Learning from others....

We are never too old to learn!


But the NHS as a 'learning organisation' does not always make the most of opportunities.....
In the UK, the most impressive success with patients becoming involved and engaged with a section of their record through an electronic medium is almost certainly 'Renal Patient View'. This had been developed to enable patients with kidney disease to take a full and active part in managing their condition. And crucially it is useful to both patients and clinicians alike, with positive impact on self care motivation, and enabling improvements in quality of patient care and care planning.
If like me you want to learn more have a look at the site below:
http://www.kidneycare.nhs.uk/_Aboutus.aspx

For more detailed information they have two excellent recent publications, firstly the final evaluation report on Renal Patient View
http://www.kidneycare.nhs.uk/Library/RPV_Final_Evaluation_Report.pdf

Secondly a short guide on how to encourage patients to use the service:
http://www.kidneycare.nhs.uk/Library/HowtoguideRPVuptakeTJKGii.pdf

So - involve the clinicians, sort out the administration, value and use the facility and encourage patients to use it - Simples! Pointing the way ahead for GP record access......

Peter S

Up and moving...

Things are starting to move - with the 'prominent' placement of leaflets to introduce 'Records Access' as an option on the main reception desk at the surgery. We are having a few requests for detailed information each week, and 10 people now have RA passwords.

I am starting to recognise more clearly the challenge of managing another 'active list', creating and distributing passwords, activating access and planning the transition to a 'business as usual' plan. Not always straight forward with the priority being secure handling of this critical access information.

There is a significant workload that will need to be absorbed into routine working practices, but we aim to minimise printing costs by e-mail distribution of detailed leaflets and instructions.

The RCGP have been invited to lead a work stream that will determine the path and delivery of widespread RA across England. I hope they will be taking into account the ability and experience of all practices, not just the firm and established advocates. The very practical 'front end' administration at practice level needs to be deliverable by hard pressed staff with minimal resource implications. I suspect that many will be looking for a 'template' they can follow to enable RA with minimal effort, utilising literature that is trusted and building on early success with more straightforward transactional services.

Perhaps the close involvement of suppliers will help us to understand better how GP core or third party software needs to develop rapidly to smooth the administration of the process, and to generate easy automated reports.

Not feeling brave enough to 'actively recruit' patients as we are are likely to raise expectation beyond the capacity to manage the process yet!

Peter S

Oh so slow.....

Confession time - too busy to actively promote the service at present.

Result - nine requests for Records Access to date, and only one fully processed.

Main blocker - me, the staffing and administration of the process!

Action - pursue current interested parties to fully implement RA for them.

Constraints - staff sickness limits my current ambition and expectation.

Concern - what would we do if this became a 'target'?

Requirement - GP system software that makes RA administration easy.


Conclusion - Snow Patrol are excellent in concert.......


Peter S.

Lessons from Kaiser in USA on Records Access

Fascinating Webinar on wednesday with the US team leading Records Access for patients in the Kaiser Permanente organisation.

In 2010 they had 2.5 million appointments booked on-line, 12 million e-mails, 10 million prescription repeats and almost 30 million laboratory tests - covering 8.8 million patients.

Points I particularly noted:

• KP developments have been transaction led, and activity increased year on year
• Significant investment in integrated support information for patients through the portal
• Appointment/medication transaction activity does NOT shame UK
• On-line record access is ‘Results’ focussed and basic non-urgent communication
• Communication is via controlled, not 'open', e-mail
• UK advocates have already gone WAY beyond the Kaiser Physician comfort zone with consultation details etc
• Listen to, respect and address concerns of the (many) professional ‘Nay sayers’
• They do not have specialist appointment booking – we DO (C&B)
• E-mail contact workload does build, and is clearly causing increasing concerns
• 3 e-mail contacts/year per on-line patient, 800 per year per physician in 2010
• Need to integrate RA with daily workflow tasks
• They share concerns over release of ‘harmful’ test results
• KP wrote all the content (much exists for us in NHS Choices and other accredited resources etc)
• Webex attendees tend to represent those already keen on Records Access...

So we can learn things from them - but our Heath Economies are slightly different, perhaps they can also learn from us!

So my personal 'learning points':

• Support Records Access with information patients can use to make a difference to health
• Be very cautious about opening an additional communication channel without clear aims and spare resource
• Listen and respect the views of nervous and sceptical colleagues, and learn together
• Build on the fantastic UK availability of electronic GP records to offer appointment, tests results and medication ordering as widely and quickly as possible

Why not have a look at what KP offer below?

https://healthy.kaiserpermanente.org/html/kaiser/index.shtml

And lastly...

From the cost and activity figures given by KP compared to NHS public data I have compiled the table below from 2010, to give me a rough idea how the NHS is in comparison... (Shoot me down if I am wrong)

	Patients (million)	Spend (£ billion)	Spend per patient (£)
Kaiser	8.8	27.9	£3,170.45
England	52.2	97.1	£1,860.15

I have always thought the NHS gives value for money, no matter how hard people knock it. It remains a 'National Treasure'.

Peter Short

Another perception-reality gap?

Some weeks I read medical magazines & journals and wonder at the effort we put in to the accumulation of 'irrelevant' knowledge. But this week I have been stimulated  and challenged by a number of articles in the BMJ, if you are fortunate enough to have access, links are provided below.

Shared decision making - BMJ 2012;344:e256

Where will Records Access fit in to enhance shared decision making, and help to close the 'perception-reality gap?

Matters of Life & death and quality of life - BMJ 2012;344:e775

Will it just be the 'major' items in Health records that interest patients, or are there things that to clinicians appear trivial, that patients will consider important to understand and address?

Stop the medicalisation of old age - BMJ 2012;344:e803

Will patient and advocate scrutiny of records suggests that we (clinicians) often pursue targets/protocols and guidelines rather than the informed best interests of the older people we treat?

More questions to ponder......

Then again - I could spend all my time debating the issues and questions and be to busy to change anything or try for myself.....

Peter Short

On a more POSITIVE note!

Sometimes the 'conservative' attitude of GPs in England attracts negative publicity, but this approach can shift in a relatively short space of time.

I am very encouraged that the GPs political body has had a recent debate on 'Records Access', reported in the medical press, but perhaps not fully reflecting the new willingness to be involved in resolving the challenges to make Record Access beneficial for patients and the Health Service.

They do point out some of the issues to address before they would be able to support a widespread rollout, these include:

• Third party information - conforming to Data Protection Act requirements
• 
  
• Record understanding - assistance for patients to understand and use a clinical record
• 
  
• Security & confidentiality - confidence in getting the balance right
• 
  
• Control - understanding risks and benefits
• 
  
• Patient recorded entries - learning about how this will become possible and safe
• 
  
• Cost benefits - how will we show that the benefits are worth the effort of patients & clinicians

In the 'Information Revolution' consultation all of the same issues were raised from different parties, so perhaps my professional group are not so 'conservative' after all?

A more positive way to move towards friday - which will end with a Snow Patrol gig!

Perfect end to a challenging week?