“Do Once and Share” Feedback from the Renal Team B Stribling, K Harris, A Keogh, J Medcalf

Aims Identify the potential for using the National Programme for IT to improve the efficiency of care processes Reduce unknowing duplication Promote national consistency Reduce the waste of professional & patient time Ensure a common input to the Technical Office (central IT)

Why do it? Have at least one National Document e.g. NICE, NSF Have an active professional community of practice comprising both professional and patient organisations. Have already had systems development work undertaken by the Modernisation agency   

Scope - I Provide baseline information on the current standard clinical practice, and likely changes to clinical pathways Identify training implications Produce Guidelines for primary care on the implementation of the project Outputs for SNOMED required

Describe existing renal IT systems, and the expectations of the wider renal community for future systems Describe any finished, or pilot projects in progress Develop communication plan between National renal community and NPfIT Report to stakeholders on progress to date Produce timely reports as required Scope - II

Out of scope Comprehensive engagement with social care Comprehensive evaluation of needs of private care providers Comprehensive evaluation of the requirement for the care of children with renal disease Comprehensive training manual to include recommendations for delivery

Patient unknown to have renal disease Identified by Coincidental Investigation GP system identifies “at risk” (CVD, DM, ↑BP) Other clinic Pharmacy screening program Formal screening program (if became technically simple Symptoms of CKD (least likely) Previous acute renal failure Assessment and stage of CKD Repeat Creatinine Creatinine:age:sex:race = MDRD or other GFR estimate BP Urinalysis for blood and protein, protein:creatinine ratio Screen for other disease eg DM Drug / PMH / Lifestyle history Clinical Advice System NELH Map of Medicine Local Referral Guideline Assessment Nephrology Advice “Virtual Nephrologist” or Other method of communication Nephrology Outpatients Choose and book Templates Access to all previous data PMH, FH, DH, BP,GFR, Urinalysis, Imaging etc † X-ray Pathology Doctor Specialist Nurse Dietician Pharmacist & electronic Prescribing support NELH Stable CKD * Return GP CDMP with Tailored management plan based on standard templates All test results Re-referral advice Progressive CKD Shared primary / secondary care Other Renal Disease requiring specialist advice Shared primary / secondary care Patient info throughout Tailored to CKD stage and individual patient Language Paper as well as IT CKD initial assessment Pharmacist review Medicines management Guidelines / policies etc Advice and support Pharmacy/ Others “One Stop” Referral to other speciality e.g. Urology Guideline Primary care Stable CKD * Chronic Disease Management Program (CDMP) Renal or other † consider possibility that patient might prevent this

Patient unknown to have renal disease Identified by Coincidental Investigation GP system identifies “at risk” (CVD, DM, ↑BP) Other clinic Pharmacy screening program Formal screening program (if became technically simple Symptoms of CKD (least likely) Previous acute renal failure Assessment and stage of CKD Repeat Creatinine Creatinine:age:sex:race = MDRD or other GFR estimate BP Urinalysis for blood and protein, protein:creatinine ratio Screen for other disease eg DM Drug / PMH / Lifestyle history Clinical Advice System NELH Map of Medicine Local Referral Guideline Assessment Nephrology Advice “Virtual Nephrologist” or Other method of communication Nephrology Outpatients Choose and book Templates Access to all previous data PMH, FH, DH, BP,GFR, Urinalysis, Imaging etc † X-ray Pathology Doctor Specialist Nurse Dietician Pharmacist & electronic Prescribing support NELH Stable CKD * Return GP CDMP with Tailored management plan based on standard templates All test results Re-referral advice Progressive CKD Shared primary / secondary care Other Renal Disease requiring specialist advice Shared primary / secondary care Patient info throughout Tailored to CKD stage and individual patient Language Paper as well as IT Pharmacist review Medicines management Guidelines / policies etc Advice and support Pharmacy/ Others “One Stop” Referral to other speciality e.g. Urology Guideline Primary care Stable CKD * Chronic Disease Management Program (CDMP) Renal or other † consider possibility that patient might prevent this CKD initial assessment

Assessment of CKD

Local Referral guidelines

Commissioned by Renal Information Exchange Group (RIXG) Provides web-based information to Renal patients about diagnosis, treatment, test results, clinical correspondence, Transplant suitability Renal PatientView

Existing Functionality Majority of Renal units already have a well developed clinical computer system Functional, locally managed and flexible Contains many of the key elements of an Electronic patient record Able to share information, but until now not been a high priority

31 of 52 English & Welsh units (as defined by Renal Registry 2004 report as having IT systems) responded. 6 of 7 Scottish units with IT systems responded. (+ One with no IT system) 2 Northern Ireland units responded 3 Paediatric units responded 42 units total Existing Functionality

Risks/Issues NELH –not complete within this project timescale Implications of SNOMED Map of Medicine –not complete within this project timescale Renal Dataset ready 2007

Conclusion Described a reproducible framework on which to hang IT to support CKD Described existing functionality (what we have to protect) Promoted Renal as an IT literate “can-do” speciality Identified “easy” opportunities for further innovation and road-testing existing ideas