Real-Time Digital Medicine

Dr Amir Hannan

Full-time General Practitioner (www.htmc.co.uk)

Information Management & Technology clinical lead, NHS Tameside & Glossop

Primary Care IT lead, NHS North-West (www.northwest.nhs.uk)

Map of Medicine clinical lead, NHS North-West

Member of the HealthSpace Reference Panel, NHS Connecting for Health (www.healthspace.nhs.uk)

Member of the Clinical Leaders Network (www.cln.nhs.uk)

amir.hannan@nhs.netCartoon taken from www.mediclicks.net

Addenbrookes Hospital

Cambridge

17th February 2009

Summary Addenbrookes Access to Health Records

Why did I start sharing records with my patients?

The “best” PHR /EMR in the world….

Partnership of Trust

Paradigm Shift in Healthcare

Building the next generation healthcare system

How do we enable patients to access their records

www.htmc.co.uk

What can patients see?

What are patients doing with access to their health records

Time for YOU to get access to YOUR health records

•Shipman murdered his patients.•Fictitious “diseases” added to patient notes after they had died.•Thought to have used morphine which he collected in other people’s names.•Ramifications felt throughout the world!

Why ?•Sit down protest in the surgery•No IT system•Patients to see•Job to do…

Rebuilding TRUST in me and the Medical Profession

The “best” Personal Health Record / Electronic Medical Records in the

world….

…is about to get better…

Partnership of Trust

The Paradigm Shift in Healthcare

IT based health care system

Internet

Increase in health literacy

Patient access to Electronic Health Record

Patient choice

Choice leads to better outcomes

But there are concernsIn general, the first reaction is anxiety, worry and avoidance 

Patients seeing our muddles, red herrings, poor typing, inappropriate phrasing        

Patients seeing 3rd party info that they should not see         

Patients seeing something that would cause them serious harm         

It will increase litigation against us

We don’t have time to promote records access and do all the other things we have to do        

Patients will take longer boring on about minor irrelevancies in the record        

Patients will come more often, worried well         

Patients won’t understand what we write         

Clinicians will have to change the way we write         

We will not be able to speculate about diagnoses any more: this pt may have MS, wait+see          

Who’s helping us? PATIENTS General Medical Council The Medical Defence Organisations Information Commissioner’s Office EMIS / PAERS Department of Health NHS Connecting for Health National Information Governance Board Local Care Record Development Board NHS Tameside & Glossop NHS North-West (formerly known as NW SHA) Local Medical Committee Self Help Groups Patients and the Public International Council for Medical & Care Compunetics (www.icmcc.org) Primary Healthcare Specialist Group, British Computer Society Map of Medicine MPs Patients know best (of course!)Etc etc etc

So let’s build a system that supports

clinicians, patients and the system!

Supports Summary Care Record

SupportsHealthSpace

Supports Google Health / HealthVault

Supports patients and GPs

Let’s have a blended approach

Why does Records Access matter?

Record access complements and enhances most of the processes of care  

Research suggests that full record access: is safe, is popular with patients (wouldn’t you like to have access whenever and

wherever you were?) improves patient confidence in themselves and their clinicians, enables patients to improve the accuracy of their records, improves the efficiency of consultations probably improves preventative and self-care. 

Record access is also recommended as it: Improves communication with patients Supports copying letters to patients complies with the Data Protection Act is recommended for patient safety improves the process of obtaining informed consent is necessary for information governance

So how do we do it?

Are you eMPOWERed yet ?e

Medical

Patient and the Public

cOmmunication

World wide web

Electronic

Record

Feature List for Patients

Feature List for Clinicians / Staff

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Using HealthSpace

Using HealthSpace

Map of Medicine via NHS Choices

Map of Medicine via NHS Choices

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

Haughton Thornley Medical Centreswww.htmc.co.uk

What do patients see?

Patient access to GP record

Patient Access to GP record

Book appointment online

Patients or their families

can order repeat

prescriptions on-line

Can easily see what

patients are taking and not taking

Blue i button gives further information directly from the repeat

script explaining what the

medication is for

Up-to-date repeat

prescriptions

Order Repeat Medication

Information re Aspirin

Information re Aspirin

Information re Aspirin

Information re Aspirin

Ordering repeat prescriptions

Access GP record

GP record - Summary screen

GP record - Summary Screen

GP record - Summary screen

GP record - Summary screen

Consultations

Links to diabetes

Foot care for diabetes

Results

Information re blood tests

Letters

Pictures

Medication

Real-time Digital Medicine from a patient perspective

Patients CAN and ARE making a

difference

Benefits beyond compliance and concordance being felt

Dear Amir, 

I am currently carrying out a records management audit at the PCT. On my travels around the PCT, the Fracture Liaison and Osteoporosis Nurse was telling me about patients from your practice who when attending to see the nurse were bringing copies of their records and reports that they had accessed from home. The nurse was very grateful as this helped in the treatment and tests that were undertaken and saved her a lot of time and also occasionally gave information that meant that either a re-scan was not undertaken again or was not necessary and therefore this prevented unnecessary appointments. I said I would pass on the positive comments to you.  

Regards Rob Anker 

Records Manager

Tameside and Glossop PCT

The Map of Medicine in the Real World

for patients with access to their records

“thought the web site was very good and was easy to use. It made me think about my illness and different things that my doctor could have or should have done to help my condition. It made me feel as if my doctor could have done more than just give me anti depressants. It will be good for more illnesses to be added. I think websites like this one has helped me manage my illness better” (patient with full access to GP electronic health record)

“I've had a look at the website and thought it very good. Some of the terminology may be a little difficult for some people especially if you have been recently diagnosed and don't know the jargon” (patient with full access to GP electronic health record)

“I had a quick look at the glaucoma one. Content very good and well summarized but not suitable for patients at all. I think only the most well informed / literate patient will be able to make sense of the information and way it is presented.” (patient with access full access to GP electronic health record and works as a consultant ophthalmologist)

“I accessed that informative site.  It was very clear, and about the best information I have had up to now.  I would imagine, though, for people of a less hardy disposition, it would prove to be a bit frightening, to see the facts put so boldly before them.  Again, there is no alternative for persons like myself taking a more holistic route to combat this disease, and with that in mind, there appears no hope.  The last option on the list is adjuvant therapy.   To face the fact that this disease is now "incurable" can be daunting.  But if you look at it from another angle, so is asthma, diabetes and arthritis.  It’s how you look at a problem and interpret it.” (patient with breast cancer with metastatic disease and who has full access to GP electronic health record)

“I found the site very interesting easy to use, also easy to understand as well. I did find my condition and found that I have had all that the experts have said, have experience all that” (patient with full access to GP electronic health record)

These are NOT just a handful of patients

These are NOT just a handful of patients

We have over 600 patients over 3 years now having access to their records in our practice alone

Young, old, English, Foreign, rich, poor, IT-savvy, not so IT-savvy – very few exceptions

Not a single problem

40 practices offering the same service around the country with more than 60% enabled to do so (all EMIS practices)

Complements the Summary Care Record by NHS Connecting for Health

Patients wondering why everybody else is not doing it!

www.htmc.co.uk has been built so that it can be deployed in another practice, across a PBC or PCT. 95% of the information is as relevant to patients in Cambridge as it is to my patients in Hyde! We are now linking to local Providers too!

ConclusioneMPOWERed patients need access to their medical records AND high quality information about their care AND how to manage it.

www.htmc.co.uk is a platform that enables you to do this

e

Medical

Patient and the Public

cOmmunication

World wide web

Electronic

Record

Isn’t it time YOU got access to YOUR records and started using it to improve YOUR health and

enter the world of REAL-TIME DIGITAL MEDICINE ?Dr A Hannan

amir.hannan@nhs.net

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www.htmc.co.uk