Computers Cardiology and Primary Care

1. Computers Cardiology and Primary Care Dr Matthew Fay Westcliffe Medical Centre Shipley

2. 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 Dr Matt Fay 2003/Cardiology&Computers

3. What’s Next • Computers in General Practice • Emis Templates and Protocols • Data extraction • Moving towards integrated practice Dr Matt Fay 2003/Cardiology&Computers

4. 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 Dr Matt Fay 2003/Cardiology&Computers

5. 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 Dr Matt Fay 2003/Cardiology&Computers

6. 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 • Don’t go too large Dr Matt Fay 2003/Cardiology&Computers

7. The Template Dr Matt Fay 2003/Cardiology&Computers

8. The Template Data Collection Dr Matt Fay 2003/Cardiology&Computers

9. The Template Data Collection Dr Matt Fay 2003/Cardiology&Computers

10. The Template Data Collection Dr Matt Fay 2003/Cardiology&Computers

11. The Template Data Collection Dr Matt Fay 2003/Cardiology&Computers

12. 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 Dr Matt Fay 2003/Cardiology&Computers

13. 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 Dr Matt Fay 2003/Cardiology&Computers

14. EMIS Protocols Essentially can be seen as ‘intelligent’ templates • Can be set to trigger at certain Reed codes • Can search a patient’s record for data • Can included templates for mass Reed code collecting and ease of editing Dr Matt Fay 2003/Cardiology&Computers

15. 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 Dr Matt Fay 2003/Cardiology&Computers

16. 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 Dr Matt Fay 2003/Cardiology&Computers

17. 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 Dr Matt Fay 2003/Cardiology&Computers

18. What does it look like in action Dr Matt Fay 2003/Cardiology&Computers

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29. 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 Dr Matt Fay 2003/Cardiology&Computers

30. 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 • Don’t under estimate the power of Excel Dr Matt Fay 2003/Cardiology&Computers

31. Moving to integrated practice. • Bradford North’s 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 Dr Matt Fay 2003/Cardiology&Computers

32. Hospital Receives letter Waits Waits Waits Patient Presents Sees GP GP Refers Waits Consultant receives letter Waits Waits Needs investigation Outpatients Waits Waits Waits Has Investigation Outpatients and decision Angiography Waits Put on waiting list Waits Waits See Cardiothoracics Outpatients and decision Long Wait Cancelled Operation New Co morbidity identified Admitted for surgery

33. 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

34. 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

35. 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

36. 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 Dr Matt Fay 2003/Cardiology&Computers

37. Questions Matthew.fay@bradford.nhs.uk