Feature: cdm Nets funds for diabetes care project

This article first appeared in the April 2012 edition of Pulse+IT Magazine.
Since its early days as a collaborative care project, cdmNet has been rolled out across the country and is now RACGP Oxygen's preferred IT solution for managing chronic illness. It is also being used as the IT infrastructure partner for the federal government's new diabetes care project, and is looking to add many more allied health professionals to its list of users.

Figures from the Australian Institute of Health and Welfare show that chronic disease affects over seven million Australians and costs the health system about $70 billion a year. Added to that is the effect chronic disease has on productivity, with the Productivity Commission estimating losses of about $12 billion a year.

The statistics are well known and many organisations are trying to tackle this burden, including from the preventative care side, but the management of chronic illness is a massive problem for the health sector. The evidence shows that the best way to treat chronic illness is to plan longitudinal care involving a whole care team, including general practitioners, specialists, nurses and allied health professionals.

The development of care plans such as GP management plans (GPMPs) are subsidised through the Medicare Benefits Schedule (MBS) and there are a number of practice and nurse incentives available, but even so, it is thought that only one quarter of all people who should be on a care plan are on one, and even worse, that only one in five of those plans are regularly followed up and reviewed.

While GPMPs and the incentives received are all well and good, the major sticking point is that the practicalities of following up a care plan are sometimes too big a hurdle. Trying to collaborate regularly by email or phone with several disparate team members can be extremely difficult and time-consuming, as is the administrative burden placed on general practice in particular to keep up with Medicare's requirements.

This is a long-standing issue, so back in 2008, Michael Georgeff, a computer scientist and professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University, founded Precedence Health Care to develop an online tool to assist healthcare professionals in better managing chronic illness. cdmNet has since been adopted by RACGP Oxygen, the eHealth arm of the Royal Australian College of General Practitioners, as its preferred IT solution for managing chronic illness.

cdmNet is also being supported by the government's Digital Regions Initiative to bring chronic disease management to rural and remote areas using the National Broadband Network (NBN), and recently became involved in the federally funded Diabetes Care Project, a two-and-a-half year trial being led by McKinsey and Co to develop a new model of healthcare delivery to improve care for people with diabetes.

With many GPs using the program, Precedence is now hoping to sign up more of the allied health professionals essential to a good care plan. Registered allied health professionals can sign up on the cdmNet website.

For Professor Georgeff, the development of cdmNet was guided by two ideals: the first was to provide the ability to share care plans with the whole care team and with the patient. “The second point and probably the more important one was to automate as many of the processes and workflows involved in collaborative care that we could,” Professor Georgeff says.

“That means we automate all of the Medicare processes, we would create, electronically sign and then distribute all of the documentation that was required, we would send reminders to patients to make appointments, and we would automate all of the workflows involved in GP management plans.”

Precedence contracted researchers from Monash and Deakin universities to conduct reviews of the product and they found a doubling of GP practice productivity, a five-fold increase in the number of reviews that were done, and a five-fold increase in home medicines reviews, he says.

“In other words, there really was a step-change in the way that chronic illness was managed and fundamentally, just because we worked in an electronic medium, it wasn't simply the sharing of the data, it was the automation of those workflows that was the key.”

cdmNet currently includes treatment guidelines for diabetes, osteoarthritis, coronary heart disease, chronic heart failure, stroke, chronic kidney disease, asthma, chronic lower back pain, chronic obstructive pulmonary disease, and depression as a co-morbidity.

cdmNet also allows a GP or practice nurse to create customised care plans for other conditions or particular patient needs. According to Precedence, based on the outcomes of the trials of cdmNet, total net earnings per GP per year for chronic disease management increase from $15,000 prior to the use of cdmNet to $45,000 using cdmNet.

cdmNet is a web-based system that allows authorised users to register and log in with a password. From the general practice side, users download a component that sits of the desktop and does two things: it alerts the GP to activities relating to chronic disease management, such as a review being due, or that a patient should be considered for a care plan. For new patients, with their consent, a click of the button automatically uploads their medical record into the online site. From there, an electronic health record is created and smart rules are used to generate a draft care plan based on the appropriate guidelines.

From Professor Georgeff's perspective, the real key is that it has been designed for collaboration so allied health professionals also register, log in and are then able to enter their appointments and progress notes. “In fact, that's what makes it work,” he says. “Allied health have adopted it very enthusiastically, primarily because it lets them really engage in the shared care.”

Patients also get a user name and password and can log in, and they receive reminders to make appointments. “At the moment we leave it to the GP to tell the patient and in many cases they don't!” Professor Georgeff says. “We haven't focused on the patient engagement because most patients leave it to the GP. They like their reminders but other than that …”

Precedence recently added a telehealth component to the solution, working in partnership with Cisco, which has provided its WebEx web-based video conferencing product. The idea is to enable GPs and allied health professionals to access different technologies with the click of one button.

“cdmNet shares the data only with the care team members, so it is a restricted setting and we do that mainly for privacy reasons, but often there's a need for a telehealth consult,” he says. “It could be because of depression or it could involve an emergency where someone with diabetes burns their foot or wants to quickly contact the doctor.

“The telehealth component is really a single button – when you are logged into cdmNet there is a single button and when you press it, it quickly brings up the whole care team and says, there is your care team, who do you want to communicate with, the GP, the specialist or whatever – and from that point on it automates the process.

“It will send emails to the participants saying we want to set a time for this teleconference, it proposes a time and then at the time of the conference it will send a reminder to everyone that it is coming up. [As cdmNet] has all of the information about the care team, we can send them all the details so the user doesn't have to enter all of that information in.”

Cisco is also a partner with Precedence in the Australian Collaborative Care Cluster (ACCC), a project first established by the Victorian government in 2009 to tackle the management of chronic disease. Precedence heads the web-based IT side of the cluster, while other partners include the Baker IDI Heart and Diabetes Institute, the CSIRO, Monash University, the RACGP, Southern Health, the Royal District Nursing Service, Dandenong-Casey General Practice Association, Diabetes Australia – Victoria, Fred Health and Bupa.

Professor Georgeff says the ACCC is based on the idea that any one part is not going to work by itself. “This brings together various other organisations who have got part of the solution with the aim that if we all work together, we'll have something that actually might help solve the problem.”

One example is the work Precedence is doing with Fred Health, the pharmacy dispensing software specialists. In this project, barcodes are attached to the patient's care plan so when they go to any pharmacist that uses Fred, it will read the barcode and show the care plan to the pharmacist, so he or she can then become more engaged in the patient's care.

More recently, Precedence Health Care was named as the key IT infrastructure component for the government's Diabetes Care Project (DCP). The DCP is trialling a new model of healthcare delivery designed to improve care for people with diabetes. A consortium, led by global management consultancy McKinsey, has been appointed to deliver the project for the Department of Health and Ageing (DoHA).

The project is hoping to involve approximately 150 general practices in Queensland, Victoria and South Australia, and up to 10,000 patients. It will compare results between two intervention groups and a control group to enable a rigorous evaluation of the outcomes.

The control group will have no change to their care, and for these patients nothing will change for the care team. Participants in intervention group 1 will receive access to cdmNet along with education and training. They are invited to use cdmNet to help integrate with the rest of the care team and provide greater visibility of the patient health record and care history.

For intervention group 2, participants will receive access to cdmNet, education and training, along with a new funding model and support from a care facilitator. It is expected that a much greater variety of interactions with allied healthcare professionals will be available to patients in this group.

A further aim of the trial is to inform future policy and funding for diabetes in the primary care space, to see if chronic disease can be managed better.

The Australian Medical Association (AMA), which opposed the government's previous attempts to change the funding structure for diabetes, helped shape the design of this pilot in its role with the Diabetes Advisory Group, which also includes representatives from Diabetes Australia.

cdmNet is also involved in two of the Wave 2 trials of the PCEHR – St Vincent's & Mater Health and Calvary Healthcare ACT. “The main aim of those projects as far as cdmNet is concerned is to make sure that we are conformant in any developments in the PCEHR,” Professor Georgeff says.

“The reality is that it is only when you have applications such as cdmNet that the PCEHR will really be taken up. For most GPs it is essential to find a strong value proposition. With cdmNet you can get productivity increases and $30,000 a year is certainly a strong incentive to use it.”

Posted in Australian eHealth

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