Computers Cardiology and Primary Care

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Computers Cardiology and Primary Care

• Dr Matthew Fay
• Westcliffe Medical Centre
• Shipley

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Computers Cardiology and Primary Care

• Westcliffe Medical Centre
• 9700 patients in urban setting
• Set just north of Bradford
• 7.5 whole time equivalent clinicians
• As team of whole and p/t Doctors and NP
• Computerised since 1994
• Paper light since 1997
• EMIS LV since Dec 1999 (currently LV 5.2)
• No dedicated computer worker

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Whats Next

• Computers in General Practice
• Emis Templates and Protocols
• Data extraction
• Moving towards integrated practice

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The Computer and General Practice

• Level of computerisation
• We own a computer
• We use a computer
• We have our prescriptions on computer
• We have some patient data on computer
• We have our consultations on computer
• We have all patient data on computer
• We allow the computer to aid our decisions

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Data in General Practice

• Reed codes
• Large selection of alternatives
• In hierarchical trees
• Agreement on the root codes use
• Inform whole team
• Attempt to engage secondary care

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What is a CHD template

• List of agreed Reed Codes
• Accessed while in the consultation
• Useful for mass data collection
• Can also be a memory aid

• Dont go too large

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The Template
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The Template

• Data Collection

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The Template

• Data Collection

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The Template

• Data Collection

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The Template

• Data Collection

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Templates Problems

• Tend to be set to single Reed codes
• If the template is too long people will not use
  it
• Asks for information even is already recorded
• Go for speed no technical complexity

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EMIS Protocols

• Allow a degree of computer aided decision making
  by allowing EMIS to search the patient record for
  data and by-passing the steps of the template
  that have already been completed

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EMIS Protocols

• Essentially can be seen as intelligent
  templates
• Can be set to trigger at certain Reed codes
• Can search a patients record for data
• Can included templates for mass Reed code
  collecting and ease of editing

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Protocol Basics
Built in Stages which determines the action Such
as Display a template, print a prescription
Direction To determine which stage the protocol
will go to in answer to the rule
Rules Such as find clinical data
Rules Ask the operator a question
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Protocol Basics
Stages
Display the introduction screen
Direction
Rules
Find Reed code 246 in last 6 months
If Reed code found Go to stage 2 If Reed Code not
found Go to stage 3
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Protocol Basics
Stage 3
Display Information screen Blood Pressure not
recorded
Direction
If yes go to stage 4 if no go to stage 5
Rules
has the BP been recorded today Y/N
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What does it look like in action
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So what can be achieved .

• BP can be better monitored
• If Aspirin therapy is contraindicated this is
  better documented
• Smoking status is consistently recorded
• Betablocker commenced
• Cholesterol measured and controlled

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Data Extraction

• Bradford North and Incentives
• All CHD NSF targets are part of the PMS incentive
  scheme.
• Data extraction
• Through templates the data sets are tight
• PCT agreed targets are set annually
• In EMIS clinical audits are useful
• Dont under estimate the power of Excel

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Moving to integrated practice.

• Bradford Norths experience
• CHD collaborative has brought primary and
  secondary care together
• Have the consultants with you
• Understand the pathway of care
• Understand your goal
• Share your problems as well as the successes
• Ask the patients their perspective is unique

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Hospital Receives letter
Waits
Waits
Waits
Patient Presents
Sees GP
GP Refers
Waits
Consultant receives letter
Waits
Waits
Outpatients
Needs investigation
Waits
Waits
Waits
Has Investigation
Outpatients and decision
Angiography
Waits
Waits
Waits
Put on waiting list
Outpatients and decision
See Cardiothoracics
Long Wait
Cancelled Operation
New Co morbidity identified
Admitted for surgery
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Hospital Receives letter
Advanced Access
Unified Referral Form
Patient Presents
Sees GP
GP Refers
Consultant/GPSI receives letter
Triage
Needs investigation
Waits
Waits
Waits
Has Investigation
Outpatients and decision
Angiography
Informed of Plan at time of angio
Advice and plan to GP
Waits
Put on waiting list
See Cardiothoracics Unified Referral Form
Pre hab nurse completes checks for surgery
Operation and Discharge
Admitted for surgery
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Advanced Access
Unified Referral Form
Waits Max 2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at time of angio
Diagnosis, Advice and plan to GP
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Advanced Access
Unified Referral Form
Waits Max 2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at time of angio
Diagnosis, Advice and plan to GP
Waits
Put on waiting list
See Cardiothoracics Unified Referral Form
Pre hab nurse completes checks for surgery
Operation and Discharge
Admitted for surgery
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Advanced Access
Unified Referral Form
Waits Max 2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at time of angio
Diagnosis, Advice and plan to GP
Waits
Put on waiting list
See Cardiothoracics Unified Referral Form
Pre hab nurse completes checks for surgery
Operation and Discharge
Admitted for surgery
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Unified Cardiac Referral Form

• GPs suffering form fatigue
• Single form for all cardiology services
• For services ECHO, ETT,RACPS etc.
• Also all consultant/GPwSPI referrals
• Has data set required by cardio services
• Integrates with Emis so data can automatically be
  inserted
• Faxed to single number in ECG department

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Questions

• Matthew.fay_at_bradford.nhs.uk