1 nyhdif conference 2011 fred and his dog using communication and social media for patients with...

11NYHDIF Conference 2011NYHDIF Conference 2011

Fred and his dog Fred and his dog Using communication and social media for patients Using communication and social media for patients

with multiple problemswith multiple problems

Mary HawkingMary HawkingGP DunstableGP Dunstable

John Perry prize 2009John Perry prize 2009UKCHIP level 3UKCHIP level 3

member PHCSGmember PHCSG(Primary Health Care Specialist Group)(Primary Health Care Specialist Group)

Committee member EMIS NUGCommittee member EMIS NUG

NYHDIF Conference 2011NYHDIF Conference 2011 22

History of FredHistory of Fred

• EoE LTC scenario as Adam

• In scenario for SRPG report 2009

• At HC2011 with confidentiality issues

• PHCSG adoptee

• CLICSIGs around use of social media

• Looking into what is already available


FredFred

• 70 yr old lives alone with dog• Recent amputee – leg• Multiple LTCs: DM, RhA, COPD, depression.

– Medical care from GP, Community Matron, and 4 different AQP teams.

• Formal domiciliary care both social & medical• Informal support network• Responsibilities - dog


ObjectivesObjectives

• Support Fred living independently at home• Prevent harm from:-

– Lack of communication around social care– Medical accidents and safety breaches– Lack of essential medical information– Uncoordinated care– Unnecessary admissions– Omission needed care from unassigned responsibility

• Use of modern ICT to enable above.


Keeping Fred at home..Keeping Fred at home..

Informal care & support

Medical care

Care at home

Coordination&

Communication

Fred(and dog)


Fred’s supportFred’s support

• Direct official care at home– DNs (insulin & stump)– Carers– Social support e.g. lunch clubs, day centres– Rehabilitation– Shopping & housework– Dog

• Informal care network

• Medical care from multiple providers

• Communication between previous three


A Fred-friendly interfaceA Fred-friendly interfacewhich needs contentwhich needs content


““Manuel, when faced with a problem you do not Manuel, when faced with a problem you do not understand, do any part of it you do understand, understand, do any part of it you do understand,

then look at it again”then look at it again”Robert Heinlein, The Moon is a Harsh Mistress.Robert Heinlein, The Moon is a Harsh Mistress.

• Management by multiple medical teams

• Informing people when Fred not home

• Informal support network

• Calendar management

• Difficult – discuss later

• Messaging• Single point of contact• Phone/fax/acknowledgement

• RallyRound http://rallyroundme.com/welcome or similar

• Phone• Care coordinator

99NYHDIF Conference 2011NYHDIF Conference 2011

RallyRoundRallyRoundhttp://rallyroundme.com/welcomehttp://rallyroundme.com/welcome


RallyRound 2RallyRound 2


Patient centric Patient centric Who is responsible?Who is responsible?

Medication

SecondaryCare

Disease Specific

Pathways

Community care

Fred

GP

Medication

SecondaryCare

DiseaseSpecific

Pathways

Community Care

GP

Fred


Information and Clinical Information and Clinical Governance in Fred’s medical careGovernance in Fred’s medical care

• Who is responsible?

• What information do all providers need to avoid harm?

• Buck stops where?• No model for shared

care• Medication• Actions of others in

real time• Plans/pathways• Pecking order• Agreed coordination


Care shared between medical Care shared between medical teamsteams

• Fred has 4 LTCs + amputation

• Medical management of each condition by different AQP plus GP, DN and other services

• Problems with coordinating and prioritising

• No single source of real time information

• Considerable risk of harm due to lack of information.


The underlying problemThe underlying problem

• Many medical conditions• Management of one

condition impinges on others

• No model for this• No system for

communication or information

• No prioritisation in management

• This is the pattern for future

• Each managed by different team

• Pathways may not be provided by single AQP

• Communication/shared care agreement between teams

• Lack of record information• Lack of information on

medication• Followup & monitoring• Coordination• Responsibility


What is available?What is available?

• Telemedicine• Virtual Wards• Community Matrons• Clinical Portals• Patient controlled records

• SCR• SSEPRs• Purposive record sharing e.g

EMIS Web & MIG

• Require infrastructure• One central organisation in

control• Not available in England• Patients Know Best• Howareyou (not to be

confused with HowRU)• Information entered &

controlled by patients• Limited GP data only• Governance issues• Difficult many-to-many• Governance issues


Single organisation solutionsSingle organisation solutions

• Telecare• Virtual Wards• Community Matron

• Pros– Single path

responsibility– Clear organisation– Virtual inpatient model

• Cons– ? Suitable for Freds– Difficult to implement

with multiple AQPs– Medical responsibility?


Guided CareGuided Carehttp://www.guidedcare.org/http://www.guidedcare.org/


RecordsRecordsalready availablealready available

• Whole record upload• Patient Access

– http://www.htmc.co.uk/ • SCR +/- enrichment• Virtual records EMIS Web• SSEPRs (SystmOne)• Patient held records• PMR websites

– http://www.patientsknowbest.com/

– https://www.howareyou.com/

• Others?

• Pros & Cons– Hampshire read only– PAERS read only GP – Virtual & SSEPR need

proprietary software– GP only (apart SSEPRs)– Complicated sharing

arrangements– Would need to be regarded

as prime entry– Updating– Confidentiality– Access control


Patient Record AccessPatient Record Access


Patients Know BestPatients Know Besthttp://www.patientsknowbest.com/http://www.patientsknowbest.com/


How are you?How are you?http://www.patientsknowbest.com/http://www.patientsknowbest.com/


How are you? Not to be confused How are you? Not to be confused with HowRU?.....with HowRU?.....

http://www.abies.co.uk/howruhttp://www.abies.co.uk/howru


MedicationMedication

• Major risk to patient• AQPs with own pathways

• Independent prescribers• Real Time information• Compromise

• Is a common medication record possible/desirable?

• https://woodcote.wordpress.com/2011/04/27/medication-repository-anyone/

• Errors common• And other AQPs –

including GPs• Only qualified in own

specialities• Need coordinated ICT• Care coordinator• Agreed responsibilities


Will DALLAS solve Fred’s problems?Will DALLAS solve Fred’s problems?

• DALLAS - (Delivering assisted living lifestyles at scale)

• Following the WSD (Whole System Demonstrator) program

• Funded

• Needs many participants to submit bid• Kings Fund event

http://www.kingsfund.org.uk/events/past_events_catch_up/supporting.html#tab_1


DALLAS – caveat ref FredDALLAS – caveat ref Fred

• Projects at Kings Fund all telecare with single organisation backup

• Majority single LTC

• Information into GP system: not out of it• http://www.telehealthsolutions.co.uk/products/home-pod/

• WSD & DALLAS about admission prevention rather than holistic medical care.


Telecare communicationTelecare communicationTwo way communication?Two way communication?


Conclusions - 1Conclusions - 1• New patterns of care need new organisational structures

– Multiple medical care from multiple providers

– Need new structures

– Who is in overall control

– Role of GP

– Role of CCG

– Medical Defence Organisations

• Information is essential– Record

– Medication

– Activity

– Real time

• Whole System approach essential


Conclusions - 2Conclusions - 2

• Fred’s medical needs/care not covered fully• Depending on ICT requires:-

– Organisation– ICT infrastructure– IT literacy

• Patient• Care providers• User-friendly interface

– Disability and access issues– Long term planning– Cooperation between organisations and individuals– Management


Is there the will - or ability - to look Is there the will - or ability - to look after Fred?after Fred?

• Questions?

1 nyhdif conference 2011 fred and his dog using communication and social media for patients with...

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comwelcomenyhdif conference

formal domiciliary care

medical teamsfred

freds medical carewho

objectivessupport fred

lack of communication

social caremedical accidents

use of social medialooking