“Do Once and Share”
Feedback from the Renal Team
B Stribling, K Harris, A Keogh, J Medcalf
Aims
• Identify the potential for using the National Programme for IT to improve the efficiency of care processes
• Reduce unknowing duplication• Promote national consistency• Reduce the waste of professional & patient time• Ensure a common input to the Technical Office
(central IT)
Why do it?
Have at least one National Document e.g. NICE , NSF
Have an active professional community of practice comprising both professional and patient organisations.
Have already had systems development work undertaken by the Modernisation agency
Scope - I
• Provide baseline information on the current standard clinical practice, and likely changes to clinical pathways
• Identify training implications• Produce Guidelines for primary care on the
implementation of the project• Outputs for SNOMED required
• Describe existing renal IT systems, and the expectations of the wider renal community for future systems
• Describe any finished, or pilot projects in progress
• Develop communication plan between National renal community and NPfIT
• Report to stakeholders on progress to date• Produce timely reports as required
Scope - II
Out of scope
• Comprehensive engagement with social care• Comprehensive evaluation of needs of private
care providers• Comprehensive evaluation of the requirement for
the care of children with renal disease• Comprehensive training manual to include
recommendations for delivery
Patient unknown to have renal diseaseIdentified by• Coincidental Investigation• GP system identifies “at risk” (CVD, DM, ↑BP)• Other clinic• Pharmacy screening program• Formal screening program (if became technically simple• Symptoms of CKD (least likely)• Previous acute renal failure
Assessment and stage of CKD•Repeat Creatinine•Creatinine:age:sex:race = MDRD or other GFR estimate•BP•Urinalysis for blood and protein, protein:creatinine ratio•Screen for other disease eg DM•Drug / PMH / Lifestyle history
Clinical Advice SystemNELH
Map of Medicine
Local Referral Guideline
Assessment
Nephrology Advice“Virtual Nephrologist” orOther method of communication
NephrologyOutpatients
Choose and bookTemplates
Access to all previous dataPMH, FH, DH, BP,GFR,Urinalysis, Imaging etc †
X-ray
Pathology
Doctor
Specialist Nurse
Dietician
Pharmacist & electronicPrescribing supportNELH
Stable CKD *•Return GP CDMP with•Tailored management plan based on standard templates•All test results•Re-referral advice
Progressive CKD•Shared primary / secondary care
Other Renal Disease requiring specialist advice•Shared primary / secondary care
Patient info throughoutTailored to CKD stage and individual patientLanguagePaper as well as IT
CKD initial assessment
Pharmacist reviewMedicinesmanagement Guidelines / policies etc
Advice and supportPharmacy/Others
“One Stop”
Referral to other specialitye.g. Urology
Guideline
Primary care
Stable CKD *Chronic DiseaseManagementProgram (CDMP)Renal or other
† consider possibility that patient might prevent this
Patient unknown to have renal diseaseIdentified by• Coincidental Investigation• GP system identifies “at risk” (CVD, DM, ↑BP)• Other clinic• Pharmacy screening program• Formal screening program (if became technically simple• Symptoms of CKD (least likely)• Previous acute renal failure
Assessment and stage of CKD•Repeat Creatinine•Creatinine:age:sex:race = MDRD or other GFR estimate•BP•Urinalysis for blood and protein, protein:creatinine ratio•Screen for other disease eg DM•Drug / PMH / Lifestyle history
Clinical Advice SystemNELH
Map of Medicine
Local Referral Guideline
Assessment
Nephrology Advice“Virtual Nephrologist” orOther method of communication
NephrologyOutpatients
Choose and bookTemplates
Access to all previous dataPMH, FH, DH, BP,GFR,Urinalysis, Imaging etc †
X-ray
Pathology
Doctor
Specialist Nurse
Dietician
Pharmacist & electronicPrescribing supportNELH
Stable CKD *•Return GP CDMP with•Tailored management plan based on standard templates•All test results•Re-referral advice
Progressive CKD•Shared primary / secondary care
Other Renal Disease requiring specialist advice•Shared primary / secondary care
Patient info throughoutTailored to CKD stage and individual patientLanguagePaper as well as IT
Pharmacist reviewMedicinesmanagement Guidelines / policies etc
Advice and supportPharmacy/Others
“One Stop”
Referral to other specialitye.g. Urology
Guideline
Primary care
Stable CKD *Chronic DiseaseManagementProgram (CDMP)Renal or other
† consider possibility that patient might prevent this
CKD initial assessment
Assessment of CKD
Assessment of CKD
Local Referral guidelines
• Commissioned by Renal Information Exchange Group (RIXG)
• Provides web-based information to Renal patients about diagnosis, treatment, test results, clinical correspondence, Transplant suitability
Renal PatientView
Existing Functionality
• Majority of Renal units already have a well developed clinical computer system
• Functional, locally managed and flexible
• Contains many of the key elements of an Electronic patient record
• Able to share information, but until now not been a high priority
• 31 of 52 English & Welsh units (as defined by Renal Registry 2004 report as having IT systems) responded.
• 6 of 7 Scottish units with IT systems responded. (+ One with no IT system)
• 2 Northern Ireland units responded• 3 Paediatric units responded
42 units total
Existing Functionality
Risks/Issues
• NELH – not complete within this project timescale
• Implications of SNOMED
• Map of Medicine– not complete within this project timescale
• Renal Dataset ready 2007
Conclusion
• Described a reproducible framework on which to hang IT to support CKD
• Described existing functionality (what we have to protect)
• Promoted Renal as an IT literate “can-do” speciality
• Identified “easy” opportunities for further innovation and road-testing existing ideas
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