Transcript Fred and his dog

Fred and his dog
Using communication and social media for patients
with multiple problems
Mary Hawking
GP Dunstable
John Perry prize 2009
UKCHIP level 3
member PHCSG
(Primary Health Care Specialist Group)
Committee member EMIS NUG
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History of Fred
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EoE LTC scenario as Adam
In scenario for SRPG report 2009
At HC2011 with confidentiality issues
PHCSG adoptee
CLICSIGs around use of social media
Looking into what is already available
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Fred
• 70 yr old lives alone with dog
• Recent amputee – leg
• Multiple LTCs: DM, RhA, COPD, depression.
– Medical care from GP, Community Matron, and 4
different AQP teams.
• Formal domiciliary care both social & medical
• Informal support network
• Responsibilities - dog
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Objectives
• Support Fred living independently at home
• Prevent harm from:– Lack of communication around social care
– Medical accidents and safety breaches
– Lack of essential medical information
– Uncoordinated care
– Unnecessary admissions
– Omission needed care from unassigned responsibility
• Use of modern ICT to enable above.
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Keeping Fred at home..
Coordination
&
Communication
Informal care
& support
Fred
Care at home
(and dog)
Medical care
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Fred’s support
• Direct official care at home
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DNs (insulin & stump)
Carers
Social support e.g. lunch clubs, day centres
Rehabilitation
Shopping & housework
Dog
• Informal care network
• Medical care from multiple providers
• Communication between previous three
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A Fred-friendly interface
which needs content
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“Manuel, when faced with a problem you do not
understand, do any part of it you do understand,
then look at it again”
Robert Heinlein, The Moon is a Harsh Mistress.
• Management by multiple
medical teams
• Informing people when Fred
not home
• Difficult – discuss later
• Informal support network
• RallyRound
http://rallyroundme.com/welcome
or similar
• Phone
• Care coordinator
• Calendar management
• Messaging
• Single point of contact
• Phone/fax/acknowledgement
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RallyRound
http://rallyroundme.com/welcome
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RallyRound 2
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Patient centric
Who is responsible?
Fred
GP
Community
care
Medication
GP
Secondary
Care
Community
Care
Medication
Fred
Disease
Specific
Pathways
Secondary
Care
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Specific
Pathways
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Information and Clinical
Governance in Fred’s medical care
• Who is responsible?
• What information do
all providers need to
avoid harm?
• Buck stops where?
• No model for shared
care
• Medication
• Actions of others in
real time
• Plans/pathways
• Pecking order
• Agreed coordination
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Care shared between medical
teams
• Fred has 4 LTCs + amputation
• Medical management of each condition by
different AQP plus GP, DN and other
services
• Problems with coordinating and prioritising
• No single source of real time information
• Considerable risk of harm due to lack of
information.
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The underlying problem
• Many medical conditions
• Management of one
condition impinges on
others
• No model for this
• No system for
communication or
information
• No prioritisation in
management
• This is the pattern
for future
• Each managed by different
team
• Pathways may not be provided
by single AQP
• Communication/shared care
agreement between teams
• Lack of record information
• Lack of information on
medication
• Followup & monitoring
• Coordination
• Responsibility
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What is available?
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Telemedicine
Virtual Wards
Community Matrons
Clinical Portals
Patient controlled records
• SCR
• SSEPRs
• Purposive record sharing e.g
EMIS Web & MIG
• Require infrastructure
• One central organisation in
control
• Not available in England
• Patients Know Best
• Howareyou (not to be
confused with HowRU)
• Information entered &
controlled by patients
• Limited GP data only
• Governance issues
• Difficult many-to-many
• Governance issues
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Single organisation solutions
• Telecare
• Virtual Wards
• Community Matron
• Pros
– Single path
responsibility
– Clear organisation
– Virtual inpatient model
• Cons
– ? Suitable for Freds
– Difficult to implement
with multiple AQPs
– Medical responsibility?
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Guided Care
http://www.guidedcare.org/
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Records
already available
• Pros & Cons
• Whole record upload
• Patient Access
– http://www.htmc.co.uk/
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SCR +/- enrichment
Virtual records EMIS Web
SSEPRs (SystmOne)
Patient held records
PMR websites
– http://www.patientsknowbest.c
om/
– https://www.howareyou.com/
• Others?
– Hampshire read only
– PAERS read only GP
– Virtual & SSEPR need
proprietary software
– GP only (apart SSEPRs)
– Complicated sharing
arrangements
– Would need to be regarded
as prime entry
– Updating
– Confidentiality
– Access control
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Patient Record Access
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Patients Know Best
http://www.patientsknowbest.com/
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How are you?
http://www.patientsknowbest.com/
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How are you? Not to be confused
with HowRU?.....
http://www.abies.co.uk/howru
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Medication
• Major risk to patient
• AQPs with own pathways
• Independent prescribers
• Real Time information
• Compromise
• Is a common
medication record
possible/desirable?
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• Errors common
• And other AQPs –
including GPs
• Only qualified in own
specialities
• Need coordinated ICT
• Care coordinator
• Agreed responsibilities
https://woodcote.wordpress.co
m/2011/04/27/medicationrepository-anyone/
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Will DALLAS solve Fred’s problems?
• DALLAS - (Delivering assisted living
lifestyles at scale)
• Following the WSD (Whole System
Demonstrator) program
• Funded
• Needs many participants to submit bid
• Kings Fund event
http://www.kingsfund.org.uk/events/past_events_catch_up/supporting.html#t
ab_1
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DALLAS – caveat ref Fred
• Projects at Kings Fund all telecare with
single organisation backup
• Majority single LTC
• Information into GP system: not out of it
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http://www.telehealthsolutions.co.uk/products/home-pod/
• WSD & DALLAS about admission
prevention rather than holistic medical
care.
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Telecare communication
Two way communication?
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Conclusions - 1
• New patterns of care need new organisational structures
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Multiple medical care from multiple providers
Need new structures
Who is in overall control
Role of GP
Role of CCG
Medical Defence Organisations
• Information is essential
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Record
Medication
Activity
Real time
• Whole System approach essential
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Conclusions - 2
• Fred’s medical needs/care not covered fully
• Depending on ICT requires:– Organisation
– ICT infrastructure
– IT literacy
• Patient
• Care providers
• User-friendly interface
– Disability and access issues
– Long term planning
– Cooperation between organisations and individuals
– Management
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Is there the will - or ability - to look
after Fred?
• Questions?
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