Transcript protocols - computers, cardiology and primary care

Computers Cardiology and
Primary Care
Dr Matthew Fay
Westcliffe Medical Centre
Shipley
Computers Cardiology and
Primary Care
• Westcliffe Medical Centre
– 9700 patients in urban setting
– Set just north of Bradford
– 7.5 whole time equivalent clinicians
• As team of whole and p/t Doctors and NP
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Computerised since 1994
Paper light since 1997
EMIS LV since Dec 1999 (currently LV 5.2)
No dedicated computer worker
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What’s Next
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Computers in General Practice
Emis Templates and Protocols
Data extraction
Moving towards integrated practice
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The Computer and General
Practice
• Level of computerisation
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We own a computer
We use a computer
We have our prescriptions on computer
We have some patient data on computer
We have our consultations on computer
We have all patient data on computer
We allow the computer to aid our
decisions
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Data in General Practice
Reed codes
•Large selection of alternatives
•In hierarchical trees
•Agreement on the root codes use
•Inform whole team
•Attempt to engage secondary care
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What is a CHD template
• List of agreed Reed Codes
• Accessed while in the consultation
• Useful for mass data collection
• Can also be a memory aid
•Don’t go too large
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The Template
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The Template
Data Collection
Prompt
Sub prompt
Ischaemic heart disease
Coronary artery operations
(792)
TL balloon angiopl coron a NOS (7928z)
Acute myocardial infarction
(G30)
Old myocardial infarction
(G32)
Angina pectoris
(G33)
Systolic blood pressure
Diastolic blood pressure
(2469)
(246A)
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The Template
Data Collection
Prompt
Sub prompt
FH - Ischaemic heart dis. (ZV173)
FH:
FH:
FH:
FH:
FH:
FH:
Mother
Father
Sister
Brother
Aunt
Uncle
(12K)
(12L)
(12M)
(12N)
(12Q5)
(12Q6)
FH - Ischaemic heart dis. (ZV173)
FH:
FH:
FH:
FH:
FH:
FH:
Mother
Father
Sister
Brother
Aunt
Uncle
(12K)
(12L)
(12M)
(12N)
(12Q5)
(12Q6)
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The Template
Data Collection
Prompt
ECG – general
Serum cholesterol
Tobacco consumption
Sub prompt
(321)
ECG requested
ECG normal
ECG abnormal
(3211)
(3216)
(3217)
Never smoked tobacco
Pipe smoker
Cigar smoker
Stopped smoking
Current non-smoker
Cigarette smoker
(1371)
(137H)
(137J)
(137K)
(137L)
(137P)
(44P)
(137)
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The Template
Data Collection
Prompt
Sub prompt
Left ventricular failure
(G581)
Congestive heart failure
(G580)
Non-insulin depd diabetes mell (C109)
Insulin depnd diabetes mellitus (C108)
Ischaemic heart disease
(G3)
Ihd Protocol
(PROIHDCRAIG22)
Recall date
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Templates Problems
• Tend to be set to single Reed codes
• If the template is too long people will
not use it
• Asks for information even is already
recorded
• Go for speed no technical complexity
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EMIS Protocols
Allow a degree of computer aided
decision making by allowing EMIS to
search the patient record for data
and by-passing the steps of the
template that have already been
completed
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EMIS Protocols
Essentially can be seen as ‘intelligent’
templates
• Can be set to trigger at certain Reed
codes
• Can search a patient’s record for data
• Can included templates for mass Reed
code collecting and ease of editing
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Protocol Basics
Built in Stages which determines the action
Such as Display a template, print a prescription
Rules
Such as find clinical data
Rules
Ask the operator a question
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Direction
To determine
which stage
the protocol
will go to in
answer to the
rule
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Protocol Basics
Stages
Display the introduction
screen
Rules
Find Reed
code 246 in
last 6 months
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Direction
If Reed code
found
Go to stage 2
If Reed Code
not found
Go to stage 3
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Protocol Basics
Stage 3
Display Information screen
Blood Pressure not recorded
Direction
‘has the BP been
Rules recorded today’ Y/N
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If yes go to
stage 4
if no go to
stage 5
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What does it look like in
action
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So what can be achieved .
• BP can be better monitored
• If Aspirin therapy is contraindicated
this is better documented
• Smoking status is consistently
recorded
• Betablocker commenced
• Cholesterol measured and controlled
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Data Extraction
• Bradford North and Incentives
– All CHD NSF targets are part of the
PMS incentive scheme.
• Data extraction
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Through templates the data sets are tight
PCT agreed targets are set annually
In EMIS clinical audits are useful
Don’t under estimate the power of Excel
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Moving to integrated
practice.
• Bradford North’s experience
– CHD collaborative has brought primary and
secondary care together
– Have the consultants with you
– Understand the pathway of care
– Understand your goal
– Share your problems as well as the successes
– Ask the patients their perspective is unique
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Patient Presents
Waits
Sees GP
GP Refers
Waits
Waits
Hospital
Receives
letter
Waits
Waits
Needs investigation
Has Investigation
Waits
Waits
Outpatients
Outpatients and decision
Waits
Waits
Consultant
receives letter
Angiography
Waits
Put on waiting
list
Waits
See Cardiothoracics
Long Wait
Admitted for surgery
New Co morbidity
identified
Waits
Outpatients and decision
Advanced
Patient Presents Access
Waits
Unified
Sees GP Referral
Form
Needs investigation
Has Investigation
Waits
GP Refers
Triage
Outpatients and decision
Waits
Admitted for surgery
See Cardiothoracics
Unified Referral
Form
Consultant/GP
SI receives
letter
Angiography
Informed of Plan at
time of angio
Advice and plan to GP
Pre hab nurse
completes checks
for surgery
Hospital
Receives
letter
Waits
Operation and Discharge
Put on waiting
list
Advanced
Patient Presents Access
Has Investigation
Unified
Sees GP Referral
Form
Directly on to Angio waiting list
Diagnosis, Advice and plan to GP
Waits Max
GP Refers 2 weeks
RACPS
Angiography
Informed of Plan at
time of angio
Advanced
Patient Presents Access
Has Investigation
Unified
Sees GP Referral
Form
Waits Max
GP Refers 2 weeks
Directly on to Angio waiting list
Admitted for surgery
See Cardiothoracics
Unified Referral
Form
Angiography
Informed of Plan at
time of angio
Diagnosis, Advice and plan to GP
Pre hab nurse
completes checks
for surgery
RACPS
Waits
Operation and Discharge
Put on waiting
list
Unified Cardiac Referral
Form
• GPs suffering form fatigue
– Single form for all cardiology services
• For services ECHO, ETT,RACPS etc.
• Also all consultant/GPwSPI referrals
• Has data set required by cardio services
– Integrates with Emis so data can
automatically be inserted
– Faxed to single number in ECG
department
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Questions
[email protected]