GP Perspective on Connected Health

1. Dr Declan Woods
National Healthcare Conference 1st April 2014
Technology & Digital IT Forum-Connected Health

2. What is General Practice?
• Vast majority of patients are managed within the community by GPs
• The number of patients presenting to general practice is increasing
from year to year
• General Practice is the first point of contact with the health services
for most patients
• Cradle to grave

3. Current Technology in General Practice
What technology is working well in General Practice?
• GP Software
• Healthlink
– NIMIS
– Lab Reports
– eReferrals – Cancer, Early Arthritis
– GP Out-of-Hours Messaging
• PCRS

4. Caredoc Case Study
• Excellent example of a fully integrated healthcare
service with a complete electronic patient record
• Award winning ICT platform developed over the
last 15 years
• Interoperable with other healthcare services

5. The Caredoc Organisation
• GP Cooperative with 670 participating GP
members
• Not for profit company
• Governed by a Board of Directors and
Management Team, fully indemnified
• Collaboration between GPs, HSE and Department
of Health (since 1999)

6. What is Caredoc?
Integrated Technology Platform

7. Joined up and integrated
A focus on patient care needs
Delivers high quality appropriate healthcare services
Easily navigable for patients & staff
ICT Interoperable, scalable & adaptable
Caredoc’s approach

8. Caredoc patient centric ICT System
• Seamless flow of electronic data through the patient journey
• Data precedes the patient
• Clinical Decision Support Software
• Special Patients Notes / Care plans
• IT connectivity to Treatment Centres and Mobile Units
• Technology devices: Workstations, Laptops, Tough books and Tablets.
• Linked to daytime G.P. Surgery software
• Linked to the Acute Hospital Network – SLHK
• Deaf/Hard of hearing texting service using 3G/GPRS mobile solution

9. Complete out-of-hours electronic Patient
Record
• Patient demographic details
• Call handler notes
• Nurse triage notes
• Access to previous encounters (if the patient has been seen in the out-of-hours or CIT service)
• Doctor consultation notes
• Receptionist notes
• “Special Patient notes” – important information about a patient (palliative care notes, drug
notes etc – received from patients own GP)
• Full auditable files
• Event list – who interacted with the patient record
• Complete log of all people who have accessed the file (both to add notes but also who viewed
the file)
• Nothing deleted from files – all information, even when altered, is available for audit

10. Implications for clinical practice
Visibility & Accuracy
• Information on patient interactions with healthcare services is captured in
Electronic Patient Record database.
Seamless flow of electronic data through the patient journey
• Patient information is delivered in a timely and
efficient manner.
• Information precedes the patient.
• Rules out unnecessary duplication.
• Productivity is improved.
• Provides clear visibility for the GP on their patients at
all times.
Information precedes the patient at each point of care

11. Caredoc Network
• Network that covers the South East of Ireland (Carlow,
Kilkenny, Waterford, Tipperary, Wexford, South
Wicklow)
– Approximately 834 system users
– 13 Treatment centres
– Users: Doctors, Triage Nurses, Clinical Nurses, Nurse
Prescribers, Call Handlers, Receptionists, Administration
– Mobile Units (Home Visits & CIT Visits)
• Connectivity with the NEDOC , D-DOC and NoWDOC
Out-of-Hours Services

12. The right care at the right time
CAREDOC operates with The Nightingale Teleguides - an algorithm-based clinical
decision support software (CDSS) tool . They are a set of symptom based, age and
gender specific clinical algorithms, which enable the right person to reach the
right level of care at the right time.
Clinically Safe & Evidence-Based
Improves efficiency of Remote Patient Management
Reduces unnecessary A&E / GP visits
Expert Clinical Decision Support Software

13. Challenges facing General Practice
• Our aging population
• Increasing life expectancy
• The rise in complex chronic health conditions
• Finite budget
• Limited resources – Manpower
• Lack of Individual Health Identifiers (IHI) for
every citizen
• Lack of ICT Interoperability and connectivity

14. What is required?
• Increased collaboration between healthcare providers
• Need for effective and appropriate care to be delivered
by the most appropriate healthcare provider
• Build services in the community
• Integrated technology to support collaboration

15. Reality of Healthcare Services
No single discipline can practice in isolation or meet all of the
changing needs of patients today -- Interoperable ICT systems,
collaborative research and healthcare partnerships are critical to
avoid silos and improve patient care.
HEALTHCARE PROVIDERS
INDUSTRY RESEARCH
& TECHNOLOGY
COLLABORATION
PATIENTS

16. eReferral
&
eDischarge
ePrescribing
&
eMedication
Management
Research, Predict
ive Modeling
& Data Mining
Enhanced
connectivity
Telehealth
 New areas of interoperability and connectivity
 Sharing of information more effectively
 Expand the concept of healthcare through new services to
create greater efficiencies
 Individual Health Identifiers
Examples of technology projects that need to be addressed:
Next steps

17. eHealth Strategy 2013
• International experiences
– Denmark
– UK Whole system Demonstrator
• eHealth can deliver better patient care, improved
outcome and increased savings
• Change management and collaboration
• Investment in healthcare ICT
– 0.85% of total healthcare budget relative to EU 2-3%