1. Person Centred Medical Neighbourhood Readiness Program

2. Misbah Faiz – After Hours Program Officer – m.faiz@cesphn.com.au
Liam Shanahan – Health Informatics and Strategy Program Lead –
Misbah Faiz – After Hours Program Officer –
Lucy Armstrong – Aged Care Project Officer –

3. Rationale for Change
Electronic communications are not standard practice between GPs, specialists, allied health providers and hospitals
Even when electronic communication is used, there is doubt as to whether the communication has been received or acted upon
Questions around the impact on clinician’s workflow
Timely receipt of electronic communications may improve patient satisfaction with the health system and may facilitate more timely review and follow-up

4. Overarching Aims and Objectives
To move practices along the continuum to a higher performing primary care practice
Practices will be supported to deliver a stronger, more systematic yet flexible approach to the management, referral and review of patients with chronic and complex health needs
Electronic communications are seen as business as usual for all providers in the health care neighbourhood, and their use is expected by patients and carers

5. Enhanced and timely electronic communications
Diagnosis Results
Enhanced and timely electronic communications
Health Pathways
Change management process to develop high performing primary care practices
- Training - Shared Care Planning Tools - Data Quality - Digital Health

6. Analysis and Design Results
Need
Inputs
Output
Outcomes
Short Term
Long Term
Optimised patient care through enhanced and timely communication
Secure messaging vendors
LHD staff
PHN staff
General Practice Staff
Specialists
AHPs
Clinical Leadership
Training sessions for practices on embedding electronic communication into workflow
Commitment from LHDs and GPs to utilise electronic communications
Translating evidence from case studies into practice
eReferrals being made
Discharge summaries received correctly
Accurate GP records
Assuring users of the integrity of the system
Meaningful use of My Health Record
Accurate records of GP details in LHD systems
Enhanced integration and coordination of clinical services to optimise patient care
Assumptions
Patient care is negatively impacted by lack of electronic communication
Implementing electronic communication will improve patient care
Adequate uptake and embedding into work flow
External Factors
LHDs/NSW Health may implement state-wide electronic communication standards
Capacity and drive of partner organisations
Commonwealth funding models for use of electronic communication and My Health Record

7. Mission Statement
We will undertake a proof of concept activity that focuses on developing a high performing general practice through seamless electronic communication as part of a medical neighbourhood that provides ongoing, comprehensive, whole-person care.

8. Action Plan with timescale
Re-assessing our Needs Assessment to really narrow down on key gaps and issues
Scaling back and starting small
Targeting one chronic condition
Working with a small number of practices (connecting to one LHD based)
Stronger engagement with the LHD
Look to trial over 12 months