self care and patient access to their electronic health records dr amir hannan full-time general...
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SELF CARE AND PATIENT ACCESS TO THEIR ELECTRONIC HEALTH RECORDS
Dr Amir HannanFull-time General PractitionerHaughton Thornley Medical Centres, HydeInformation Management & Technology lead,
NHS Tameside & GlossopPrimary Care IT lead, NHS North-WestMember of the Clinical Leaders Network
Yvonne BennettPatient of Haughton Thornley Medical CentresSecretary of HTMC Patient Participation GroupMember of the National Clinical Reference Panel for HealthSpace / Summary Care RecordNHS Connecting for [email protected]
Self Care Week
Ensuring the commissioning framework rewards outcomes improvement
• We want the principle of “shared decision-making” to become the norm: no decision about me without me.
Ensuring the commissioning framework rewards outcomes improvement
• Involving patients in their care and treatment improves their health outcomes (and)…their adherence to a chosen treatment
Ensuring the commissioning framework rewards outcomes improvement
The primary purpose of the NHS is to improve the outcomes of healthcare for all
Monitoring and rewarding outcomes improvement within local commissioning systems
• NICE provides quality standards
• Local HealthWatch organisations will ensure that the views from patients and carers are a part of local commissioning…
• NHS Commissioning Boards provide quality payments
• GP consortia will receive….a premium for achieving high quality outcomes and for financial performance
•away from information belonging to the system, to information enabling patients and service users to be in clear control of their care;•away from patients and service users merely receiving care, to patients and service users being active participants in their care;•away from information based on administrative and technical needs, to information which is based on the patient or service user consultation and on good clinical and professional practice;•away from top-down information collection, to a focus on meeting the needs of individuals and local communities;•away from a culture in which information has been held close and recorded in forms that are difficult to compare, to one characterised by openness, transparency and comparability;•away from the Government being the main provider of information about the quality of services to a range of organisations being able to offer service information to a variety of audiences; and•in relation to digital technologies, away from an approach where we expect every organisation to use the same system, to one where we connect and join up systems.
This government is committed to moving:
Data Information Knowledge
Knowledge-Driven Healthcare Systems
Data Information Knowledge
Knowledge-Driven Healthcare Systems
Knowledge Skills Attitudes
Data Information Knowledge
Structures Processes Outcomes
Knowledge-Driven Healthcare Systems
Knowledge Skills Attitudes
Data Information Knowledge
Structures Processes Outcomes
Knowledge-Driven Healthcare Systems
Knowledge Skills Attitudes
Data Information Knowledge
Structures Processes Outcomes
Knowledge-Driven Healthcare Systems
Knowledge Skills Attitudes
Family of classifications
Sharing the records
Immediate Care
Continuing Care
Preventative
Health Promotion
Patients
Public
Admin
Government
Standards
Science &
Research
Clinicians
The “eMPOWERed Patient”
Reactive vs Proactive
Passive Enabled Informed Empowered eMPOWERed
Patient Person Family
Partnership of Trust
The Paradigm Shift in Healthcare
• IT based health care system
• Internet
• Increase in health literacy
• Patient access to Electronic Health Record
• Patient choice
• Choice leads to better outcomes
Framework for sharing clinical knowledge across care settings
Localisable benchmark for clinical processes
Evidence based care pathways available in any setting
Practice-based web portalwww.htmc.co.uk
Decision Aid: www.prosdex.com
Health Authority
GP practices
CommunityHealth VisitorsDistrict Nurses
Community Mental Health Team
Acute Trust
ManagementClinicians
‘Old’ organisations working within a Local health Community
Practice ManagersReceptionistsSecretaries Counsellors
Nurses
Local Medical C
omm
ittee
GPs
PCTChief Executive
PCT BoardPEC
Directors e.g. FinanceClinical LeadsRBMS / Tier 2
Communications Manager
etc
GP practice
CommunityHealth VisitorsDistrict Nurses
Community Mental Health Team
Specialist nurses
e.g. dermatology
GPwSIs
Salaried GPs
OoH service
SHA
Acute TrustManagement
CliniciansPALS
Social Services
Patient Participation Groups
Patients
Voluntary SectorMIND
Victim SupportAge Concern
Local Government
OthersHealth Protection Unit
Immunisation Co-ordinatorOldham PCT
Practice ManagersReceptionistsSecretaries Counsellors
Nurses
LMC
GP
PharmacistsCo-op
Independents
“Old” organisations working within a Local health Community
CATSGM NHS
CATSLocal CATS
SHA Community
Acute Trust
Others
General Practice
Patient
PCTSocial services
Pharmacists
Voluntary sector
Local gov
3-D View of Reality Today showing Complexity of Communication
Acute Trust
Acute Trust
Acute trust
PCT
PCT
PCT
CATS
Private hospitalPrivate hospital
SHACommunity
Acute Trust
Others
General Practice
Patient
Social services
Acute Trust
Acute trust
PCT
PCT
Voluntary
The NHS and Partner OrganisationsThe Patient’s World
Patient
Family
Friends Work
TV, radio, newspaper
Surgerywaiting room
Surgeryconsulting room
A & E
OOH waitingroom
CATS
PCT
PharmacistsLocal Govt
Private hospital
Text / Mobile
“Facebook”
“Second Life”
Google/ internet
Nintendo Wii, PS3, XBox
Hospital bed
Blog
SHACommunity
Acute Trust
Others
General Practice
Patient
Social services
Acute Trust
Acute trust
PCT
PCT
Voluntary
The NHS and Partner OrganisationsThe Patient’s World
Patient
Family
Friends Work
TV, radio, newspaper
Surgerywaiting room
Surgeryconsulting room
A & E
OOH waitingroom
CATS
PCT
PharmacistsLocal Govt
Private hospital
Text / Mobile
“Facebook”
“Second Life”
Google/ internet
Nintendo Wii, PS3, XBox
Hospital bed
Blog
RED = Areas we have influenced in the practice
An eMPOWERed Patient
eMedicalPatient and the PubliccOmmunicationWorld wide webElectronicRecorded
So what makes us different?
• We take responsibility for our own health• We are part of a ‘partnership of trust’ with our doctor• We have access to a computer, not necessarily our own• Or these days it may be a mobile phone or I pad• We are NOT STUPID, we are aware of security issues• We tend to
– Shop online– Check insurance quotes– Book holidays– Use internet banking– And many more
• So WHY NOT maintain our health online!
Partnership of TrustPatient/DoctorDoctor/Patient
Illustration from Health Service Journal
A consultation with the doctor• We discuss with the doctor our health problem• We listen to their advice• We may question their suggested medication
– This isn’t to challenge the doctor but to find what is best for us
• We may not accept the medication just then• We may want to do our own research• We may have personal moral issues with some
medications• We DO get back to our doctor
What do I need for my care?• I want to be able to do everything I can to the best of
my ability• I want to know the bigger picture and not just the next
step• I want to review things in my own time so that I can
better monitor my own health and that of my loved ones
• I want to become EMPOWERED by being enabled, informed, listened to and given choices
• I want the best healthcare around me!
So where do we go?
• Everybody has their own favourite sites
• Encouraged to use trusted websites– These could be
• Our Practice website www.htmc.co.uk• patient.co.uk• NHS Choices• BBC
What do I need for my care?www.htmc.co.uk
Once we have decided
• We go back to see our doctor
• We then discuss our findings
• We could have a different medication to the one suggested
• Or we just accept the offered medication
What do I need to do?
Appointment setting via EMIS Access
I may be due for my repeats
Prescription ordering
What do I need for my care?
Access to full health record
What do I need for my care?Free text as well as coded data with information links
Results
Abnormal test
results
Information re blood tests
Letters
www.htmc.co.uk
Map of Medicine - Healthguides
So what next?
• We now take charge• We decide to try the new medication• We fit this into our regime• How?
Whatever works for us
But what happens if things change?
• Our condition may deteriorate– It may be that we need to have special care– It may be that we need residential care– It may be a nursing home– It may even mean a hospice
• It may not be ourselves but ones we care for– The problems can still be the same– And the needs can be the same
What I have done
• I have made sure that my family are aware that I want my records shared with any nursing home/hospice
• My family are also aware of any healthcare that I want or do not want
• My husband has also done the same• We are both happy for our sons to have access to
our records– Whether we are alive or dead
• To us, this is common sense and we would encourage others to do the same
Haughton Thornley Medical Centres, Hyde
EMIS Access Across NWOrdering prescriptions and booking appointments online
EMIS Access Across NWFull access to the GP electronic health record
Number of Practice using the MR module by PCT
PCTs March
2010Central Lancashire PCT 1Cumbria PCT 2East Lancashire PCT 1Liverpool PCT 1North Lancashire PCT 1Oldham PCT 1Stockport PCT 2Tameside & Glossop PCT 4Western Cheshire PCT 1Grand Total 14
Workshops in the NW
• 1st workshop for 15 practices to learn lessons about their access to records
• 2nd workshop amongst representatives from 239 practices that have are offering online ordering of prescriptions and booking appts but not full access to the records
• Lessons learned will help to develop further Programme of Work
• Outcome: More practices offering records access and raise standard of care
Map of MedicineEvidence based localised patient pathways across primary and secondary care
www.renalpatientview.orgPatient access to secondary care data
www.renalpatientview.orgPatient access to secondary care data
Renal Units Using Renal Patient View43 out of 78 units nationally
Focusing on the outcomes that matter to patients
Principles of
Records Access
• You have the right of access to your own health records. These will always be used to manage your treatment in your best interests.(NHS Constitution)
www.rcgp.org.uk/pdf/Health_Informatics_Enabling_Patient_Access.pdf
Focusing on the outcomes that matter to patients
Patients accessing their personal records and inputting
personal data
Commission evidence based patient
pathwayseg Map of Medicine
Improved compliance, concordance, quality and outcomes with constrained costs and variation with happy and healthy patients, staff and organisations
Patient Reported Outcome Measures
Decision Aids
Patient Experience
Carers and Nursing Homes
Next steps • Think about self care• Read the guidance on enabling patients to access electronic health records• Ask your own GP for access to your own records online• Check what your own GP website is offering• Contact your GP consortia leads• Contact your PPG leads and patient groups including LiNKS• Contact your self care SHA lead• Contact the Long Term Conditions leads• Find out what is happening with Map of Medicine in your area• Have you got your Map of Medicine pathway?• What about passing your own record to your children as part of your care
plan?
We have only just started to scratch the surface…
Thank You
Isn’t it time YOU got access to YOUR records?
www.htmc.co.uk