Computers Cardiology and Primary Care
Dr Matthew FayWestcliffe Medical Centre
Shipley
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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
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What’s Next
• Computers in General Practice• Emis Templates and Protocols• Data extraction• Moving towards integrated
practice
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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
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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
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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
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The Template
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The Template
Data Collection
Prompt Sub prompt
Ischaemic heart disease Coronary 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)
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The Template
Data Collection
Prompt Sub 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)
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The Template
Data Collection
Prompt Sub 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)
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The Template
Data Collection
Prompt Sub 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
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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
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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
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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
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Protocol BasicsBuilt in Stages which determines the action
Such as Display a template, print a prescription
RulesSuch as find clinical data
RulesAsk the operator a question
DirectionTo determine which stage
the protocol will go to in
answer to the rule
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Protocol Basics
Stages
RulesDirection
Display the introduction screen
Find Reed code 246 in
last 6 months
If Reed code found
Go to stage 2If Reed Code
not foundGo to stage 3
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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
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What does it look like in action
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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
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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
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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
Patient Presents Waits Sees GP Waits GP Refers
Waits
Hospital Receives letter
WaitsConsultant receives
letter
WaitsOutpatients
Waits
Needs investigation
WaitsHas Investigation WaitsOutpatients and decision
Waits
Waits
Angiography
Outpatients and decisionWaitsSee CardiothoracicsWaitsPut on waiting list
Long Wait
Admitted for surgery New Co morbidityidentifiedCa
ncel
led
Ope
ratio
n
Patient PresentsAdvanced
Access Sees GPUnified Referral
FormGP Refers
Hospital Receives letter
Consultant/GPSI receives
letter
Triage
Informed of Plan attime of angio
Needs investigation
WaitsHas Investigation WaitsOutpatients and decision
Waits
Angiography
WaitsSee CardiothoracicsUnified Referral
Form
Admitted for surgery Operation and Discharge
Advice and plan to GP
Put on waiting listPre hab nurse
completes checks for surgery
Patient PresentsAdvanced
Access Sees GPUnified Referral
FormGP Refers RACPS
Informed of Plan attime of angio
Waits Max2 weeks
Has Investigation Directly on to Angio waiting list Angiography
Diagnosis, Advice and plan to GP
Patient PresentsAdvanced
Access Sees GPUnified Referral
FormGP Refers RACPS
Informed of Plan attime of angio
Waits Max2 weeks
Has Investigation Directly on to Angio waiting list Angiography
WaitsSee CardiothoracicsUnified Referral
Form
Admitted for surgery Operation and Discharge
Diagnosis, Advice and plan to GP
Put on waiting listPre hab nurse
completes checks for surgery
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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
Questions
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