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Meeting the challenge

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                                                                                                                                   Issue 10 December 2009



                                                                          Pathway
    Meeting the challenge                                                                                                                              Dr Mike Stein
                                                                                                                                                       Medical Director
 As we face the challenge of
                                                                             320
 addressing cost reductions in the                                           280
 NHS, projects using the Map of                                              240
                                                                                                                                     Dear Colleague,
 Medicine in communities such as                                             200
                                                                             160
 Western Cheshire, Wirral and South                                                                                                  This year 53 NHS communities -
                                                                             120
 Devon have demonstrated reduced                                              80
                                                                                                                                     comprised of over 150 Acute, Mental
 hospital admissions, cut waiting times                                       40                                                     Health and Primary Care Trusts - used
                                                                               0                                                     the Map to help re-design over 260
 and saved money. 2009 also saw the
                                                                                                                                     local pathways of care.
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 first article in a peer-reviewed journal
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 quantitatively demonstrating how the                                        Figure two: The number of localised pathways            With all participating NHS
 Map reduced inappropriate referrals.                                        published in England since Sept 2008                    organisations able to see each other’s
                                                                                                                                     pathways, the Map is now a cost
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                                                                             This year, the Intel Healthguide                        effective mechanism to share
                                                                             Telehealth product was launched in                      innovation across the NHS –
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                                                                             Scotland incorporating Map of                           regionally and nationally. Indeed, a
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                                                                             Medicine clinical rules; providing                      quality paper focused on high impact
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                                                                             nurse-led monitoring and guidance                       pathways from the NHS North West,
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                                                                             at home for those with chronic                          has shown the value of the Map for the
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                                                                             conditions.                                             Strategic Health Authority.
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                                                                             Software tools and support are now                      And on NHS Choices, over 45,000
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                                                                                                                                     unique users (citizens of England and
     Figure one: The number of Map of Medicine                               incorporate pathways into the                           Wales) accessed the Map in a single
     active LHC’s in England since 2007
                                                                             systems used at the point of care.                      month in order to “see what the doctor
                                                                             This allows single click access to                      sees” – a great end to the year.
 The Map is now working with more
                                                                             Map pathways.
 than 150 trusts on local                                                                                                            We look forward to welcoming all NHS
 implementation programmes,                                                  In 2010, our focus will be on                           Trusts and citizens to the Map of
 focused on demonstrating how the                                            pathways that can be used as part of                    Medicine platform in the New Year.
 NHS can improve patient outcomes                                            clinically-led improvement                              Wishing you a healthy 2010!
                                                                             programmes to delivery quality,
 and lower healthcare delivery costs.
                                                                             efficiency and patient experience
 Local programmes have now                                                   improvements. We are also                               All best wishes,
 adapted over 260 pathways,                                                  continuing to refine our editorial                      Dr Mike Stein
 covering a wide range of clinical                                           methodology, and over the coming
 areas including COPD, heart failure                                         months, will be implementing the
 and obesity.                                                                next generation of our pathways.



                                                                                   New, enhanced Pathways coming soon                NHS North West proves the value of the Map
                                                                                   Stop Smoking support in Milton Keynes             Successful international eHealth collaboration

          In this issue                                                            Raising awareness across the South of England     Listening to your views - survey results
Stop Smoking support for                                                             Raising awareness
                                                                                     of the Map across
adults in Milton Keynes                                                              the South of England
Milton Keynes is a rapidly                                                           Map of Medicine awareness
growing town with a younger                                                          events took place in South
than average population where                                                        Devon, Kent and Medway, East
life expectancy is increasing.                                                       Sussex and West Sussex over
However, smoking remains the                                                         the past two months. Each event
single largest cause of avoidable                                                    attracted around 70 attendees,
ill-health and premature death                                                       where they saw presentations
with more than 1,400 deaths in                                                       from Early Adopters about how
2005. High on the list of priorities,                                                they are using the Map and
localising the Map marks phase                                                       demonstrations of the Map in
one of work being planned to                                                         action.
tackle this health issue.
                                                                                     In South Devon, for example, the group
Pam Berry, manager of the Stop                                                       heard from primary care, secondary
Smoking Service explained the                                                        care, programme leads and
challenge. “We want people to get all                                                commissioning managers about their
the help they need to quit. By                                                       experiences and the process they
localising the Map of Medicine we can                                                undertake to localise pathways. GPs
be sure that staff are quite clear about                                             Dr Thomas and Dr Deakin described
where to find information about agreed     An unexpected benefit of using the        the Map as the “gold standard for
prescribing practice, and have ready       Map has been to bring different           best practice in primary care, not just
access to the contact details for          disciplines together, alongside           for GPs.”
referral to our service. We see the Map    members of the public, to share their
                                           perspectives. This has opened up new      Early adopters NHS Eastern and
as a new tool in the kit-bag.”
                                           opportunities to engage with patients     Coastal Kent and NHS Medway were
It was not all plain sailing. The pilot    and the group is now focusing on          joined by the Deputy Chief Information
tested local processes but the             communications work.                      Officer of NHS South East Coast as they
potential benefits are apparent: “As a                                               updated the audience on progress
locum GP, I work in several practices      For further information see the project   across the region, including work on
across Milton Keynes” writes GP John       pages at: http://bit.ly/81RM2Y.           Pathways across Kent.
Richards. “With the Pathway localised,     Contact: Heather Behan,                   Regional awareness events will continue
I know that doctors like me know           Project Manager, Quality: MK              across England and Wales in 2010, so
where to look for the information we       heather.behan@mkpct.nhs.uk                keep an eye on the Map of Medicine
need to help patients quit.”
                                                                                     website, www.mapofmedicine.com,
                                                                                     for an event near you.


NHS North West shows the value of the Map
NHS North West recently                                      Annual savings of       A reduction in hospital admissions and
produced “Driving Quality and                                around £180,000         annual savings of £212,000 has been
Efficiency in the NHS”, a paper                              have been               achieved in the Western Cheshire
that shares their experience of            achieved in the Wirral Local Health       Local Health Community, which used
                                           Community through the design and          the Map to develop and communicate
working together in healthcare
                                           commissioning of a new service for        a Cellulitis programme.
communities to improve service
                                           Age Related Macular Degeneration
quality, patient safety and reduce                                                   Establishing change programmes
                                           (AMD). Publicising this service on the
costs. It outlined some of the                                                       focused on a relatively small number
                                           Map made it widely available to all
benefits seen by early adopters                                                      of ‘high impact’ clinical pathways
                                           Wirral GPs. This service reduced
of the Map and how the Map is                                                        represents a significant opportunity to
                                           waiting and treatment times, and
                                                                                     deliver costs savings across the NHS,
being used to communicate                  delivered cheaper and more
                                                                                     and will be the focal point for 2010.
service changes to clinicians.             effective care.


 2
                                                                                         Issue 10 December 2009


New, enhanced pathways coming soon
Map of Medicine is constantly             - ‘Updates to this pathway’, which       Another new feature is the‘red flag’
transforming the way disparate              describes major changes in this        node. These are used to highlight and
information is brought together             new version of the pathway             indicate to a clinician the seriousness
into a single source of best                                                       of issues requiring urgent attention, or
                                          As these nodes will always be
                                                                                   to describe warning signs requiring
practice.                                 present at the top of each page of
                                                                                   special attention, therefore always
                                          the pathway, they serve as a
In February, the Map will be                                                       ensuring that the most serious
                                          resource that is easy to refer to,
launching the first set of our new                                                 diagnosis is considered, or ruled out
                                          assisting clinicians in both the
look pathways. These will be the                                                   as early as possible.
                                          primary and secondary care
first pathways that have been
                                          settings. Through the ‘Information       We have also changed the way that
created using the latest editorial
                                          resources for patients’ node, we         we cite our evidence sources, and
methodology (see Pathway,
                                          assist the clinician in providing        now attribute every sentence in the
September 2009).
                                          patients and families with               quick info text to the specific source
The new look pathways have a              information about how to understand      that the information comes from.
number of core elements. Each             and deal with their condition, and the
                                                                                   These unique features will provide
pathway begins with three nodes:          availability of support groups.
                                                                                   clinicians with reliable, valuable
- ‘Background information’, which         The main pathway flow now begins         guidance through every decision-
  includes the scope of the pathway       with the clinical presentation for the   making step of a patient’s journey.
- ‘Information resources for patients’,   condition, the patient history to be
                                                                                   Over the next year, all pathways on
  which includes information for          taken and the examinations to be
                                                                                   the Map will move to this new look.
  patients, their family, and carers      conducted.




                                                                                                                              3
                                                                                              Issue 10 December 2009


  Navigating the
  Map of Medicine
                                             Listening to your views
                                             More than 150 Map of Medicine users         England and Wales. The user
  Did you know?                              recently took part in our first ever        satisfaction survey was carried out by
                                             satisfaction survey. Following hot on       Map of Medicine in September 2009
                                             the heels of an awareness survey            amongst a sample of registered users.
  All clinical content in the                undertaken over the summer, the
  Map of Medicine is available                                                           Thank you to everyone who took part.
                                             results have made interesting reading.
                                                                                         We continue to increase our focus on
  through specific views.
                                             In the eighteen months since the last       customer satisfaction, ensuring our
  A view contains all of the Map’s           survey, awareness of the Map jumped         customers are the centre of our
  pathways, a few of which may have          nearly 40%. Over two thirds of those        decision making. Look out for your
  been customised to reflect the actual      who have used the Map say it made           oppourtunity to take part in 2010.
  practices or resources available in a      them think about their clinical practice,
  local healthcare community. A local        and a third changed something in their
  view is named after the healthcare         clinical practice as a result.
                                                                                         Map on London’s Quality
  community that publishes it.                                                           Observatory
                                             As the roll out of the Map moves
  All views are arranged into a tree-like    towards being business as usual for         The Map is available through a new
  structure, with the International view     many early adopters, this is excellent      web portal providing information for
  at the top and all local views below it.   news. One of the key areas users            clinicians, commisioners and providers
  Each lower level of the structure          would like to see the Map offer in the      on quality and efficiency in areas
  represents a more granular                 future was integration with primary         relating to patient experience, safety
  geographical area. A local view            care systems.                               and effectiveness in healthcare.
  inherits its clinical content from the
                                             The awareness survey was carried out        London’s Quality Observatory portal
  views above it, all the way up to the
                                             by TNS Healthcare in August 2009. A         supports the NHS in the capital to
  International view, except for the
                                             total of 300 interviews were conducted      implement Healthcare for London. For
  pathways that are customised for
                                             amongst a representative sample of          more information visit
  that view.
                                             GPs, nurses and specialists in              ww.csl.nhs.uk/products/lqo.html



Successful international                                                                   Meet us at
                                                                                           Care Pathways 2010
eHealth collaboration                                                                      20th January 2010
                                                                                           Manchester Conference Centre
                                                                                           Process Mapping, Analysis
Map of Medicine is highlighted               single source of best practice.
                                                                                           and Redesign
as an example of successful                  Licensed for use in England, Wales
                                                                                           24th February 2010
international eHealth                        and Queensland, Australia, the Map is         Manchester Conference Centre
collaboration in an essay on                 also being piloted by the Denmark
                                             National Board of Health (NBH). Map           Venous Thromboembolism
Evaluating eHealth1.                                                                       (VTE) Reducing the Risk
                                             of Medicine is also collaborating with
                                                                                           25th February 2010
The essay discusses some of the              the World Health Organization (WHO)
                                                                                           Manchester Conference Centre
opportunities and challenges on              to provide eHealth technologies to the
international eHealth collaboration. It
calls for greater international evaluation
                                             developing world.
                                                                                           Contact us
of the impact of eHealth and its                                                           UK
potential benefits. The authors believe                                                    Tel: +44 (0)20 7492 6300
eHealth has enormous potential for                                                         info@mapofmedicine.com
improving care in all nations, as well as
                                                                                           Australia
for realising savings if international       1. Bates DW, Wright A (2009) Evaluating       Tel: +61 (0)422 844 239
collaborations become more frequent,         eHealth: Undertaking Robust International     au.info@mapofmedicine.com
allowing more knowledge generation           Cross-Cultural eHealth Research. PLoS
                                             Med 6(9): e1000105.doi:10.1371/journal.
and data interchange.
                                             pmed. (available at                           Subscribe
Map of Medicine is constantly                http://www.plosmedicine.org/article/info:
transforming the way disparate                                                             To subscribe to The Pathway
                                             doi/10.1371/journal.pmed.1000105)
                                                                                           newsletter, email your details to
information is brought together into a
                                                                                           newsletter@mapofmedicine.com


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