Q. Can you tell us about the early life of Brisdoc and your current role at the organisation?
A. It was originally an OOH co-operative in the early days of doctors being able to give up doing their own out of hours work. We are talking around 2004, but it’s since diversified into providing some daytime services. It runs several practices and runs units in the two main acute hospitals in Bristol, the Bristol Royal Infirmary and Southmead Hospital.
I’ve been fully employed by Brisdoc for the past four years, having been a GP partner before that. My main interest in doing the clinical co-coordinator role was to try to get to a point where we could look up patients’ records across the entire region on one system because, originally in OOH services, you had a blank screen and knew nothing about the patient at all.
Q. The very success of new services often depends on ensuring that IT arrangements and data-sharing systems are of a quality standard. Was this the case for Brisdoc?
A. As healthcare leaders we’ve all been chasing this type of joined-up technology – and in our case we’ve, essentially, found the promised land. As far as data-sharing is concerned we want to know every single thing about a patient and their medical history and have it available to us at the touch of a button; we want a complete jigsaw where all the pieces are in place.
Of course, data protection considerations are of paramount importance and good information governance is equally important. We have had to proceed very carefully and slowly with our data-sharing systems but, as of the last 18 months, we’ve been in a position where our new GP data-sharing system – used by all GPs in the area – has provided us with a high-functioning data-sharing web account platform. This platform basically includes every patient in the area – about one million in total.
I can look up anyone at a moment’s notice as if I was in my own surgery and have all the necessary resources available to me in the night time as in the day. It’s an excellent way of ensuring patients are safe because you know which conditions they suffer from, have knowledge about prescriptions they are taking, can find out about their allergies and about their past medical history.
Q. In terms of clinical operations and diagnosing patients how transformative will this development ultimately prove to be?
A. Well it means that clinicians can immediately start a referral process. If I think someone needs to go to a stroke clinic or a transient ischaemic attack clinic or to have blood tests, I can order them there and then. Up to this point those types of decisions were having to be deferred until the next day – so the whole system now becomes more efficient.
Running parallel to this new system is ‘Connecting Care’. This is an IT project in Bristol, South Gloucestershire and North Somerset that’s been running for three years. It’s a fantastic system that centrally manages a series of varied data streams using Medical Interoperability Gateway (MIG) data, hospital data and social care data.
To put this in simple terms, I can sit at my computer and have two tabs open, which I often do, and look at my new web account platform and my Connecting Care account side-by-side and so have a deeply detailed volume of data from which I can review. For instance, based on hospital data, users can check who is currently sitting in A&E or see when a patient was last admitted to a ward. All hospital letters are on the system too, meaning a patient’s medical history can be quickly referenced.
Social services’ safeguarding information is available, end of life data and lots of material that you wouldn’t ordinarily have access to as a GP or in your GP practice IT system; we now have additional value that is making a huge difference to patient care. Connecting Care is a project that hopes to attract more and more relevant data as time goes on. It’s just a case of bridging the gap between social care and healthcare and helping people develop the vision for a fully joined-up world.
Q. Why has this project proven to be so successful with homeless and destitute patients in particular?
A. Homeless people often arrive for a consultation with me in the middle of the night without being able to offer any shred of medical information. I will try to investigate by looking up their name on the NHS spine and try and find a NHS number and a summary care record; this will tell me where they were last registered with a GP. If they’ve seen our receptionist then they are temporarily registered on our system and then, if they are from the Bristol, South Gloucestershire and North Somerset region, I can then look them up on the new web account platform.
This is the beauty of the new system. Sometimes you’ll find that a patient has been registered with 10 GPs across the region but the great thing is you can see all the medical notes taken by all those surgeries on this one account. I can then look them up on Connecting Care and see how many times they have been to A&E, if they have appointments coming up, source any safeguarding information, housing and social care information and prison records.
I also have access to the mental health AWP RiO (electronic care record system) which is really useful for following patients’ progress notes and specific mental health information. I have access to the council housing register too. I gradually put all the pieces together. It takes a bit of research but at the moment if I look up about six databases I have a pretty full picture about any homeless person.
Q. Has the creation of this new system and new way of working led to budgetary savings
A. Well this is the really interesting thing, it certainly has the potential to. By having this information we can change the pathways people take and I think it would be very easy to show that, armed with this incredible range of information, we can avoid people going to A&E, avoid unnecessary admissions and unnecessary referrals and, because we can see what’s already been done, we can eliminate the risk of repeat referrals.
Q. In terms of staff training, is there much progress that needs to be made before this type of system runs live
A. Well, in our case, progress has been incremental. We have been monitoring the usage of the new web account platform from the beginning and there has been a steady uptake; within the OOH world at least, it’s universally accepted as being the best way to work. With regard to homeless services there was only myself and a few others who had to be trained so that was very easy.
Q. How are practice managers finding the new approach to data-sharing?
A. I think data-sharing is certainly catching on with practice managers. They all have access to the new system, of course. St Peter’s Hospice has completed a separate data-sharing agreement with all practices to share all their information relating to end of life care. Bristol Community Health have also agreed to share their information with GP practices, so practice managers and doctors havebenefited from that. They are quickly getting used to the new functionality of their ICT systems too.
Q. Is data available to evaluate whether secondary care referrals have been reduced as a result of using the new data services?
A. That’s a more difficult project. That’s like trying to measure what you haven’t done- measuring the reduction in admissions avoided. The methodology used for such an undertaking is fraught with difficulty – so I suppose we haven’t cracked that just yet but, no doubt, there will be small projects created to look into it further.
Q. What does the future hold for Brisdoc with respect to ICT developments?
A. We are always chasing new data streams. For instance, in my role working to co-coordinate services for the homeless we need to have data-sharing with the prison service, the police and with addiction services. There are always new services to join up and it helps the functioning of multidisciplinary teams. For example, if I’m dealing with a street drinkers’ outreach team, where there are lots of people from the council involved, we need a place where we have a multidisciplinary blog or forum that keeps everyone updated on events in the community.
Also, patients hate having to repeat their stories. This is the problem with many of our pathways – people are forced to tell their stories over and over again. Really all NHS services should have their own templates which also populate with data from different parts of the whole service so that when a clinician carries out an assessment most of the key information has already been put in because that data is fresh, doesn’t need repeating and is linked to the patient’s NHS number. This constant repetition – that wastes time and irritates patients – needn’t happen any longer.