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Garton Smith Website version TEDS Journey to the GP GPLO

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Garton Smith Website version TEDS Journey to the GP GPLO Powered By Docstoc
					            ‘TEDS’
          Journey
         to the GP
Dr Jacquie Garton-Smith
   Hospital Liaison GP
  Royal Perth Hospital
The journey begins 1997:
      Collect data…

 GP Complaints
 GP Satisfaction Survey
  Mailed late 1997
  Report 1998
GP SATISFACTION SURVEY
         1998
 Discharge Summaries:
 LEGIBILITY - 64% dissatisfied
 CONTENT - 85% dissatisfied
 TIMELINESS - ?%
- 43% received within 2 weeks
- 97% expected to receive within 2 wks
- 43% wished to receive within 2 days
Overcome barriers…
Strategies to improve
current system
 Mail copy to GP
 Education to RPH Drs
“GP Notify”
       Review…
GP Complaints
GP Notify evaluation
Preliminary results GP
Satisfaction Survey 2000

     ILLEGIBILITY +++
             &
     CONTENT AN ISSUE
    Find Allies…
Get the right people in
       the room
 Drivers & Executive
 Commission the “doers”
  Start small with a
  long term view…
         TEDS
“Interim” measure 2000
Initially optional
Printed, signed, posted and filed
? GP Notify to send by fax/email
  (once security concerns resolved)
       Review…
     TEDS 2001 - 3
Enhanced for RPH Drs & GPs
Monitored & encouraged use
Monitored GP Complaints
Repeat GP Satisfaction survey
  2003…
TIME to GP receiving by mail
   still a HUGE PROBLEM
         Review…
Secure electronic safer than fax
GPs increasingly computerised
Information to drop into GPs
electronic patient record
              BUT
PKI & EPR in infancy at the time
DoHWA policy precluded
 Overcome barriers…
Lobbied DoHWA
New DoHWA policy 2002/3
    “Sharing of Information for
     Continuity of Health Care”
Awaited “whole of health” approach
                 BUT
GPs still crying out for timely
      discharge info
        Be creative…
No significant FUNDING BUT
RPH losing revenue as no electronic
exchange with referring private labs
  Cost-neutral solution overall ?
EOI 2003 → Healthlink responded
 Many GPs already used to download
 pathology & radiology
 Fairly simple :TEDS → HL7 message
         HealthLink
    >50 million messages/year

     Throughout WA
▪ 630 (735) General Practices
▪ 32 (35) Private & Government Labs
▪ > 1.5 million messages/year
    Local support plus Call Centre
8am -5pm WST Monday to Friday and
AH technician on call for weekends
   Privacy Authentication and Security
Strong links with Australian Government
      Certificate Authority (HeSa)
Start small with a long term view…
  RPH Discharge Summary
        Trial 2005
 Further Development of HL7 message
 Testing with De-identified Data in
 Medical Director by HealthLink & Perth
 and Hills Division of General Practice
 Testing previous TEDS to 10 PHDGP
 General Practices Medical Director &
 further design
 Testing of Additional GP Software by
 Healthlink & Perth and Hills DGP
RPH Discharge Summary Trial
          2005-6
 Made TEDS mandatory at RPH
 Went live 16 November 2005 to test GPs
 Expressions of Interest sent to GPs
 state-wide by HealthLink and Divisions
   EOI’s from 239 sites (1100 GPs)
   572 GPs at 125 (55 rural) sites set up
 Best Practice, Genie, Medical Director,
 Medtech 32
 415 GPs at 93 sites received a TEDS
     Review…
TEDS Monitoring 2006
25% TEDS sent electronically April 2006
3000-3500 TEDS completed/month =
94% eligible discharges
high standard
Successful GP evaluation
 → CONTINUATION ENDORSED
Start small with a long
      term view…
RFQ for electronic transmission
↑ uptake, timeliness of completion &
quality
More GPs & Practices
Close Liaison with WA HealthConnect
Other sites?
Other patient related correspondence
eg GP Notify, Outpatient letters?
             Review…
 Inaccuracy of discharge medications
                   &
   omission of serious events during
  admission on the discharge summary
                evidenced by
GP surveys and complaints
“Qualitative Evaluation of TEDS at Royal
Perth Hospital In 2005” (Maurice Guzman)
“Medication Management in the Emergency
Department – How accurate is the Medication
History?” and
the Discharge Liaison Project at FHHS (verbal
report, GPLO, FHHS).
What’s in the bag should=
what’s on the summary=
 what the patient takes!
 The patient should go home with
 a list of medications, what they
 are for and an understanding of
 how to use them.
 Accurate documentation of
 medications in the discharge
 summary (TEDS).
All to be managed
 efficiently within
 existing workloads…
►RPH QUALITY FUNDING 2006-7
Enhancing Medication Safety at
      Discharge Aims:
To generate a medication profile
for the patient and a discharge
prescription from the Discharge
Medication entered in TEDS
To enable an electronic progress
summary to promptly notify the GP
of events eg a medication reaction
►DoHWA SAFETY & QUALITY INCENTIVE
   REFORM (SQuIRe) FUNDING 2007
 RPH Medication Reconciliation
1) Enhancement of TEDS software to facilitate
  medication reconciliation
2) Redesign medication management process at
  ward level so that:
   TEDS becomes the central portal for
  medication management from admission to
  discharge
  plan for future requirements to implement:
   PBS Reform
   medication continuum of care principles.
►DoHWA SQuIRe FUNDING 2007
         TEDS Multi-site
South Metropolitan Area Health Service

  Swan Districts (existing users)
  Fremantle
  Bentley
  Armadale
  Rockingham
  Includes electronic transmission
  of Care Management Plan (CMP)
To complete 2007/early 2008

 Discharge Script        } & ward
 Patient Medication List } processes
 TEDS Multi-site Deployment
 E- transmission of
        Care Management Plan
 Medication Action Plan
        (for Pharmacy use)
    What’s next???
Improve:
 ↑ uptake TEDS
 timeliness of completion
 quality, especially medication

Prepare for PBS reform
More PMS’s, GPs & Practices
Continued liaison with DoHWA
 Other hospitals?
 Other patient related correspondence?
   What helped ‘TEDS’
   journey to the GP?
Collecting data
Finding allies – Executive & Drivers
Overcoming barriers
Starting small with a long term view
Being creative to find solutions
Reviewing (and repeating steps
above)
Lots of Patience and Dogged
          Persistence …
         QUESTIONS?
     Dr Jacquie Garton-Smith
        Hospital Liaison GP
        Royal Perth Hospital
            08 9224 1696
jacquie.garton-smith@health.wa.gov.au

				
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