Fred and his dog: an update

I’ve spent a good deal of time on Fred’s problems – and the resulting powerpoint presentation is on the NYHDHIF 2011 conference [1]
My final conclusion is that there are a good many excellent initiatives to address many of Fred’s problems: I suspect Fred will still need his Fred book to keep on top of all of them and link them together!
However, I have not found an answer to the problem of multiple AQPs providing care for different pathways of care to the same patient, and I suspect the only safe answer is to have one organisation in charge – the model of Virtual Wards [2], the Whole System Demonstrators (WSD) and other Telecare/Telehealth models [3] or care managed by a Community Matron/GP consortium or the US Guided Care model [4].

The PHCSG has discussed the problems of multiple prescribers in different organisations frequently: If you’ve missed it, read Ewan’s blog [9].
One of the problems is that to be successful and comprehensive, it would require all organisations involved to use epresribing: it may be a long time in coming.
Would a partial medication repository help Fred – or would the fact that it was partial and possibly not used by one or more AQPs add to Fred’s very real risk from incompatible or contra-indicated medication?

Direct patient access to their GP record would help Fred to allow selected health care providers to access his GP record: I am not clear that this would solve the problem – and Fred might be understandably cautios about sharing his access with all of the organisations caring for him – especially AQPs who might or might not have the same duty/degree of confidentiality as the NHS (and many patients don’t trust even the NHS).
Look at the Haughton Thornley Medical Centre website for a patient centred discussion of the issues. [10]

Can anyone produce a model where care can be shared safely between multiple organisations caring for different conditions in a single patient – or suggest how relevant information can be shared between the different AQPs, who will probably have different IT record structures using different drug dictionaries and Coding (if any)?

One of the needs we identified was the need for communication between the informal carers: have a look at Rally Round Me [5]: it looks as though this might be the answer for Fred.

Then there are the patient controlled records (PMRs) – sites such as Patients Know Best [6] and Howareyou [7] (not to be confused with HowRU [8]) – but as all the information is entered by the patient, I cannot at present see how they fit in with Fred’s needs to have his formal and informal care providers communicate with each other as well as with him.

Still, the preliminary results of the WSD have been hailed as providing the ideal way to improve care of LTCs – I’m not clear whether the demonstrators included patients with multiple comorbidities – by Andrew Lansley no less: so we will be encouraged to implement telecare with all the attendant infrastructure.
Will this suit Fred?

I haven’t concentrated on digital access: it should be possible – or could be made possible – to use interactive TV – and/or PC accessibility including screen readers and voice control.
If there is the will to do so.

[1] http://www.nyhdif.org.uk/previous_conferences.htm
[2] http://en.wikipedia.org/wiki/Virtual_Wards
[3] http://www.kingsfund.org.uk/events/past_events_catch_up/supporting.html#tab_1
and http://www.telehealthsolutions.co.uk/products/home-pod/
[4] http://www.guidedcare.org/
[5] http://rallyroundme.com/welcome
[6] http://www.patientsknowbest.com/
[7] https://www.howareyou.com/
[8] http://www.abies.co.uk/howru
[9] https://woodcote.wordpress.com/2011/04/27/medication-repository-anyone/
[10] http://www.htmc.co.uk/getaccessnow/

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