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IT is vital in the long term

THERE IS A GROWING EMPHASIS within the NHS on the importance of what we used to call chronic disease management, and now refer to as the management of long-term conditions. This began to take centre stage with the advent of nGMS and QOF. 2004’s NHS Improvement Plan has been followed by the Public Service Agreement (PSA) target for improving outcomes for people with long-term conditions, and now by Supporting People With Long-Term Conditions.
Regardless of the particular initiative currently under way in primary care, the practice’s clinical IT systems and management of these systems are of paramount importance. The primary care team will have an ongoing need for assistance with their IT systems. You need to be aware of the resources that you can deploy to assist them. External experts can make all the difference to a struggling customer.
Cracking the code
The great majority of your target customers will use computerised clinical systems, and most of them will use a clinical system from one of the three currently dominant suppliers: EMIS, InPS and iSOFT.
While there are many differences between these systems, the key feature they all have in common is that they allow all members of the general practice multidisciplinary team to record information about their patients, using Read Codes. Read Codes are alphanumeric codes used to represent all of the symptoms, diagnoses and other findings that the GP team need to record about their patients. Crucially, in the new era of nGMS, it is vital that practices understand and use the correct Read Codes to maximise their income. For a small number of already well-organised practices, this is a breeze; but some way into the second nGMS year, many of your target customers are still struggling to make progress. This may be because there is a gap between the skills required and those available in the practice, or because they have the skills required but not the time necessary to do the work.
The human touch
While the clinical IT systems are used to make the relevant note entries (using Read Codes), in most cases these systems are not up to the job of actually helping the practice to monitor their progress against the many targets that nGMS imposes. Thus various nGMS software packages exist that analyse the Read Coded information in the clinical systems and present it in tabular and graphical formats, helping practices to see how they are doing and which areas they may need to work harder on.
As good as some of these software packages are, they are not the whole solution. Software, in the absence of expert human intervention, can only go so far. One limitation common to many of these nGMS tools is that they only pick up and analyse data on patients who are correctly coded. This is a big problem. We know from our experience of thousands of practices around the UK that the number of patients not falling into medically appropriate nGMS clinical domains often runs into the hundreds. This adversely affects prevalence figures and practice payments.
Another disadvantage of such tools is that they can drive clinicians to focus too much on the targets they need to achieve to gain GMS payment. Patients falling outside the target parameters can sometimes be seen as a lesser priority – and some practices that have achieved their percentage targets are inclined to look no further. 70% attainment on a clinical domain can leave hundreds of patients not being treated to target.
For example, the screenshot below shows that a practice has achieved 69% of the BP target for hypertension – so it might be feeling quite satisfied. But the corollary is that 804 patients are not being treated to target!


A helping hand
Struggling practices need to evaluate where they are and where their key needs are on the road map for reliably producing good quality, auditable data.
This process has five stages:

• Read Code coaching: while almost all members of the primary care team will be able to make Read Coded note entries, there is often a lamentable lack of understanding of their proper use and structure.
• Data review: a review of the data recording practices and the information held on the clinical computer system will be useful. It will identify the level and consistency of coding usage in the practice, and provide an opportunity to make an informed decision about what data should be recorded and by whom.
• Template development: efficient data entry is crucial. Data entry templates offer advantages of speed and consistency of coded recording over the basic facilities offered by the clinical systems. Most clinical systems have a template facility, and the use of expert-configured, practice-specific templates is highly recommended.
• Search and reporting: once the agreed data are being entered consistently, attention can be turned to getting the data out. All clinical systems have built-in reporting systems. Maximum effectiveness can be achieved by engaging an expert to produce focused and detailed reports.
• Effective audit: When a practice begins to use the information recorded and reported out to achieve improvements in processes and outcomes (including financial outcomes), it is well on the way to becoming an effective auditor of its data.

Knowing where your target customers are on this five-point learning curve will create many opportunities for you. Deploying and driving forward customer-focused initiatives will set you apart from the competition.
Looking ahead
Initiatives such as Practice Based Commissioning are likely to have a significant impact on the management of long-term conditions. Extra IT systems will be required to make a success of PBC.
The slow but perceptible progress of Choose and Book (a new service being introduced throughout England in 2005 whereby, during the consultation with their GP, patients are able to choose which hospital their GP refers them to and book a convenient appointment electronically) is beginning to impact on general practice, and doctors will have to learn about the additional software and information systems that support it.
SNOMED CT (a coding system that has greater depth and coverage of healthcare and is a superset of the Read Codes) is to replace the Read Codes as the definitive coding system for the NHS. These ongoing developments will further emphasise the crucial importance of IT systems within primary care.
Go for IT
Computer systems have been a fact of life in primary care for a long time. In the future, they will play a still more important role in all aspects of the primary care team’s work, including the nGMS/QOF aspects of chronic disease management and the initiatives for management of people with long-term conditions. Many practices are going to require more and more help to find their way through the ever-growing maze of IT systems and issues. Some of these practices are your target customers. Make sure that you are well positioned to understand their IT challenges and, where necessary, call in the cavalry to help them out.

Oberoi Consulting has worked with over 3,000 practices nationally, providing Clinical Systems training and hands-on Audit Support. It supports practices by helping them to record better data, improve patient care and maximise practice income.
Book a place on our course ‘IT and Selling in Chronic Disease Management – an Insider’s Guide’:
Oberoi Consulting Ltd, 19 St Christopher’s Way, Patriot Way Business Park, Pride Park, Derby DE24 8JY www.oberoi-consulting.com Tel. +44 1332 224251 Fax +44 1332 348841

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