"National Shared Care Plan Programme: Frequently asked questions"
National Shared Care Plan Programme: FAQs Patient Frequently Asked Questions Am I eligible to participate in the programme? To participate in the programme you must: Have a long term health condition Be willing to provide feedback to researchers on what is working and what isn’t Work with a member of your healthcare team to develop a shared care plan. What is a ‘shared care plan’ A shared care plan is: Based on your views of your health goals and priorities Developed in partnership with your healthcare provider, yourself and if you choose to, with your family or carer. Mutually agreed problems, goals, actions, timeframes and accountabilities for all involved. A common source of information and a means of communication for you and the healthcare providers involved in your care. Who will have access to information in the Care Plan? You and your healthcare professionals will be able to access and contribute to your care plan. You can nominate family members or carers to have access. Your health information is not available to insurance companies, employers, or other third parties. Everyone who accesses your information is recorded in a log which you will be able to see and discuss with your health professional, if necessary. When does the programme start and finish? If you participate in the programme you will be involved in the trial phase which starts now and finishes at the end of this year. If it is successful, it will continue into future years and more patients and healthcare providers will become involved. What is involved in participating? Researchers will be collecting information to evaluate success. You may be asked by a researcher to take part in a number of interviews. This could be over the phone or face to face. No identifiable information will be collected. Your contribution will be combined with other participants and at the end of the trial a report will be prepared with a recommendation to the National Health IT Board. Provider Frequently Asked Questions What is a shared care plan? It is personal health information that is shared with healthcare consumers and their health professional as part of this pilot. It is: based on consumer views of their health goals and priorities developed in partnership between the healthcare consumer and healthcare professional A common source of information and a means of communication between healthcare professionals and with the healthcare consumer Who is eligible for a shared care plan? To participate in the pilot programme a patient must: Have a long term health condition Be willing to provide feedback to researchers Work with a member of your healthcare team to develop a shared care plan Will it take extra time to gain patient consent and what level of support is offered from the programme? The pilot programme will be evaluated by the National Institute for Health Innovation. Participating patients will sign a consent form and complete a questionnaire. If patients or health care providers need additional guidance on completing the forms, they can contact the National Institute for Health Innovation using the details provided on the consent form. Who can enrol a patient into the Shared Care Plan Programme? For the pilot projects, healthcare consumers will be enrolled in a shared care plan programme by a member of their primary care team. Will a patient always have only one Care Plan? If the patient is diagnosed with several long term conditions, will separate Care Plans be created for each condition? The approach being trailed during the pilots will involve only one care plan for each patient, but the plan may include items relating to one or more conditions. What is the process for primary care (GP or practice nurse) to engage with secondary care, e.g. requesting a secondary care consult for a patient? Participating practices will be informed about which secondary teams are available to be engaged by them during the pilots. Individuals within those teams can be added as care team members by sending them a request for assistance in the form of a “task” (e.g. for a home visit). If the patient is not already known by the secondary team, they may request a formal referral. What level of integration is available between the GPs PMS (MyPractice and MedTech) and the Shared Care system? The following integration with PMS systems will be available at the beginning of the pilots. Additional integration features are planned to be made available following feedback from pilot participants during the pilots. Integration Feature MedTech32 MyPractice Automatic population of key enrolment data Summary view of information to be forwarded to CCMS Enrolment notification Automatic updates of PMS with selected data from CCMS What notifications will be sent to members of the Care Team? The following notifications will be available from the start of the pilots. Notification of successful enrolment in shared care programme to enrolling clinician, via MyPractice or MedTech32. Notification of new tasks (email notification to clinician receiving a request, alerting them to the task in CCMS). Overdue tasks (email reminder of overdue tasks to both the assignee and assignor). Notes: Communication on urgent matters that place the patient clinically at risk should be made using existing communication methods. Notifications can be sent to a specific user and copied to a designated group email address for the health service provider (in case of the situation where the user may be absent on unplanned or planned leave). Patients with access to the patient portal will also be able to receive email notifications of new and overdue tasks. System emails do not contain patient information. Who will have access to information in the care plan? Healthcare consumers and healthcare professionals will be able to access and contribute to a personal care plan. Patients can nominate family members or carers to have access. Health Information will not be made available to insurance companies, employers, or other third parties. Everyone who accesses patient information is recorded in a log which you can discuss with patients if necessary. What information will be available to secondary care clinicians, if the patient is admitted to ED or any other service in the hospital? Secondary care clinicians providing care to a patient will be able to view summary shared care information. This may include a list of current medications, a list of diagnoses, laboratory results, a list of current shared care team members and the shared care plan itself. Secondary care clinicians who are participating directly in the pilots will be able to both view and edit shared health information. What is involved in participating in the programme? Providers participating in the programme need to: Allow access for the Project Team to complete a site audit to ensure the technology is accessible where you work and participate in user training. Select appropriate patients, and participate with the patients and other team members in the development and refinement of the patient’s care plan Provide feedback to the project team to improve the quality and effectiveness of the care planning process Take part in the independent evaluation of the project, with periodic short interviews and other data collection If you are interested in participating in future phases, please contact the programme team via the contact information on the programme website. Where will data be stored and is it secure? Patient’s shared health information and care plan are stored in a New Zealand data centre which observes high levels of security, suitable for potentially sensitive health information. Data is encrypted during transfer between care team members, using accepted standards for sensitive electronic information. System emails do not contain patient information.