Developing a single electronic health care record: Better information, care and outcomes in a 'Better care together' world

Résumé fourni par la source

Our healthcare economy has met with significant challenges in recent years, with challenges to patient safety, clinical quality, suboptimal patient experiences and major financial challenges.A systematic reorganisation of our clinical services has begun with a clinically led strategy for a very different configuration of clinical services, in a process known as 'Better care together'.New patterns of care and patient flow have been devised, with more emphasis on supporting informed self-care, reducing outpatient follow-up when not really necessary, or providing support through technically supported clinics (telephone, webex).We need to identify patients who are vulnerable before a crisis occurs, to provide early community health and social interventions to limit unnecessary hospital admissions and also to support active early discharge planning and repatriation to homes and the community.1. Mrs Peacock is 65 years old, lives in a small rural town, has experienced moderate abdominal pains for two weeks and lost one stone in weight.She would like to see her general practitioner (GP), but having telephoned the single point of contact (Care Coordination Centre), which is the central area contact and booking centre, the first available appointment with her GP is seven days away.The contact centre can see GP clinic bookings and is able to make two other offers, including an appointment with a GP Partner in her own practice in five days and a third offer of an appointment with a GP in a neighbouring small town in two days.Mrs Peacock prefers the appointment in two days.The GP at the different practice can provide a consultation for Mrs Peacock, see all her GP Electronic Patient Records (EPR) and Mrs Peacock receives timely, safe and effective assessments and treatment. 2.Colonel Mustard is a 73-year-old who suffered a stroke three months ago, developing a moderate severity right hemiparesis.He had a complicated eight-week inpatient stay requiring extensive rehabilitation before discharge from hospital, but over the last four weeks Colonel Mustard has struggled with worsening mobility with his Zimmer frame and has fallen in the last two days at home.Mrs Mustard calls the single point of contact (Care Coordination Centre) for help and advice.The booking centre telephonist takes details and involves a clinical Care Navigator, who can quickly access Colonel Mustard's EPR and see GP details through Emisweb and also hospital care details through Lorenzo.This includes diagnoses, detail of functional capability and care needs.Instead of a traditional approach of organising ambulance transport to the emergency department (ED) and then another potentially prolonged hospital admission, the Care Navigator is able to mobilise the Integrated Core Team in the community.A physiotherapist and district nurse visit the patient at home within two hours, they have access to all relevant EPR records and care plans and put in place a comprehensive supportive care package over the next two weeks.The outcome is that Colonel and Mrs Mustard receive the support and care they need at home, in a personal setting and a further long inpatient stay with attendant risks, including risks of hospital acquired infection, has been avoided. 3.Professor Plum is a 78-year-old who lives on his own with no family or social support and is admitted with severe leg cellulitis and recent background of poor mobility and poor self-care.Within two days, his cellulitis has improved on intravenous antibiotics, but he is still unsteady on his feet.The Care In order to provide this different landscape of 'Better care together' health and social services, we need different groups of healthcare workers, working in different ways and supported by information at point of care.Digital EPR records in GP surgeries, communities and the hospital need to be joined up, so that the relevant information is available at point of care, to support decisions at the next point of care and also joined up with social services.Summary views of other clinical EPRs are currently available in ED, Acute Medical Unit (AMU), Acute Surgical Unit (ASU), and by pharmacists and palliative care teams within Morecambe Bay hospitals.Data and information that need to be shared include messages, documents and care plans. VISIONPlease imagine these different experiences for our patients in the future!

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