Using E-Consultations to Create a Seamless Patient Journey

SystmOne is being used by clinicians in Bradford & Airedale tPCT to reduce the number of unnecessary referrals to secondary care for renal patients. The programme is proving popular and there is now scope to expand it beyond CKD, and even beyond Bradford & Airedale PCT.

CKDEAS Update

The Chronic Kidney Disease Electronic Advisory Service (CKDEAS) was developed by Dr John Connolly, GP at the Ridge Medical Practice, Bradford, and Technical Lead for Bradford and Airedale tPCT, and Dr John Stoves, a consultant in nephrology and general medicine at Bradford Royal Infirmary, with involvement and support from PACE (Promoting Action on Clinical Effectiveness) and the Bradford Institute for Health Research. It is based on an approach used originally for Diabetes in Bradford & Airedale tPCT.

The project uses SystmOne as a communication and 'e-consultation' tool between primary and secondary care clinicians. The GP in primary care records his/her findings and then shares the record (with the patient's consent) with the secondary care consultant. The consultant then views the record and records his/her own findings, which are immediately viewable by the GP.

Feedback from early adopter sites in Bradford & Airedale is very encouraging. Dr Connolly says, "The early adopter sites are telling us that the e-consultation is a worthwhile way of working; it is more efficient, it is a better use of resources and it is better for the patient."

The formal academic evaluation of the pilot is now under way. Dr Connolly says, "There is agreement that, regardless of the outcome of the academic evaluation, it could be possible to spread the e-consultation beyond the early adopter sites so that all Bradford & Airedale practices can benefit from the same way of working. Work is ongoing on developing a local tariff to make it possible to commission this way of working."

CKD E-consultation for other PCTs

The 'Renal Tsar' (the National Clinical Director for Renal Services - Dr Donal O'Donoghue) and his team are actively looking for innovations and new ways of working in the care of kidney patients.

Dr O'Donoghue has taken a great interest in the CKDEAS project as it enables hospitals to work better with GPs, and demonstrates how technology can enable clinicians to 'work smarter'.

Dr Connolly says, "The Renal Tsar has proposed the dissemination and evaluation of this work beyond Bradford, spreading the e-consultation to non-Bradford sites. Clearly, that's most likely to be fruitful in communities with a high SystmOne presence. Having this interest and enthusiasm from the Renal Tsar makes us feel like we're on the right track in Bradford and Airedale."

 E-consultation for other specialities

Dr Stoves says, "E-consultation for patients for CKD is hopefully the start of a process of improving communication for all renal patients across the primary and secondary care interface. SystmOne has exceptional functionality that allows one to interrogate the electronic patient record in great depth, for example in assessing the temporal association between changes in prescribed medication and changes in kidney function. There is great potential for SystmOne to improve communication and decision-making in other clinical specialities."
 
Now news of the benefits of e-consultation is spreading beyond the specialities of Diabetes and CKD, as Dr Connolly explains: "It's only with a central repository and an integrated record that you can achieve such benefits for your patients. This is where the SystmOne model is out-plussing other forms of electronic record. In Bradford & Airedale, there are several specialities interested in using e-consultation to communicate between primary and secondary care, namely mental health, infertility testing, osteoporosis scan reporting, cardiology, anticoagulation decision making and endocrinology. There is also a huge enthusiasm by a specialist and GPwSI (GP with Special Interest) around using e-consultation for genetic counselling. We hope to progress these over the next few weeks."

For more information or suggestions about how e-consultations could benefit other clinical pathways, email john.connolly@bradford.nhs.uk