Shared records aid cuts in outpatient visits

Electronic consultations by secondary care clinicians with access to shared care records can save up to 70% of outpatient appointments, a conference heard this week.

Dr Richard Pope, consultant diabetologist and medical director at Airedale NHS Trust, told a conference run by primary care IT supplier TPP that e-consultations had the potential to transform care, saving money for the NHS and time for patients.

Dr Pope was one of the driving forces behind a scheme started in 1999 to create shared care electronic records for patients with diabetes in Airedale, set up with practices using TPP’s SystmOne GP system.

He told the conference: “I deal with 50-70% of consultations electronically and avoid the need for consultation with patients. I know it works because I have done it for eight years – I know it’s safe and I know patients like it.”

Clinicians in Airedale agreed a diabetes template to enable consistent data recording and records are available to view in either direction with patient consent.

Dr Pope told the conference that no patients had withheld consent to share information with primary care.

He added: “This shows what our patients’ wishes really are. They want to cross the secondary care divide and they want to do it now.”

The system enables the hospital clinic to see what has been done in primary care to avoid duplication and also enable intra-district team referrals, e-referrals and proactive targeted interventions.

Dr Pope added: “If a patient has been seen by out-of-hours with, for example, a hypo, we can plug the diabetic nurse in without being asked. It’s a patient-focused approach.”

Dr Pope said that since the initial project with diabetes, Bradford and Airedale have gone on to set up shared care record systems using TPP with a variety of other specialisms including out-of-hours, palliative care, rheumatology, renal medicine and podiatry.

He added: “The future model is to use this remote consultation tool to support delivery of care for a much more complex range of conditions than is currently acceptable.”

Dr Pope said e-consultations would create radical changes in patient flows and although he acknowledged the potential threat to the balance of the health economy he said he believed these could be overcome.

Dr Pope urged those attending the conference to set up their own e-consultation systems with secondary care and identified diabetes, respiratory and chronic kidney disease as three key areas where such a pattern of care could work very well.

He added: “Don’t be constrained by Payment by Results. If you are seen to be doing something which is clinically sensible and safe and with built in governance you will find it hard to find a clinician who shoots you down.”