Health IT: The Death of Envelopes

THERE ARE 4 WAYS OF ACHIEVING CHANGE
EDUCATION OF PATIENTS AND PROFESSIONALS
MANAGEMENT
TECHNOLOGY
COMMISSIONING

HOW WILL INFORMATION TECHNOLOGY TRANSFORM THE JOB OF THE PATIENT?

THE WWW ALLOWS PATIENTS TO ACCESS THE SAME NOWLEDGE AS CLINIANS

www.nhs.uk

TECHNOLOGY ALLOWS KNOWLEDGE TO BE NOT ONLY MADE AVAILABLE TO PATIENTS; IT ALLOWS KNOWLEDGE TO BE SENT TO PATIENTS BEFORE THE CONSULTATION

Knowledge Clinician Patient informs Is given 20th Century knowledge flow

Knowledge Clinician Patient 21st Century knowledge flow

Knowledge Clinician Patient www Seeks advice Offers reflection

This will change the responsibilities of the patient

MR X has familial hypercholesterolaemia Every six months he receives an email reminder from the lab to have a blood test He receives 2 SMS reminders if no blood sample is received within 2 weeks If no specimen is received, his GP receives a copy email If there is a result, it is sent to the GP and to his Healthspace, a personal website, where it is stored in sequence Appropriate advice and support is automatically generated

‘ Decision aids [for patients]improve knowledge, reduce decisional conflict and stimulate patients to be more active in decision making without increasing their anxiety [they] have little effect on satisfaction and a variable effect on decisions’ Decision aids for patients facing health treatment of screening decisions; systematic review [ of 17 studies which met the inclusion criteria , out of 500 found ] O’Connor A M (1999) Brit med J 731-734

Muir Gray has early prostate cancer Having ascertained that he has a dvd player he is sent the HealthDialog/NSC dvd and a paper document; this includes both interviews with men who have cancer form DIPEX and a report of uncertainty inDUET’s At the consultaton he decides to enter a RCT

Muir Gray has rheumatoid arthritis and is being treated with methotrexate Every month he gets an email reminder to send a blood sample for whit blood count He is sent 2 SMS reminders If no blood sample is received his GP is notified , with a record of the prescriptions that he has collected from the pharmacist and receives a request to ask him to come for a discussion If the blood test is within the acceptable range MG is sent a result as a rss feed for direct entry to his Healthspace If the blood test is not within the acceptable range MG is asked to make an appointment with the rheumatoid clinic and emailed advice ; his GP is copied in to the correspondence

HOW WILL INFORMATION TECHNOLOGY TRANSFORM THE JOB OF THE CLINICIAN?

The job of the clinician of the 21st C will not be to remember everything; it will be to relate the knowledge to the unique needs of the patient and help the patient relate the options to their values

Evidence The values the patient places on benefits and harms of the options Patient’s clinical condition; other diagnoses & risk factors Choice Decision Knowledge Support provides evidence ‘just in time’

Muir Gray has familial hypercholesterolaemia Every six months he receives an email reminder from the lab to have a blood test He receives 2 SMS reminders if no blood sample is received within 2 weeks If no blood arrives is received his GP receives a copy email If there is a result appropriate advice and support is automatically generated and emailed to Muir who lives in Oxford OX2 8JQ

The Oxford Lab Service Muir Gray 21/06/1944 NHS number 400 186 6897 Cholesterol 5.3 This cholesterol level is unchanged ; there is no need to increase statins. The first step is to increase the amount of walking; try to walk an extra 3,000 steps every day(30 minutes walking the brisker the better) have you considered buying a dog? To find a big dog for sale near you click here For access to full text of guidance, with supporting evidence, click here To test your knowledge in one minute click here NB THIS TEST AS LAST DONE ONLY 12 MONTHS AGO; THERE IS NO NEED TO RETEST MORE THAN ONCE EVERY THREE YEARS. THE LAB WILL NOT PROCESS A SAMPLE UNTIL 3 YEARS HAS ELAPSED

A common core of quality assured knowledge must be delivered to professionals and patients; clean clear knowledge is as important as clean clear water

This is the quality of knowledge most citizens, and many professionals, consume

Guidance in long esoteric documents can be embedded in lab request and report forms

“ The false positive rate [for Hepatitis C] is especially important in low prevalence settings where the number of false positives may exceed the number of true positives” Booth JCL et al (2001) Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27

What it really looks like

Royal Cornwall Lab Service Muir Gray 21/06/1944 NHS number 400 186 6897 ELISA 25.5 Hepatitis C is of low prevalence in Cornwall. National guidance is that diagnosis should be confirmed by PCR test in low prevalence populations For PCR test click here For access to full text of guidance click here To test your knowledge in one minute click here

The consultation will not just be face to face but will be extended, at both ends

New style consultations Patient learns about condition from NHS Direct TV at home at the suggestion of the GP or receptionist Patient interacts and informs using patient data entry Face to face consultation Patient works through options using a patient decision aid, considering likely outcomes against their values Face to face consultation Patient reflects at home , drawing on the values of other patients from the Database of Individual Patient Experiences

HOW WILL INFORMATION TECHNOLOGY CHANGE THE MANAGEMENT OF THE SERVICE

Neither hospitals nor primary care organisations are core healthcare businesses

All serious health problems are managed by more than one bureaucracy and always will be. They are managed by clinical networks which cross the boundaries of many bureaucracies. These have been called hypertext organisations

Shared Aims Hypertext organisation Bureaucratic Organisation Ikujiro Nonaka and Hirotaka Takeuchi The Knowledge Creating Company OUP 1995

This has already been achieved in screening

The National Down’s Syndrome Screening Programme is a healthcare system a knowledge based organisation, a hypertext organisation, which ensures 600,000 women get a consistent service from hundreds of bureaucracies and thousands of professionals Most of healthcare is Brownian motion

The same could be done with all common problems, such as epilepsy

A National Epilepsy Service would have A National set of objectives, criteria and standards - A National Dataset A single specification for all information system providers A National knowledge base updated annually by the National Epilepsy Library A nationally agreed template of a care pathway, expressed using the Map of Medicine A National community of practice, including patients X local services, where X is >1 and <150

Health IT: The Death of Envelopes

by Health Informatics New Zealand on Jun 26, 2011

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Health IT: The Death of Envelopes — Presentation Transcript