SELF CARE AND PATIENT ACCESS TO THEIR ELECTRONIC HEALTH RECORDS Dr Amir Hannan Full-time General...

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

[email protected]

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]

http://www.htmc.co.uk/

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.


• Involving patients in their care and treatment improves their health outcomes (and)…their adherence to a chosen treatment


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



Knowledge Skills Attitudes


Structures Processes Outcomes


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

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

[email protected]

[email protected]

SELF CARE AND PATIENT ACCESS TO THEIR ELECTRONIC HEALTH RECORDS Dr Amir Hannan Full-time General...

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