Pathology messaging: a view from general practice

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Pathology messaginga view from general practice

• Simon de Lusignan
• GP Woodbridge Hill Surgery
• Senior Lecture St Georges London

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Overview

• Why?
• How?
• Use of data in clinical audit
• What next?

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Rationale for pathology messaging

• Volume of data
• Reduction in errors
• Information about normal ranges or actions
• Trends can be identified in the consultation
• Data for audit

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Why

• Problems with the volume of data coming into
  practices

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Why - 2

• Manual data entry is expensive and liable to
  result in errors

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Why - 3

• Scanning of data only transfers text

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Why - 4

• Information about whether tests are normal

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Why - 5

• Trends in data can be visualised in the
  consultation

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Why - 6

• Use data for clinical audit

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How

• Not all clinical systems are the same
• Examples of the process from
• EMIS (Egton Medical Information Systems) is the
  commonest used in the UK
• Torex Synergy, another example

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How -2 The list of tests
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How 3 select a test
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How 4 File them one by one
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How 5 Choose a comment to insert
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How 6 The comment that will appear in the
medical record
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How 7 Example of normal ranges
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How 8 A microbiology result spreads over three
pages, only one is useful!
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How 9 The useful page
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How 10 Page 3!
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How 11 Custom messages can be added
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How 12 It is possible to navigate to other parts
of the record using the transfer function key
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How with Torex Synergy
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How with Torex - 2
Principal difference is that Torex is a POMR
(Problem Orientated Medial record and the
results are linked to the medical problem
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Using data for clinical audit

• Examples
• 1. Instant cholesterol audit for my practice
  comparing Total and LDL-cholesterol for November
  and June in the whole population, and patients
  with CHD
• 2. Renal data more sophisticated analysis!

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Before
After
Total cholesterol
Total cholesterol
Before
After
LDL cholesterol
LDL cholesterol
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Before
After
Total cholesterol
Total cholesterol
Before
After
LDL cholesterol
LDL cholesterol
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Renal data

• Calculating GFR is possible using the abridged
  MDRD formula
• Requires Age, sex and creatinine
• ideally racial group (if black)

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Discussion
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Discussion

• Getting numerical data into the GP clinical
  record is of value for patient care
• Immediate
• Clinical audit and Quality improvement
• (And now for performance related pay)
• Scope for improvement
• Normal values
• More derived values e.g. GFR
• Interface improvement
• Sending more data e.g. All BP

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The Downside

• Affordances of paper are lost

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Conclusions

• Pathology links are of enormous value to GPs
• There is scope to improve the range and value of
  the data transmitted

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Thanks for listening

• Simon de Lusignan
• slusigna_at_sghms.ac.uk