs.
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Risk Stratification and Register Manager
- Non-validated Categorisation Number of Admissions in
Last Year
Age:
90+
80-89:
70-79:
60-69
50-59
<50:
Risk Factor Count
Risk Factors:
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CVD
CVA
Heart failure
Diabetes
AF
COPD
Asthma
Palliative Care
CKD
Dementia
Epilepsy
Learning Difficulties
PVD
Smoker
On Warfarin
On NSAIDs
Alcohol > 40 Units/Week
Obesity
On Mental Health Register
Cancer Diagnosis
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Risk Stratification and Register Manager
• Allows practice to
make decisions based
on categorised data
• No probability of
admission risk is
reported
• Cannot demonstrate
change in risk
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Risk Stratification and Register
Manager
• Qadmissions Version:
1.Probability reported.
2.High level of granularity in the
stratification.
3.Allows practice to demonstrate
improvement in overall risk.
4.Stratifies register itself to enable high risk
patients to be managed first.
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Risk Stratification and Register Manager
• Both Versions:
1. 2% Monitor
2. Run weekly, this
can help practices
stay on top of the
workload, with
patients easily
being
added/removed
from the register.
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