Life at the Coalface There’s light at the end of the tunnel

Typical Day in General Practice

CarePlus

Integrated Family Health Centre

None of us are as smart as all of us.

(Special conditions apply: above statement does not include Minister of Health).

The Genesis of Good Ideas

Old system New systemCentralisedSpecialist-ledProfessional careSiloed professional groupsSupplier drivenQuality of careCare and diseaseInstitutional care

DecentralisedGeneralist-ledSelf-managementMulti-disciplinary teamPatient focusedQuality of lifeHealth and behaviourCommunity care

“I can plan my care with people who work together to

understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me”.

“We are sick of falling through gaps. We are tired of organisational barriers and boundaries that delay or prevent our access to care. We do not accept being discharged from a service into a void. We want services to be seamless and care to be continuous”.

National Voices

“I“ Statements

“The patient is always a person,The person is sometimes a patient.The person is more than an individual.The person is part of a context.The person exists because of their context”

Providers involved for 5 hours per year, patients for the other 8755 hours

Patients, families and communities have assets that should be used

Partnership of Equals- with patients not to patients

Informed and empowered patients are more likely to make healthy lifestyle choices.

On-line self help tools reduced consultation rates by ~20%.

Co-Production

“ All changes and new concepts that we initiate in order to make the healthcare sector more person- centred must include all stakeholders. We must make sure that everybody is on board or we are not likely to succeed”

Jacqueline Bowman-Busato European Platform for Patients’ Organisations

“ There needs to be a radical redesign to move the focus of health from a quality improvement health focus to a courageous pursuit of wellbeing”

Donald Berwick

We spend too much time hearing about the “what” and not enough about the “why”- data is a poor motivator

Be a “Dot-Joiner”- orchestrate, encourage, payment formats, it’s more sociology than technology

Listen to the Nay-Sayers- they’re vocalising what the silent majority think

“Fly under the radar”- make changes then work out the governance.

Challenges for Practices

Quality is never an accident. It’s always the result of high intention, sincere effort, intelligent direction and skilful execution. It represents the wise choice of many alternatives

Embed health in all government policy Reduce Variability Allow staff specialisation and create

community specialists

Quality Issues

Quality of Care Quality of Life. We need to work on Advanced Care Planning, Advanced Directive and NFR orders.

Health/Disease Health/Behaviour Institutional Care Care in and by

communities Years of Healthy Life not just Years of Life. Care co-ordinators/Navigators Health Care Home/Neighbourhood Networks

Work Needed in NZ

Changes will be evolutionary not revolutionary

Pace of change will be dictated by what providers can cope with and wish to do

Underlying philosophy is to make care more patient centred and coordinated

However changes should also make our work more enjoyable and allow us to work to the top of our scopes

The Big Picture coming to a Small Screen near you

Care SelectCare InsightSecure MessagingPatient Portals

On the Small Screen

Health Link Tool- used to make e-referrals to private specialists and NGOs.

Doesn’t require the recipient provider to have a PMS

Will allow provider to send back an inbox message to our PMS

Care Select

• Sport Northland • Hospice • Arthritis Foundation • Alzheimer’s society • Cancer Society • Northable • Epilepsy Northland • Stroke Foundation • Parkinson’s society • Plunket • Maori Providers • Manaia PHO

CareSelect NGO Providers

Health Link Tool- used to make e-referrals to private specialists and NGOs.

Doesn’t require the recipient provider to have a PMS

Will allow provider to send back an inbox message to our PMS

Care Select

Gives a view of classifications, medications, allergies, immunisations to external providers

Currently being accessed by ED, WhiteCross, Mid/Far North afterhours GPs and the hospital pharmacists

Most used by hospital pharmacists

May be replaced by CCMS Secure Messaging tool.

Care Insight

A component of the Care Connect Tool Trial starting in the Hokianga and Bush Road

Medical Centre to allow 2 way messaging between general practice and hospital specialists

A more elegant solution than e-referral simple advice

Message can be initiated by secondary services

May lead to more comprehensive shared EHR

CCMS- Secure Messaging

MedTech Manage My Health and My Practice Health 365.

Access if via a secure website- same level of security as internet banking

Patients can be enrolled at whatever rate practices feel comfortable with

Patient Portals

• save time for practice staff • improve workflow management • reduce phone tag • reduce paperwork • automate patient recalls and appointment reminders • improve safety by giving patients a written record of clinical instructions • provide 24/7 convenience for patients without extending practice hours • increase patient’s awareness and ability to manage their own health.

Potential Benefits to the Practice

Patient Portal have an option to allow patients to read their notes from the time they enrol onto the portal

Evidence strongly suggests that having Open Notes

Improves health literacy Improves compliance Strengthen doctor/patient relationships Is well liked and accepted by doctors and patients Does not increase patient complaints or doctors workload

Open Notes

“Good will is easy. It gets complicated when it’s about money and income.”

Love without a budget is not true love

Ply the CEO with drinks

Light at the end of the tunnel