THE INTEGRATION OF PATIENT INFORMATION

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THE INTEGRATION OF PATIENT INFORMATION

• Michael Domay FIBMS
• Anticoagulant Dosing Service
• Poole Hospital NHS Trust

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THE OVERVIEW

• ELECTRONIC PATIENT REQUESTING
• PATIENT COMMUNICATION
• WEB SITE

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THE INTEGRATION OF PATIENT INFORMATION

• MULTIPURPOSE APPROACH TO USING THE
  ANTICOAGULATION THERAPY RECORD PASSBOOK

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Practical Objectives

• The reduction in time for processing patient
  information
• The reduction in the number of manual tasks
  performed by staff
• The reduction of unnecessary communication by the
  patient to the Anticoagulant Clinic
• A permanent record of results, events and
  medication for the patient

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The focus of the OBJECTIVE

• The speeding up of the ROUTINE PROCESS
• The elimination of COMPLEXITY
• Design the process within the pass book
  reporting routine
• COMMUNICATION
• by means of FREE TEXT and/or PRESET TEXT in
  the PASS BOOK

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Management Objectives

• QUALITY vs. PRODUCTIVITY
• For decades the ethic of improving productivity
  meant sacraficing quality
• The opposite is often true in that-
• Higher quality leads to lower costs
• Achieved by REDUCING COMPLEXITY of a procedure
• GREATER EFFICIENCY IN LESS TIME

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Administration of Endoscopy Intervention in a
patient on warfarin
(GREATER EFFICIENCY IN LESS TIME)

• WORK PERCEIVED
• WORK IN PRACTISE
• RETURN TO WORK PERCEIVED BY
• REDUCING COMPLEXITY

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WORK PERCEIVED
entered into database
Memo from endoscopy
patient notified of instruction
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WORK IN PRACTICE
entered into database
Memo from endoscopy
patient notified of instruction
letter
Phone Engaged No reply
Ansa Phone
Next Day!
Phone Engaged No reply
Confirm reply
Min(n..)
Phone Engaged No reply
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WORK COMPLEXITY REDUCED
Memo received Into Clinic
Memo sent by endoscopy
patient notified of instruction
Instructions entered into database
and Passbook/form (2 minutes)
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WORK PERCEIVED
vs. COMPLEXITY
REDUCED
entered into database
Memo from endoscopy
patient notified of instruction

Memo sent by endoscopy
Memo received Into Clinic
patient notified of instruction
Instructions entered into database
and Passbook (form)
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Poole general background

• High density population
• High proportion of population are retired
• Venous samples taken at surgery and pathology
• Centralised testing
• Equivalent of two full time staff one biomedical
  scientist (lead person), one haematology nurse
  specialist
• One part-time (two hours per day) assistant for
  printing of results into passbook
• Consultant haematologist available on bleep if
  necessary

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Poole general statistics

• Started using DAWN September 2001 . Total 3300
• November 2002. Total 4300
• New patients increase by 100 per month
• Process between 180 250 per day
• Cardioversion requests 25 per month
• Endoscopy requests 20 per month
• Dental requests 5 per month
• See 25 patients per week for initiation and/or
  first out patient consultation after ward
  discharge
• See 50 patients per week with ad hoc enquiries
  at phlebotomy
• Educational
• Clinical governance issues on
  working practises
• Clinical directorate meetings on
  thrombosis
• GP tutorials
• User group meetings

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PRIMARY Customer Requirements ________ the
patient __________

• Identification as taking Warfarin
• Secure documentation from Pathology Service
• Current INR result
• Current dose
• Next test date
• Transport arrangements
• Clear instructions on warfarin when having minor
  invasive procedures
• Clear instruction when a technical problem arises
• Results by return of post

PASS BOOK
DOSING AND INTERVENTION INFORMATION
PATIENT Satisfaction
RETURN OF POST
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SECONDARY Customer Requirements _____ the
pathology staff _______

• The system requires
• Failsafe transfer of information
• Efficient process to reduce operator fatigue
• Minimal manual intervention
• Elimination of telephoning wherever possible
• Elimination of letter writing
• Delegating of Report printing

PASS BOOK
TEXT COMMUNICATION PROCEDURES
STAFF Satisfaction HOME IN TIME FOR TEA!
LESS TIME COMMUNICATION BY PHONE AND LETTER
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Meeting the Needs of the PATIENT

• ROUTINE reporting
• to the patient

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Meeting the Needs of the PATIENT

• Reporting of
• TECHNICAL
• faults
• to the
• patient

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Meeting the Needs of the PATIENT

• Communicating the warfarin instructions for
  minor medical
• and surgical procedures

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Meeting the needs of the STAFF

• THE ROUTINE process is speeded up by
• Minimal interruptions
• Communication
• by means of free text and/or preset text in
  the pass book

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Meeting the needs of the STAFF

• The use of the phone wherever possible is
  reserved for the CRITICAL EVENT
• Where the application of text messages in the
  pass book is inappropriate

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Meeting the needs of the STAFF

• Identifying the
• VARIABLES

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PRESET TEXT - Cessation of warfarin

• Identifying the
• NONVARIABLES

TEXT LETTER
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PRESET TEXT General Instructions

• Identifying the
• NONVARIABLES

SYSTEM INSTRUCTIONS
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PRESET TEXT

• 1. INR result within range

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PRESET TEXT

• 2. INR result within range with hospital
  transport arranged

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PRESET TEXT

• 5. INR not processed due to sample identity
  problem

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PRESET WITH FREE TEXT

• 6. INR result within range, future
  cardioversion procedure and instruction

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PRESET WITH FREE TEXT

• 7. INR result within range. Endoscopy date and
  instructions

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PRESET TEXT Cessation of warfarin
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PRESET TEXT
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PRESET TEXT
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EDITING PRESET TEXT
30 characters
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ACCESSING FREE TEXT
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ACCESSING FREE TEXT
60 characters
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THE OBJECTIVE
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SUMMARY - Effect on staff without modification
of process

• Aware of fatigue through interruptions, and
  repetitive work at 150 books
• Administrative work unfinished
• Notelets reminders identifying incomplete tasks
• There is a deterioration in staff concentration
  and a rapid increase in fatigue when the natural
  flow of a repetitive process is constantly
  interrupted

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SUMMARY THE CURRENT SYSTEM

• Number of outgoing and incoming calls
  dramatically reduced
• Review 60 books per hour
• (with printing)
• Review 150 books per hour
• (without printing)
• Fatigue apparent at 200 250 books
• Administration work processed more quickly
• The delegation of the printing of results is an
  integrated part of the reporting of the process

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THE MANAGEMENT PERSPECTIVE
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THANK YOUFOR YOUR ATTENTIONQUESTIONS
PLEASE