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

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Presentation on theme: "Computers Cardiology and Primary Care Dr Matthew Fay Westcliffe Medical Centre Shipley."— Presentation transcript:

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

2 Dr Matt Fay 2003/Cardiology&Computers 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

3 Dr Matt Fay 2003/Cardiology&Computers 3 Whats Next Computers in General Practice Emis Templates and Protocols Data extraction Moving towards integrated practice

4 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

5 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

6 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 Dont go too large

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

8 Dr Matt Fay 2003/Cardiology&Computers 8 The Template Data Collection PromptSub prompt Ischaemic heart diseaseCoronary artery operations (792) TL balloon angiopl coron a NOS (7928z) Acute myocardial infarction (G30) Old myocardial infarction (G32) Angina pectoris (G33) Systolic blood pressure (2469) Diastolic blood pressure (246A)

9 Dr Matt Fay 2003/Cardiology&Computers 9 The Template Data Collection PromptSub prompt FH - Ischaemic heart dis. (ZV173)FH: Mother (12K) FH: Father (12L) FH: Sister (12M) FH: Brother (12N) FH: Aunt (12Q5) FH: Uncle (12Q6) FH - Ischaemic heart dis. (ZV173)FH: Mother (12K) FH: Father (12L) FH: Sister (12M) FH: Brother (12N) FH: Aunt (12Q5) FH: Uncle (12Q6)

10 Dr Matt Fay 2003/Cardiology&Computers 10 The Template Data Collection PromptSub prompt ECG – general (321)ECG requested (3211) ECG normal (3216) ECG abnormal (3217) Serum cholesterol (44P) Tobacco consumption (137)Never smoked tobacco (1371) Pipe smoker (137H) Cigar smoker (137J) Stopped smoking (137K) Current non-smoker (137L) Cigarette smoker (137P)

11 Dr Matt Fay 2003/Cardiology&Computers 11 The Template Data Collection PromptSub prompt Left ventricular failure (G581) Congestive heart failure (G580) Non-insulin depd diabetes mell (C109) Insulin depnd diabetes mellitus (C108) Ischaemic heart disease (G3) Ihd Protocol (PROIHDCRAIG22) Recall date

12 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

13 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

14 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 patients record for data Can included templates for mass Reed code collecting and ease of editing

15 Dr Matt Fay 2003/Cardiology&Computers 15 Protocol Basics Built in Stages which determines the action Such as Display a template, print a prescription Rules Such as find clinical data Rules Ask the operator a question Direction To determine which stage the protocol will go to in answer to the rule

16 Dr Matt Fay 2003/Cardiology&Computers 16 Protocol Basics Stages Rules Direction Display the introduction screen 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

17 Dr Matt Fay 2003/Cardiology&Computers 17 Protocol Basics Stage 3 Rules Direction Display Information screen Blood Pressure not recorded has the BP been recorded today Y/N If yes go to stage 4 if no go to stage 5

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

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29 Dr Matt Fay 2003/Cardiology&Computers 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

30 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 –Dont under estimate the power of Excel

31 Dr Matt Fay 2003/Cardiology&Computers 31 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

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

33 Patient Presents Advanced Access Sees GP Unified Referral Form GP Refers Hospital Receives letter Consultant/GP SI receives letter Triage Informed of Plan at time of angio Needs investigation Waits Has Investigation Waits Outpatients and decision Waits Angiography Waits See Cardiothoracics Unified Referral Form Admitted for surgery Operation and Discharge Advice and plan to GP Put on waiting list Pre hab nurse completes checks for surgery

34 Patient Presents Advanced Access Sees GP Unified Referral Form GP RefersRACPS Informed of Plan at time of angio Waits Max 2 weeks Has Investigation Directly on to Angio waiting list Angiography Diagnosis, Advice and plan to GP

35 Patient Presents Advanced Access Sees GP Unified Referral Form GP RefersRACPS Informed of Plan at time of angio Waits Max 2 weeks Has Investigation Directly on to Angio waiting list Angiography Waits See Cardiothoracics Unified Referral Form Admitted for surgery Operation and Discharge Diagnosis, Advice and plan to GP Put on waiting list Pre hab nurse completes checks for surgery

36 Patient Presents Advanced Access Sees GP Unified Referral Form GP RefersRACPS Informed of Plan at time of angio Waits Max 2 weeks Has Investigation Directly on to Angio waiting list Angiography Waits See Cardiothoracics Unified Referral Form Admitted for surgery Operation and Discharge Diagnosis, Advice and plan to GP Put on waiting list Pre hab nurse completes checks for surgery

37 Dr Matt Fay 2003/Cardiology&Computers 37 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

38 Questions Matthew.fay@bradford.nhs.uk


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