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Download protocols - computers, cardiology and primary care
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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 – – – – Computerised since 1994 Paper light since 1997 EMIS LV since Dec 1999 (currently LV 5.2) No dedicated computer worker Dr Matt Fay 2003/Cardiology&Computers 2 What’s Next • • • • Computers in General Practice Emis Templates and Protocols Data extraction Moving towards integrated practice Dr Matt Fay 2003/Cardiology&Computers 3 The Computer and General Practice • Level of computerisation – – – – – – – 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 Dr Matt Fay 2003/Cardiology&Computers 4 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 Dr Matt Fay 2003/Cardiology&Computers 5 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 Dr Matt Fay 2003/Cardiology&Computers 6 The Template Dr Matt Fay 2003/Cardiology&Computers 7 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) Dr Matt Fay 2003/Cardiology&Computers 8 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) Dr Matt Fay 2003/Cardiology&Computers 9 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) Dr Matt Fay 2003/Cardiology&Computers 10 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 Dr Matt Fay 2003/Cardiology&Computers 11 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 Dr Matt Fay 2003/Cardiology&Computers 12 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 Dr Matt Fay 2003/Cardiology&Computers 13 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 Dr Matt Fay 2003/Cardiology&Computers 14 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 Dr Matt Fay 2003/Cardiology&Computers Direction To determine which stage the protocol will go to in answer to the rule 15 Protocol Basics Stages Display the introduction screen Rules Find Reed code 246 in last 6 months Dr Matt Fay 2003/Cardiology&Computers Direction If Reed code found Go to stage 2 If Reed Code not found Go to stage 3 16 Protocol Basics Stage 3 Display Information screen Blood Pressure not recorded Direction ‘has the BP been Rules recorded today’ Y/N Dr Matt Fay 2003/Cardiology&Computers If yes go to stage 4 if no go to stage 5 17 What does it look like in action Dr Matt Fay 2003/Cardiology&Computers 18 Dr Matt Fay 2003/Cardiology&Computers 19 Dr Matt Fay 2003/Cardiology&Computers 20 Dr Matt Fay 2003/Cardiology&Computers 21 Dr Matt Fay 2003/Cardiology&Computers 22 Dr Matt Fay 2003/Cardiology&Computers 23 Dr Matt Fay 2003/Cardiology&Computers 24 Dr Matt Fay 2003/Cardiology&Computers 25 Dr Matt Fay 2003/Cardiology&Computers 26 Dr Matt Fay 2003/Cardiology&Computers 27 Dr Matt Fay 2003/Cardiology&Computers 28 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 Dr Matt Fay 2003/Cardiology&Computers 29 Data Extraction • Bradford North and Incentives – All CHD NSF targets are part of the PMS incentive scheme. • Data extraction – – – – 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 Dr Matt Fay 2003/Cardiology&Computers 30 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 Dr Matt Fay 2003/Cardiology&Computers 31 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 Dr Matt Fay 2003/Cardiology&Computers 37 Questions [email protected]
