1. Computers Cardiology and Primary Care
Dr Matthew Fay
Westcliffe Medical Centre
Shipley

2. Computers Cardiology and Primary Care
Westcliffe Medical Centre
9700 patients in urban setting
Set just north of Bradford
7.5 whole time equivalent clinicians
As team of whole and p/t Doctors and NP
Computerised since 1994
Paper light since 1997
EMIS LV since Dec 1999 (currently LV 5.2)
No dedicated computer worker
Dr Matt Fay 2003/Cardiology&Computers

3. Dr Matt Fay 2003/Cardiology&Computers
What’s Next
Computers in General Practice
Emis Templates and Protocols
Data extraction
Moving towards integrated practice
Dr Matt Fay 2003/Cardiology&Computers

4. The Computer and General Practice
Level of computerisation
We own a computer
We use a computer
We have our prescriptions on computer
We have some patient data on computer
We have our consultations on computer
We have all patient data on computer
We allow the computer to aid our decisions
Dr Matt Fay 2003/Cardiology&Computers

5. Data in General Practice
Reed codes
Large selection of alternatives
In hierarchical trees
Agreement on the root codes use
Inform whole team
Attempt to engage secondary care
Dr Matt Fay 2003/Cardiology&Computers

6. Dr Matt Fay 2003/Cardiology&Computers
What is a CHD template
List of agreed Reed Codes
Accessed while in the consultation
Useful for mass data collection
Can also be a memory aid
Don’t go too large
Dr Matt Fay 2003/Cardiology&Computers

7. Dr Matt Fay 2003/Cardiology&Computers
The Template
Dr Matt Fay 2003/Cardiology&Computers

8. Dr Matt Fay 2003/Cardiology&Computers
The Template
Data Collection
Prompt
Sub prompt
Ischaemic heart disease
Coronary artery operations (792) TL balloon angiopl coron a NOS (7928z) Acute myocardial infarction (G30) Old myocardial infarction (G32) Angina pectoris (G33)
Systolic blood pressure (2469)
Diastolic blood pressure (246A)
Dr Matt Fay 2003/Cardiology&Computers

9. Dr Matt Fay 2003/Cardiology&Computers
The Template
Data Collection
Prompt
Sub prompt
FH - Ischaemic heart dis. (ZV173)
FH: Mother (12K) FH: Father (12L) FH: Sister (12M) FH: Brother (12N) FH: Aunt (12Q5) FH: Uncle (12Q6)
Dr Matt Fay 2003/Cardiology&Computers

10. Dr Matt Fay 2003/Cardiology&Computers
The Template
Data Collection
Prompt
Sub prompt
ECG – general (321)
ECG requested (3211) ECG normal (3216) ECG abnormal (3217)
Serum cholesterol (44P)
Tobacco consumption (137)
Never smoked tobacco (1371) Pipe smoker (137H) Cigar smoker (137J) Stopped smoking (137K) Current non-smoker (137L) Cigarette smoker (137P)
Dr Matt Fay 2003/Cardiology&Computers

11. Dr Matt Fay 2003/Cardiology&Computers
The Template
Data Collection
Prompt
Sub prompt
Left ventricular failure (G581) Congestive heart failure (G580) Non-insulin depd diabetes mell (C109) Insulin depnd diabetes mellitus (C108) Ischaemic heart disease (G3)
Ihd Protocol (PROIHDCRAIG22)
Recall date
Dr Matt Fay 2003/Cardiology&Computers

12. Dr Matt Fay 2003/Cardiology&Computers
Templates Problems
Tend to be set to single Reed codes
If the template is too long people will not use it
Asks for information even is already recorded
Go for speed no technical complexity
Dr Matt Fay 2003/Cardiology&Computers

13. Dr Matt Fay 2003/Cardiology&Computers
EMIS Protocols
Allow a degree of computer aided decision making by allowing EMIS to search the patient record for data and by-passing the steps of the template that have already been completed
Dr Matt Fay 2003/Cardiology&Computers

14. Dr Matt Fay 2003/Cardiology&Computers
EMIS Protocols
Essentially can be seen as ‘intelligent’ templates
Can be set to trigger at certain Reed codes
Can search a patient’s record for data
Can included templates for mass Reed code collecting and ease of editing
Dr Matt Fay 2003/Cardiology&Computers

15. Protocol Basics Rules Direction Rules
Built in Stages which determines the action
Such as Display a template, print a prescription
Direction
To determine
which stage
the protocol
will go to in
answer to the
rule
Rules
Such as find clinical data
Rules
Ask the operator a question
Dr Matt Fay 2003/Cardiology&Computers

16. Protocol Basics Stages Direction Rules Display the introduction screen
Find Reed code 246 in last 6 months
If Reed code found
Go to stage 2
If Reed Code not found
Go to stage 3
Dr Matt Fay 2003/Cardiology&Computers

17. Protocol Basics Stage 3 Direction ‘has the BP been Rules
Display Information screen Blood Pressure not recorded
Direction
If yes go to stage 4
if no go to stage 5
Rules
‘has the BP been
recorded today’ Y/N
Dr Matt Fay 2003/Cardiology&Computers

18. What does it look like in action
Dr Matt Fay 2003/Cardiology&Computers

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29. Dr Matt Fay 2003/Cardiology&Computers
So what can be achieved .
BP can be better monitored
If Aspirin therapy is contraindicated this is better documented
Smoking status is consistently recorded
Betablocker commenced
Cholesterol measured and controlled
Dr Matt Fay 2003/Cardiology&Computers

30. Dr Matt Fay 2003/Cardiology&Computers
Data Extraction
Bradford North and Incentives
All CHD NSF targets are part of the PMS incentive scheme.
Data extraction
Through templates the data sets are tight
PCT agreed targets are set annually
In EMIS clinical audits are useful
Don’t under estimate the power of Excel
Dr Matt Fay 2003/Cardiology&Computers

31. Moving to integrated practice.
Bradford North’s experience
CHD collaborative has brought primary and secondary care together
Have the consultants with you
Understand the pathway of care
Understand your goal
Share your problems as well as the successes
Ask the patients their perspective is unique
Dr Matt Fay 2003/Cardiology&Computers

32. Cancelled Operation Hospital Receives letter Patient Presents Sees GP
Waits
Waits
Waits
Patient Presents
Sees GP
GP Refers
Waits
Consultant receives letter
Waits
Waits
Needs investigation
Outpatients
Waits
Waits
Waits
Has Investigation
Outpatients and decision
Angiography
Waits
From general practice to consultant, very separated service
Patterns of change tool box and friends
Put on waiting list
Waits
Waits
See Cardiothoracics
Outpatients and decision
Long Wait
Cancelled Operation
New Co morbidity
identified
Admitted for surgery

33. Hospital Receives letter Patient Presents Sees GP GP Refers
Advanced
Access
Unified
Referral
Form
Patient Presents
Sees GP
GP Refers
Consultant/GPSI receives letter
Triage
Needs investigation
Waits
Waits
Waits
Has Investigation
Outpatients and decision
Angiography
Informed of Plan at
time of angio
Advice and plan to GP
From general practice to consultant, very separated service
Patterns of change tool box and friends
Waits
Put on waiting list
See Cardiothoracics
Unified Referral Form
Pre hab nurse
completes checks
for surgery
Operation and Discharge
Admitted for surgery

34. Directly on to Angio waiting list
Advanced
Access
Unified
Referral
Form
Waits Max
2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at
time of angio
Diagnosis, Advice and plan to GP
From general practice to consultant, very separated service
Patterns of change tool box and friends

35. Directly on to Angio waiting list
Advanced
Access
Unified
Referral
Form
Waits Max
2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at
time of angio
Diagnosis, Advice and plan to GP
From general practice to consultant, very separated service
Patterns of change tool box and friends
Waits
Put on waiting list
See Cardiothoracics
Unified Referral Form
Pre hab nurse
completes checks
for surgery
Operation and Discharge
Admitted for surgery

36. Directly on to Angio waiting list
Advanced
Access
Unified
Referral
Form
Waits Max
2 weeks
Patient Presents
Sees GP
GP Refers
RACPS
Directly on to Angio waiting list
Has Investigation
Angiography
Informed of Plan at
time of angio
Diagnosis, Advice and plan to GP
From general practice to consultant, very separated service
Patterns of change tool box and friends
Waits
Put on waiting list
See Cardiothoracics
Unified Referral Form
Pre hab nurse
completes checks
for surgery
Operation and Discharge
Admitted for surgery

37. Unified Cardiac Referral Form
GPs suffering form fatigue
Single form for all cardiology services
For services ECHO, ETT,RACPS etc.
Also all consultant/GPwSPI referrals
Has data set required by cardio services
Integrates with Emis so data can automatically be inserted
Faxed to single number in ECG department
Dr Matt Fay 2003/Cardiology&Computers

38. Questions