General practice: clinical governance & patient management software

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  • General practice: clinical governance & patient management software

    1. 1. General practice: clinical governance & patient management software Harry Pert
    2. 2. Effecting Change for Better Outcomes
    3. 3. Commonwealth Fund Nov 2006 Use of EHR in general practice
    4. 4. Why has NZ been successful? <ul><li>Good software, and connectivity (PMS & Healthlink) </li></ul><ul><li>Culture ‘early adopters’ </li></ul><ul><li>Business model </li></ul><ul><li>New support for general practice from the early 90s </li></ul>
    5. 5. <ul><li>Formed 1991 </li></ul><ul><li>Capitation since 1996 </li></ul><ul><li>65,887 patients </li></ul><ul><li>15 practices </li></ul><ul><li>67 GPs </li></ul><ul><li>50 practice nurses </li></ul>
    6. 6. Developing information capacity: Fiona Thompson <ul><li>Cabling </li></ul><ul><li>Hardware </li></ul><ul><li>Software </li></ul><ul><ul><li>PMS (5 to 2) </li></ul></ul><ul><ul><li>MS Outlook </li></ul></ul><ul><ul><li>MS Word </li></ul></ul><ul><li>Training </li></ul><ul><li>Support </li></ul><ul><li>Wireless VPN </li></ul>
    7. 7. Developing information capacity <ul><li>Secure broadband internet for all receptionists, nurses and GPs </li></ul><ul><li>IPA IT staff can get onto our network for support and training </li></ul>
    8. 8. Supporting quality <ul><li>Investigations </li></ul><ul><li>All surgeries lab & x-ray connected </li></ul><ul><li>Results emailed throughout the day </li></ul><ul><li>Data management </li></ul><ul><li>Secure </li></ul><ul><li>Back up practice data overnight </li></ul>
    9. 9. Supporting quality <ul><li>Continuity of Care </li></ul><ul><li>After hours medical centre: consultation notes emailed to practice </li></ul>
    10. 10. IPA Projects & Resources <ul><li>Projects </li></ul><ul><li>Ethnicity </li></ul><ul><li>NHI number </li></ul><ul><li>Address formatting </li></ul><ul><li>Resources </li></ul><ul><li>Servers </li></ul><ul><li>Spirometers, Vaccine Fridges, Pulse oximeters </li></ul><ul><li>Scales </li></ul>
    11. 11. Sue Taft: Immunisation and child health <ul><li>Created age sex registers </li></ul><ul><li>Developed immunisation audit </li></ul><ul><li>Developed quality cycle </li></ul><ul><ul><li>Measure performance </li></ul></ul><ul><ul><li>Feedback </li></ul></ul><ul><ul><li>Intervention </li></ul></ul><ul><ul><li>Repeat </li></ul></ul>
    12. 12. Rotorua Business Awards 2003 RGPG National average Immunisations 92% 80% Flu vaccinations 68% 60% Cervical screening 72% 66% Diabetes reviews 85% 51% Smoking data 78% N/A Ethnicity data 99% 76% Satisfaction 85% 80%
    13. 13. High School Wellness Centres
    14. 14. Connecting clinics, schools, pharmacy, hospital, lab, and x-ray
    15. 15. Health.net overview
    16. 16. What have we learnt? <ul><li>Clinical governance </li></ul><ul><li>The nature of general practice </li></ul><ul><li>The role of management support </li></ul><ul><li>The new requirements of our PMS </li></ul>
    17. 17. Clinical governance <ul><li>“ Clinical governance is a system through which NHS organisations are accountable for continuously improving quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” </li></ul>
    18. 18. Creating an environment… Network RHA, HFA DHB MoH <ul><li>Clinical Support </li></ul><ul><ul><li>Clinical leaders </li></ul></ul><ul><ul><li>Clinical (nurse) specialists </li></ul></ul><ul><ul><li>Peer (cell) group leaders </li></ul></ul><ul><ul><li>Quality facilitators </li></ul></ul><ul><ul><li>Pharmacy and lab </li></ul></ul><ul><ul><li>Immunisation & child health </li></ul></ul><ul><ul><li>Education organisers </li></ul></ul><ul><li>Management Support </li></ul><ul><ul><li>Contracting </li></ul></ul><ul><ul><li>Claims processing </li></ul></ul><ul><ul><li>IM/IT </li></ul></ul><ul><ul><li>Analysis and planning </li></ul></ul><ul><ul><li>Practice support </li></ul></ul>GP GP
    19. 19. Key ingredients <ul><li>People, Processes & Technology </li></ul><ul><li>Relationships </li></ul><ul><li>Leadership </li></ul><ul><li>Ownership </li></ul>Leadership Ownership Relationships
    20. 20. Creating an environment… <ul><li>Permissive: </li></ul><ul><ul><li>High trust, low bureaucracy </li></ul></ul><ul><ul><ul><li>Innovation flourishes, achievement & morale high </li></ul></ul></ul><ul><li>Prescriptive: </li></ul><ul><ul><li>Low trust, high bureaucracy </li></ul></ul><ul><ul><ul><li>Innovation stifled, achievement & morale low </li></ul></ul></ul>
    21. 21. UK NHS: NPfIT <ul><li>“ Some of the key enablers of service transformation, such as the delivery of Information Technology will … increasingly need to be driven and owned out in the service rather than from the centre, so that patients can get the full benefits as quickly as possible ”. </li></ul><ul><ul><ul><li>David Nicholson, NHS Chief Executive Dec 2006 </li></ul></ul></ul><ul><ul><ul><li>The NHS operating framework for 2007/08 </li></ul></ul></ul>
    22. 22. Dennis Protti BJ Healthcare Computing and Information Management Dec 2003 <ul><li>Over 150 factors… identified, but only two – top management support and clinician involvement… consistently associated with successful implementation” </li></ul><ul><li>“Lack of clinician involvement has been a consistent theme in past failures” </li></ul>
    23. 23. Changing roles and responsibilities Individual care Population care Clinical Governance National Regional DHB/NGO Network Practice Provider Individual Support for best practice Decision support; Quality processes: (audit, feedback, education); Outcomes focus Long Term Conditions Proactive Structured Acute Conditions Reactive ‘Unstructured’
    24. 24. Changing roles and responsibilities Individual care Population care Clinical Governance National Regional DHB/NGO Network Practice Provider Individual Support for best practice Decision support; Quality processes: (audit, feedback, education); Outcomes focus Long Term Conditions Proactive Structured Acute Conditions Reactive ‘Unstructured’ <ul><li>Current PMS capacity: </li></ul><ul><li>good at: </li></ul><ul><ul><li>‘ traditional, reactive’ care </li></ul></ul><ul><li>Less good at: </li></ul><ul><ul><li>patient access to EHR </li></ul></ul><ul><ul><li>proactive structured care </li></ul></ul><ul><ul><li>population care </li></ul></ul><ul><ul><li>clinical governance tools </li></ul></ul>
    25. 25. and in conclusion.. <ul><li>General practice has changed, and needs to continue to change... </li></ul><ul><ul><ul><li>what we do do </li></ul></ul></ul><ul><ul><ul><li>what we could do </li></ul></ul></ul><ul><ul><ul><li>what we should do </li></ul></ul></ul><ul><li>PMS development isn’t keeping pace with changing requirements </li></ul><ul><li>Rate of change in other countries faster than NZ </li></ul>
    26. 26. Where is NZ PMS on this curve?
    27. 27. Thank you

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