There is an emphasis in modern healthcare on keeping patients, especially those with long-term conditions (LTCs) out of hospital, and providing them with services closer to home and supplied by multiple providers.
This would seem to need a new approach to organisation of care and the information – including but not exclusively medical records – to make sure that care is indeed seamless and joined up.
Meet Fred, a 70 year old widower living alone with his dog. Fred has insulin-dependant diabetes, arthritis (can’t give his own insulin), COPD, a fairly recent left leg amputation – and is understandably depressed.
Fortunately, he also has friends who often take him to the pub on Saturday nights – with the consequence that he is a frequent visitor to A&E on Sunday morning. (you haven’t forgotten the dog, have you?)
The challenge is to devise the information set-up to allow the safe management of Fred’s numerous medical and social problems, prevent medical untoward events (what if rheumatology want him on NSAIs but he is already on an ACE inhibitor to protect his kidneys? who decides which is the most important?) – and make sure the dog is looked after when Fred isn’t there!
Oh, by the way, Fred wants to be involved as well..
I’m hoping that anyone interested in the problem will be at the conference and ready to continue the discussion: will anyone be there on Monday afternoon/evening? I’m there Monday evening and both days of the conference..
Mary – I think you raise some very important challenges. In the scenario you paint is it OK to assume that Fred – or a carer; possibly a family member – has internet access?
Something from the US that may be of interest – http://tinyurl.com/6j67gry. I appreciate that having arthritis might be problematic for Fred if he indeed is internet connected (as so many 70 year old males are!) but not unsurmountable.
I share your desire to look at real world scenarios and work them through – I have recently seen many naive attempts promoted to remedy what we know are wicked problems that can probably never be resolved satisfactorily or at reasonable cost. It is important that we recognise when solutions are just not possible or where the pursuit of them leaves huge gaps in safety and accountability.
I hope to be at the conference on Monday evening.
I’m not sure whether Fred – or his informal support network – has internet access: I’m reasonably sure he can manage a TV remote – or the incentive to learn how to.
EMIS – and probably other suppliers – have the facility to allow EMIS Access to be available via a TV.
I don’t think we should focus on the technology: it’s more important to know whether Fred – or his appointed proxy – need to be able to access the information about his care and pathway(s) of care.
KP has a different setup: if only the NHS were a single organisation, life would be so much less complicated!
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