Using digital tools to manage complex care patients

In his recent blog ‘Are digital tools the way to improve access to primary care?’, UCLPartners Primary Care Quality Improvement Lead, Dr Mizan Hoque, highlighted the opportunities for digital innovation to support access in primary care.

In response to this, Dr Zenobia Sheikh shares her thoughts on how digital innovation is not only important for access to primary care but critical at every stage of the patient journey, for patients and clinicians alike.

Over the last two years a pilot project has been underway in east London, creating a specialist new ‘Complex Care Practice’. This pilot practice aims to align the care of patients with four or more long term conditions. Throughout this project digital innovation has been key to joining up health and social care services.

One aspect of the project, the use of digital technology to provide remote access to patient records, serves as a useful example of where technology currently stands within the NHS landscape, and highlights areas of care that are still yearning for rapid development.

The pilot was based on a model of integrated care, delivered by a unique, multi-disciplinary team including dual-skilled (administrative and clinical) ‘keyworkers’, Occupational Therapists and GPs, supported by a Social Worker, Practice Nurse, Practice Manager and Consultant Geriatrician.

Patients were identified using anonymised disease registers, and those with at least four out of eight pre-defined long-term conditions were invited by their current GPs to re-register at the Complex Care Practice. The practice population was drawn from across three large east London boroughs, with the central base nested within a District General Hospital site.

Due to their co-morbidities, many of the patients required care at home. Ordinarily, health and social care professionals conducting home visits can only see print outs of a patient’s medical record. These contain limited detail, and the process of printing and later disposing of these records is time consuming, duplicates work, wastes paper, and can put confidential medical information at risk.The pilot used electronic tablet devices preloaded with primary care software, which gave clinicians remote access to patient records. Past consultations, investigation results and data entry from other primary care team members were all available in real time, supporting clinicians to communicate seamlessly and provide better, more efficient bedside care.

Patients were able to view a ‘read-only’ version of their medical records from their own electronic devices, allowing them to take ownership of their care journey. In some cases patients actively supported their own care, by passing on information about themselves to other care providers.

Our patients often required every member of the team to input on their care, and so the opportunity for digital innovations to streamline communication and support improved care for this cohort is enormous. As Dr Hoque identifies, robust evaluation and the development of IT infrastructure are key challenges.

An aligned conversation on the potential for digital innovation in primary care is indeed long overdue; it will be interesting to see how e-consultations and other primary care innovations can be used to benefit populations with high level social and health need.