HOW AN INTELLIGENT DEVICE CAN CUT THE MUSTARD Dr Julian Brown

What Was Meant by This ?  Succeed  Come up to Expectations  Provide High Quality

Obviously I must Have Been Good ?  2006  +201%  

The Story  2006: I became our PCT Prescribing Lead.  My Surgery was highlighted as having significantly high admissions for diabetes.  My Surgery was terrible.  They sent me to Chicago.  I decided to create an IT solution 

The Result  Went from one of the worst to the best in 1 year.  No insulin initiations.  Reduced Admissions.  Reduced overall spend  Best HBA1C control 2009

Graph of glycaemic control achieved from 2009 QOF data.

What Had We Done?  Performance Tracking  Risk Stratification  Integrated Care  Self-Management Plans  Patient Access

Performance Tracking  Accurate Benchmarking of how the surgery and PCT is performing on clinical markers.  NICE  QOF  How we were performing in terms of outcome data.  How we were performing in terms of cost.

6. Track Overall Cost-effectiveness at surgery level

2. Risk Stratification: Identification of High Risk Patients Six types of High Risk Patients  1. Those that have poor end-point data.  2. Those that have deteriorating end point data.  3. Those that fail to have screening  4. Those who are not on or not collecting appropriate medications  5. Those that are on inappropriate medications.

2.High Risk Patients: a. Poor End Point Data  The System will automatically create weekly league tables by each parameter.

2.High Risk Patients: b. Deteriorating Scores  Looking at flux of endpoint data helps identify patients earlier.

3. Integrated Care: Sharing the eHealthcard  Secure online for ease of access by:  GPs  Other HCPs  Patients

3. Summary Reports  Allows quick overview of patient  Allows pre- diabetes clinics  Allows remote clinics  Allows compliance issues to be identified.

7. Liaising With Specialists

7. Liaising with Specialists

3. Patient Self Management Plan 7 essential steps for diabetes perfection.  Blood Pressure Control  Blood Sugar Control  Cholesterol Control  Weight Control  Healthy Lifestyle  Medication Compliance  Regular Screening

Self-Management Plans  Encourage Patients.  Educate Patients.  Essential in achieving long-term diabetes control.  Reduce complications.  Reduce costs.  Makes the Patients Happy

How did diabetesmanager work? Web based application. Automated Data Extraction from GP systems Remote performance tracking of all diabetes patients. Automated self-management plans for every patient. Allows online access for patients Allows online education and remote specialist clinics.

Why Not Apply the Same Logic to Medicines Management  7% all emergency admissions medicine induced  60% of these preventable  Each one costing average £5000

The Process

The Result is Complete Safety Monitoring

The System Allows True Integrated Care

Surgery Portal  Identifies at risk patients  Updated Weekly  Confidentiality Maintained  Surgery Has Control

Preventing Emergencies  Identifies the Patients who don’t come to see us.  The ones that manage to get themselves on drugs that are dangerous for them.  The ones that aren’t taking their protective medications.  QOF!

Better Integration  Patients  Practice Diabetes Nurses  GPs  Specialist Nurses  Podiatrists  GPs specialist interest  Consultants  Commissioning Leads  Medicines Management  online, webinars, s, reports  Communication!

The Future  Better outcome for patients  Better education of patients (autotranslation etc)  Increasing Self-management  Reduced need for medications.  Easy patient alerts  Easy patient tracking  Better outcomes for HCPs.  Reduced Emergencies.  Reduced Admissions  Better project and formulary compliance.  Better use of services.  Identification of GP Surgeries needing extra resources.  Better education  Online referrals

This can become a thing of the past!  Microvascular Neuropathy Retinopathy Renal Disease Diabetic ulcers  Macrovascular Heart Attacks Strokes Peripheral Ischaemia Diabetic Ulcers

And more importantly – it transforms Patients  Janet  She used her selfmanagement plans & diabetesmanager.org.uk for 12 months

To this one!  Same patient after 12 months using her self-management guide   Time for live demo

Does this Cut The Mustard?  2009 QIPP arrived  Quality  Innovation  Prevention  Productivity  The Future of the NHS  £20 billion Savings

How Would It Work? Quality Innovation to Implement Prevention allowing Improved Efficiency Improved Productivity Cost-Savings with reinvestment