Dr Amir Hannan Full-time General Practitioner (www.htmc.co.uk)

Information Management & Technology clinical lead, NHS Tameside & Glossop

Primary Care IT lead, NHS North-West Member of the HealthSpace Reference Panel, NHS

Connecting for Health Member of the Clinical Leaders Network

amir.hannan@nhs.net Cartoon taken from www.mediclicks.net

Yvonne Bennett Patient of Haughton Thornley Medical

Centres Member of the local Care Record

Development Board Member of the HealthSpace Reference

Panel, NHS CfH

Real-time Digital Medicine from a patient perspective

“…after a recent visit to Thornley house Dr Hannan put me wise to your web site. WOW so much info for an old timer to take in but well worth the effort on my part. I really like the self care section and the lab test on line is great now.. It’s not so much as have a jab and wait two weeks you can see what they are testing for it makes it a lot better when you know up front .well got a lot more surfing to do well done all at thornley house and doctor hannan give yourself a rise ?”

Quote from another patient of mine

% of patients NOT complying with medications by disease area

asthma 80% diabetes 55% hypertension 40% epilepsy 40% arthritis 35%

The system is not working…. There is a need for tools to help to inform as

well as manage care better for patients

So what’s the challenge ?

Drug

Clinician Patient

What’s the problem ? Patient’s condition worsens

Rushed doctor who

needs to meet a target

Pill prescribed with little

explanation

Poor concordance

Poor compliance

It’s not as simple as that! I forgot to take the tablets I didn’t realise that I had run out of tablets Your receptionists told me I had to wait 48 hrs to get my repeats The pharmacist only gave me 21 tablets and the receptionist

wouldn’t give me a repeat because I wasn’t due yet! The chemist orders them for me I didn’t know I had to take them I don’t like taking tablets Do you think I could stop the injections and go back to tablets? What about those who are foreign speaking with mental health

problems?

What is happening? Patient comes

to clinician

Clinician tells patient what to

do

Patient complies (or

chooses not to or forgets)

Patient comes to clinician Clinician / patient

explains what they are trying to do

Clinician provides information to help

patient to understand the condition, treatment,

where else to learn more and what else to do

How does this happen? Shared understanding of the problem

History Examination Differential diagnosis Access to health record

Shared understanding of the solution What clinician will do and what patient will do Access to high quality information (Map of Medicine) Access to health record

The Partnership of Trust

The Paradigm Shift in Healthcare

IT based health care system Internet Increase (generally) in health literacy Access to trusted health informatiom for patients

builds confidence Patient access to Electronic Health Record Patient choice Choice leads to better outcomes & hopefully

improved concordance

The “eMPOWERed Patient”

Reactive vs Proactive Passive Enabled Informed Empowered eMPOWERed

Patient Person Family

Are you eMPOWERed yet ? e Medical Patient and the Public cOmmunication World wide web Electronic Record

What am I doing in the consultation Listen to the patient, gain an

understanding of their health belief and their surroundings

Encourage them to become active partners Create a shared plan with SMART goals Enable patients to choose the plan Encourage patients to get access to their

electronic health records OR ask how they are using it

What am I doing in the consultation Provide tools for the patient to refer to via the

practice website NHS Choices HealthSpace Map of Medicine Framework for understanding how the practice can support the

patient

ALWAYS allow the patient to come back Share stories about other patients and how their

plans have improved their care Link the practice website to their needs and

wants

An eMPOWERed Patient

Yvonne M Bennett

So what makes us different? We take care of our own health We are part of a ‘partnership of trust’ with our doctor We have access to a computer, not necessarily our own We are NOT STUPID, we are aware of security issues We tend to

Shop online Check insurance quotes Book holidays Use internet banking And many more

So WHY NOT maintain our health online!

A consultation with the doctor We discuss with the doctor our health problem We listen to their advice We may question their suggested medication

This isn’t to challenge the doctor but to find what is best for us

We may not accept the medication just then We may want to do our own research We may have personal moral issues with some

medications We DO get back to our doctor

So where do we go? Everybody has their own favourite sites Encouraged to use trusted websites

These could be Our Practice website patient.co.uk NHS Choices BBC

Haughton Thornley Medical Centres www.htmc.co.uk

Haughton Thornley Medical Centres www.htmc.co.uk

Information re Aspirin

Information re aspirin

Information re aspirin

Haughton Thornley Medical Centres www.htmc.co.uk

Once we have decided We go back to see our doctor We then discuss our findings We could have a different medication to the one

suggested Or we just accept the offered medication

So what next? We now take charge We decide to try the new medication We fit this into our regime How?

Patient access to GP record

Patient Access to GP record

Patients or their families

can order repeat

prescriptions on-line

Can easily see what

patients are taking and not taking

Blue i button gives further information directly from the repeat

script explaining what the

medication is for

Up-to-date repeat

prescriptions

Patient Access to GP record – order repeats

Information re aspirin

Ordering repeat prescriptions

Ordering repeat aspirin

Access GP record

Access GP record

GP record - Summary screen

Consultations

Book appointment online

Links to diabetes

Foot care for diabetes

Results

Information re blood tests

Letters

Using HealthSpace

Using HealthSpace

Using HealthSpace

Using HealthSpace

Using HealthSpace

Using HealthSpace

Using HealthSpace

Using Map of Medicine

How do I manage my medication? I know I need to take my medication regularly The best way is to make it part of my routine Always making sure that my repeats are ordered well

in advance at least 1-2 weeks in advance Attending medications reviews Plan for holidays (including public holidays) For the eMPOWERed it couldn’t be simpler Anytime day or night 24x7

Ways we remember to take our medication