20131210 Electronic Health Record - is the National Health Service ready? What about patients?

Electronic Patient Record- is NHS ready? How about patients?

Dr Amir Hannan (@amirhannan)Marilyn Gollom

www.htmc.co.uk

Ten Golden Rules of Continuous Improvement

1. Problems create opportunities2. The impossible is a paradigm – change your mind to change your

performance3. Ask why five times to get to the real answer4. Eliminate excuses, do it right the first time5. Correct errors immediately6. Involve everyone – we are smarter as a group than a single

individual7. Reconsider rigid thoughts, situations change8. Think simple, not perfect solutions9. Use your mind more than your money10. The Goal: Continuous improvement over delayed perfection

With thanks to Trevor Fossey

4 Ps to Success

Patients and the PublicParadigm Shift in HealthcarePartnership of Trust

Partnership of Trust

One day at Haughton Thornley Medical Centres in Hyde, Dr Hannan phones the next patient

www.htmc.co.uk

www.htmc.co.uk

Margaret Rickson aged 83Top 50 innovator by Health Service Journal

Condition Numbers Percentage of patients with access to their records

Diabetes 212/806 26%

Ischaemic Heart Disease 105/496 21%

Low back pain 657/2364 27%

Depression / Anxiety 517/1344 38%

Cancer 64/247 25%

Chronic Kidney Disease 55/370 14%

Cyclosporin (immunosuppressant) 3/4 75%

Pregnant 82/354 23%

Learning Disability 5/44 11%

Bengali 228/1518 15%

Online prescriptions requests 663/11889 5%

Total Number of Patients 2395/11889 20%

Practice-based Web Portalwww.htmc.co.uk

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Many GP Practices have had the capability for some years now to be able to:• Book and cancel appointments on-line• Update personal information (eg phone no)• View and order repeat medications• Send messages to the practice• Access test results and letters• View a summary of the medical records• View the full medical record

…but much of this functionality is not yet widely utilised

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The Evidence shows that where Access to Records is enabled:

Patients like it! Record sharing is safe

It improves Patient-Practice relationships Patients use it intelligently to: Save their own time Save the doctors time, Make the system safer and more efficient

It does not increase litigation It appears to improve outcomes with less use of health services It helps patients feel more in control of their health and their

care

CLINICAL PERSPECTIVE• Many GPs are sceptical• Where this is working, the clinicians tell

us that it supports patient empowerment, ownership and engagement.

• Practice experience is that this change has not been revolutionary, as they feared!

• Access develops patients’ responsibility & interest in their own health.

• It enables patients to bring accurate data to consultations.

• It supports modern consultations, which are often about conditions which have no end point e.g. Osteoarthritis, Diabetes, Dementia, Depression – and the patients attitude to the condition is paramount.

• Access helps with some basic patient needs – such as checking what was agreed at the consultation.

PRACTICE PERSPECTIVE• Record access is safer: patients choose to

share their record with A+E when they get suddenly ill, or with carers who can care for them better with better information.

• Compliance and self care improve• Patients feel more in control of their care

and more informed• On-line services save the practice – and

the patient, time – giving the practice ‘Time to Care’

• The Practice is less prone to hold erroneous data

• Access provides a marketable asset• It provides an investment in the

relationship with their patients• Fits with the spirit of current NHS thinking• Less inefficiency – patients can take

referral letters to out-patients or list of allergies to out of hours providers

• Tap into patients desire for health

Challenges for enabling patient access to records and understanding

• What are the knowledge, skills and attitudes to support this for patients and the public, carers, clinicians, managers, legislators, students and educationalists and others?

• How do we encourage nurses and other allied health professionals to take an interest in this?• Morale is low and will this push staff away from wanting to do their job?• Do we have time to do this?• Where will the money come to support this?• What help is there to do Records Access?• Is the technology good enough to role this out more widely?• Is there a risk of increased litigation? • Where is the evidence that it improves outcomes or is this the right thing to do ?• Is there a standardised way of rolling this out ?• Enabling understanding is not easy but not that difficult either• Need to move clinical mindset away from fixers to facilitators of shared decision making and self care• Whose interest is it to improve health literacy?• Are we ready to do this yet at scale? • What about the Digital Divide?• Is there evidence that patients, clinicians or managers want this?• Whose role is it to drive this forwards – DoH / NHS England / CCGs / policy makers / clinicians /

managers / patients / carers / 3rd Sector / the Press / Twitter etc etc etc• What do you need to make this work for you and your family?