Guest editorial: Collaborative care: come together, right now

This article first appeared in the August 2012 edition of Pulse+IT Magazine.

Every major conference has a series of themes, but hidden among them are the unexpected jewels that can often be transformative. At HISA’s Health Informatics Conference 2012 (HIC2012) there were a number, covering a great deal more than just the PCEHR.

Three major themes dominated the HIC2012 conference – doing more with less, linking research and evidence with what is working in practice, and future visions and people to support – and these were explored in full. But among HIC’s four days of presentations, workshops, panel Q&A sessions and countless informal discussions, what were the unrecognised gems?

In an opening keynote address, Jane Halton, secretary in the Department of Health and Ageing, spoke of the recent launch of the PCEHR. It will help to change how we treat patients and enable consumers to gain personal control over and manage their own health, she said.

What a wonderful cue for the very next speaker, Regina Holliday, the patients arts advocate of the Walking Gallery movement in the US. But no cue was needed — the story of her loss transfixed her listeners.

Ms Holliday’s husband, Frederick, struggled through 11 painful weeks of hospital transfers, mis-diagnosis and inappropriate treatment before succumbing to cancer. Throughout, the couple tried in vain to gain access to medical information on Frederick’s condition, and Regina’s own research was rejected out of hand.

When she asked to see her husband’s medical record, which was discovered to comprise volumes of paper documents many inches thick, she was told, “It will cost you 73 cents per page to copy, and take three weeks to do”.

This prompted Ms Holliday to paint her now famous mural, named ’73 cents’, and initiate her patients’ advocacy movement. The moving and tragic story of Regina and Frederick’s ordeal shows how patients must be at the centre of healthcare. As Ms Holliday said, “Give us our damned data! We are all patients in the end.” It was an impassioned plea that brought the audience to its feet and would echo throughout the next three days of proceedings.

Another story of tragic loss of life showed us the need for collaboration. Nigel Millar, chief medical officer at the Canterbury District Health Board in Christchurch, New Zealand, recounted its response to the city’s devastating earthquake. It was a fascinating glimpse into how the whole spectrum of health services across hospitals, GPs, the community and social services can integrate care under a unified management and governance structure.

Collaboration and sharing of information in response to the Christchurch earthquake were not only literal life savers, in conjunction with the emergency they also drove an acceleration and rapid implementation of initiatives to integrate health systems to meet the most urgent demands for patient care and resourcing. Dr Millar’s revealing story of the healthcare response to the Christchurch tragedy gave me another pointer on where to look for a hidden gem — it must be collaborative care, and where it is working in practice.

In a workshop on the demands for participatory healthcare, session chair George Margelis threw down the challenge: “With an ageing and growing population, and the need to do more with less, how do we help people to improve their lifestyle and better manage their healthcare?”

Around 40 per cent of patient visits to GPs relate to chronic disease, while hospitals incur a not dissimilar proportion of their costs in treating chronic disease patients. And these trends are increasing. How do we collaborate to do more with less?

The introduction by Dr Margelis gave us the perfect prompt for the next presenter In his presentation on supporting chronic disease patients in the community in an online collaborative care environment, Jon Hilton described how Precedence Health Care is answering these questions.

Precedence Health Care, established by Professor Michael Georgeff, has developed and implemented a collaborative web-based service for managing the entire lifecycle of chronic disease treatment. The chronic disease care model uses the cdmNet system, which enables the patient’s care team to collaborate online in such initiatives as the Diabetes Care Project, the Digital Region Initiative in the Eastern Goldfields, and the PCEHR.

Using the cdmNet system enables:

  • Automatic creation of care/management plans which embody clinical guidelines, co-
  • morbidities, and personalisation for the patient
  • Online collaboration through integrated processes and workflows and a shared online health record centred on the patient
  • Patients’ ability to access and update their own record and be reminded of events
  • Review of the chronic care model and other aspects of online collaboration such as telehealth consultations
  • Integration of data gathering, Medicare reporting and auditing with clinical workflows.

To produce and manage a patient’s care plan, Medicare pays a GP just $550 pa, and an allied health professional only $250 pa. Yet continual review and monitoring of the care plan with the patient, which is where the intrinsic value lies, is not easy, often addresses complex co-morbidities and is very time-consuming. The Precedence chronic care plan and cdmNet system automate the extraction of information from the GP’s desktop practice system, and create a personalised care plan for sharing with the care team and patient.

A care team can include practitioners such as a medical specialist, a GP, a nurse, a dietitian, physiotherapist, podiatrist or other allied health professionals. The automated processes enabled by cdmNet for review, updates and follow-up with the patient, and management of Medicare compliance, have brought a doubling of GP productivity for patient care management.

For around 8000 patients participating so far, it is estimated there is a five times improvement in monitoring and follow up of the patient, and an overall increase in collaborative patient care estimated at around 300 per cent.

As I left my seat at one of HIC’s last sessions, the hypnotic beat of a Beatles song poured from the audio system. It was the first track from Abbey Road, their last recorded album, and the lyrics of the last few lines of one verse struck home:

Hold you in his armchair
You can feel his disease
Come together…right now…over me

Those poignant lyrics seemed uncannily apt, and brought back the impact of Ms Holliday’s dramatic presentation. There can be no better lines to exhort the importance of collaborative care and the challenge we face. Whatever the information systems that may be used – cdmNet, EMR, PCEHR – what is essential is the collaboration of clinicians, exchanging information and sharing it with patients. That is Ms Holliday’s message, and it seems Precedence Health Care is trying to do just that, just like the Beatles implored all those years ago.

Author Details

Bryn Evans
Director: JEMS Consulting
This email address is being protected from spambots. You need JavaScript enabled to view it.

Bryn Evans has many years’ experience as a chief executive of a clinical software supplier, and chief information officer in public hospitals. He is also an author, and writes extensively across a range of categories and genres, notably in the areas of sport, travel, history, information technology and eHealth.

Posted in Australian eHealth

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