templates and protocols - computers, cardiology and primary

Computers Cardiology and Primary Care

Dr Matthew FayWestcliffe Medical Centre

Shipley

Dr Matt Fay 2003/Cardiology&Computers

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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


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What’s Next

• Computers in General Practice• Emis Templates and Protocols• Data extraction• Moving towards integrated

practice


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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


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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


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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


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The Template


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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 (2469)Diastolic blood pressure (246A)


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The Template

Data Collection

Prompt Sub prompt

FH - Ischaemic heart dis. (ZV173) FH: Mother (12K)FH: Father (12L)FH: Sister (12M)FH: Brother (12N)FH: Aunt (12Q5)FH: Uncle (12Q6)

FH - Ischaemic heart dis. (ZV173) FH: Mother (12K)FH: Father (12L)FH: Sister (12M)FH: Brother (12N)FH: Aunt (12Q5)FH: Uncle (12Q6)


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The Template

Data Collection

Prompt Sub prompt

ECG – general (321) ECG requested (3211)ECG normal (3216)ECG abnormal (3217)

Serum cholesterol (44P)

Tobacco consumption (137) Never smoked tobacco (1371)Pipe smoker (137H)Cigar smoker (137J)Stopped smoking (137K)Current non-smoker (137L)Cigarette smoker (137P)


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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


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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


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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


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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


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Protocol BasicsBuilt in Stages which determines the action

Such as Display a template, print a prescription

RulesSuch as find clinical data

RulesAsk the operator a question

DirectionTo determine which stage

the protocol will go to in

answer to the rule


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Protocol Basics

Stages

RulesDirection

Display the introduction screen

Find Reed code 246 in

last 6 months

If Reed code found

Go to stage 2If Reed Code

not foundGo to stage 3


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Protocol Basics

Stage 3

Rules

Direction

Display Information screen Blood Pressure not

recorded

‘has the BP been recorded today’ Y/N

If yes go to stage 4

if no go to stage 5


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What does it look like in action


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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


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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


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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

Patient Presents Waits Sees GP Waits GP Refers

Waits

Hospital Receives letter

WaitsConsultant receives

letter

WaitsOutpatients

Waits

Needs investigation

WaitsHas Investigation WaitsOutpatients and decision

Waits

Waits

Angiography

Outpatients and decisionWaitsSee CardiothoracicsWaitsPut on waiting list

Long Wait

Admitted for surgery New Co morbidityidentifiedCa

ncel

led

Ope

ratio

n

Patient PresentsAdvanced

Access Sees GPUnified Referral

FormGP Refers

Hospital Receives letter

Consultant/GPSI receives

letter

Triage

Informed of Plan attime of angio

Needs investigation

WaitsHas Investigation WaitsOutpatients and decision

Waits

Angiography

WaitsSee CardiothoracicsUnified Referral

Form

Admitted for surgery Operation and Discharge

Advice and plan to GP

Put on waiting listPre hab nurse

completes checks for surgery



FormGP Refers RACPS


Waits Max2 weeks

Has Investigation Directly on to Angio waiting list Angiography

Diagnosis, Advice and plan to GP



FormGP Refers RACPS


Waits Max2 weeks

Has Investigation Directly on to Angio waiting list Angiography

WaitsSee CardiothoracicsUnified Referral

Form

Admitted for surgery Operation and Discharge

Diagnosis, Advice and plan to GP

Put on waiting listPre hab nurse

completes checks for surgery


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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

Questions

[email protected]

Documents

templates and protocols - computers, cardiology and primary