07 February 2008
SystmOne proving a positive force for CKD patients
Clinicians in Bradford, West Yorkshire, are piloting a new scheme aimed at cutting referrals to secondary care and improving the care pathway for Chronic Kidney Disease patients. The scheme relies on the use of clinical computer system, SystmOne, as a communication and 'e-consultation' tool between primary and secondary care clinicians.
The Chronic Kidney Disease Electronic Advisory Service (CKDEAS) was developed by Dr John Connolly, GP at the Ridge Medical Practice, Bradford, and Technical Lead for Bradford and Airedale tPCT, and Dr John Stoves, a consultant in nephrology and general medicine at Bradford Royal Infirmary, with involvement and support from PACE (Promoting Action on Clinical Effectiveness) and the Bradford Institute for Health Research.
Dr Connolly explains the aims of the project: "We're trying to improve nephrology care. In cases where a GP practice is unsure how to manage a patient who perhaps has complex problems or has borderline results, we can work alongside our consultant colleagues by sending an electronic message through SystmOne. In the traditional model of patient care, the consultant has the opportunity to examine the patient and organise tests but has no access to the GP record. They've only got what's on the paper referral. In this new model, they have access to the GP record and GP's questions before deciding whether or not they need to see the patient."
Renal consultant, Dr Stoves, has high hopes for the project: "The driver for me is making the patient journey as seamless as possible. We hope to demonstrate what those of us involved know already - that SystmOne is a positive force for high quality communication and patient management across the primary and secondary care interface."
Angela Grange, Lead Nurse for Clinical Quality and Research at Bradford Institute for Health Research is coordinating the CKDEAS project. She says, "SystmOne is ideal for this project because it is used in the majority of GP practices in Bradford as well as in some departments in secondary care."
Dr Connolly's practice, The Ridge Medical Practice in Bradford, went live on SystmOne GP in June 2006. When the emphasis for renal care moved to improving referral services, he started to investigate new uses of SystmOne. "The National Service Framework published in 2004 gave a framework for improvement for renal services. We realised that we needed to improve screening and referral processes for patients with CKD and that a multi-disciplinary approach was essential."
Dr Connolly and Dr Stoves knew about work already being done with diabetes care in the Bradford region and looked at applying the same principles to renal services. "The diabetes service had developed sharing models so that consultants could review the SystmOne GP record," says Dr Connolly. The combination of the NSF and SystmOne as the driver and tools, and the team's enthusiasm and desire to improve services in an innovative way, led to the creation of the CKDEAS project.
In order to measure the success of the project, Bradford Institute for Health Research is conducting a formal research project. Angela explains: "From our initial study, we found that 60% of patients who would previously have been referred had e-consultations and did not have to go to hospital."
The team then wrote to all Bradford GPs, inviting them to an awareness and training event, with the hope of finding a group of 15 practices to run the pilot. Response was very positive. Angela says, "We ran two communication events in September 2007, and had over 40 attendees, representing all of the GP practices in Bradford. Feedback from the GPs was very good. In fact, Dr Stoves had six e-consultations through within days of the training event."
Sending messages about a patient between GP and consultant on SystmOne is simple. The GP communicates electronically with the nephrologist by sending an electronic referral within SystmOne. This automatically generates a Task in the nephrologist's inbox.
In any instance when a patient record is shared with another organisation, patient consent must be sought. "In my experience as a GP, patients universally do give consent," says Dr Connolly. "I tell the patient that I'd like a colleague to look at their record and their test results before sending the patient to the hospital. They patients think it's a great idea."
When the consultant logs on to SystmOne, they see the referral the GP has sent. The consultant confirms a reciprocal record share so that they can access the patient record. They then look at the record to find out what they need to know about the GP's concerns, the patient and their history. The consultant then adds their findings and advice, saves the record, and sends a Task back to the GP.
"The process is straightforward," says Dr Stoves. "We have developed views within the record so that the most relevant clinical information about a patient can be seen at a glance. The consultant’s assessment and recommendations are saved in the record, and we also print off details of the e-consultation so that a paper copy is available in the hospital case notes." Data entry is facilitated by the use of carefully constructed 'Auto-Consultations' (a consultation template).
The use of SystmOne as a communication tool has led to the re-evaluation and streamlining of services. Dr Stoves says, "It has helped me to appreciate more fully the way that care is provided in the community, and in turn I think that GP colleagues now have a better understanding of what goes on in secondary care. SystmOne allows an efficient 'to and fro' exchange of information so that nephrologists can give timely responses to queries and assist GPs in making clinical decisions. We can work out whether the patient needs to come to us or continue to be looked after in primary care, thus avoiding an unnecessary hospital appointment."
Being able to see the detailed care record is of great benefit to the consultant. Dr Stoves explains, "I can build up a very clear picture of the patient with the wealth of information in the SystmOne record that wouldn't be available to me if I was sent a letter about the patient. For example, I can see details of the medical history, family history, current medication, medication history and previous communications between the GP and other specialists. We're seeking to avoid unnecessary referrals. If we, as nephrologists, can't add any value to a patient's care, clinic referral at that time is unnecessary. Conversely, we are very keen to see those patients who we think will benefit from further nephrological assessment. The CKDEAS project allows us to consult electronically about borderline or difficult cases. If the patient can be managed in primary care, closer to home, causing less stress and inconvenience, then that is what we want to encourage."
Dr John Parry is GP and TPP's Clinical Director. His practice, Holycroft Surgery in Keighley, has used the e-consultation facility: "It gives us access to high quality decision making very quickly," he says. "It's proving very successful to date, getting us answers in a timely manner and reducing the number of patients making an unnecessary trip to hospital."
For Dr Stoves, e-consultations are just the beginning: "We would like to build on the work we're doing with this project to develop an electronic renal hub within SystmOne, not only to conduct e-consultations for CKD, but to improve management within the renal anaemia, pre-dialysis, transplant and palliative renal care settings. The functionality of SystmOne will enable us to develop a seamless and efficient model of communication in all of these areas. The renal model is a prototype that can hopefully be made to work for patients with other chronic diseases."
The CKDEAS initiative is at the forefront of healthcare technology - developing innovative ways to transform the way care is delivered and communicated. TPP Clinical Director, Dr John Parry, says, "We are excited about seeing SystmOne used in this way by the CKDEAS initiative and we are very much looking forward to hearing the results and seeing other teams take up the same way of working. This sort of communication wasn't possible before the advent of a centralised system. SystmOne delivers the ideal - it improves patient care by enabling greater availability of the detailed care record in a secure and structured way. Clinicians, if they choose to do so, can reap great benefits."
