patient access to medical records: a longitudinal
TRANSCRIPT
Patient access to medical records: A longitudinal evaluation of a care information exchange in North West London. Sagar R Jilka, Hester Wadge, Dilkushi Poovendran, Dalton Coker, Ara Darzi, Erik Mayer
Centre for Health Policy, Imperial College London
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@DrSagarJilka
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What will the CIE mean for patients?
• The ability to view, add and share information about their care.
• The opportunity to take more control of their own health and care.
• New ways of communicating with health and social care professionals in their network.
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What will the CIE mean for HCPs?
• The confidence of having a more complete record of care
• Tools to support communication with fellow health and social care professionals and with individuals
• The opportunity to change ways of working to improve delivery of care
CIE could be the solution
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GPs
Acute hospitals
Mental health
hospitals
Community care
Social care
Patient
Care information about a patient is held on different systems in different parts of the NHS.
The CIE will help break down the barriers between the different care settings.
GPs
Acute hospitals
Mental health
hospitals
Community care
Social care
Patient
North West London is a good test bed
• NWL consists of 8 CCGs
• ~1.9million people in NWL
• Relatively young
group compared with
the national and
London rate
5Source: http://www.centrallondonccg.nhs.uk/media/21113/North-West-London-five-year-strategic-plan-draft.pdf
Hospital admissions in NWL
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From 2009 to 2015, the highest admission rate in NWL was 2,499 per 100,000.
The lowest was 754 per 100,000.
Across London the admission rate is 1,287 and the national average is 890 per 100,000 patients.
Emergency admissions in NWL
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Emergency admissions for NWL CCGs, 2009-2015Diabetes related
Brent has the second best ‘GP to patient ratio’
CCG Number of Active GPs
Number of registered patients
Number of patients per GP
CCG 1 304 260,612 857
CCG 2 388 369,166 951
CCG 3 254 242,428 954
CCG 4 223 212,847 954
CCG 5 211 209,683 993
CCG 6 256 304,147 1,188
CCG 7 345 426,086 1,235
CCG 8 228 304,686 1,336
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The CCG with greatest emergency admissions has the second best patient to GP ratio across NWL, suggesting that the high admission rate isn’t just a question of not having enough GPs.
But low success rate in getting a GP appointment
Percentage of patients who said they were able to get an appointment last time they tried to see or speak to a GP or nurse
CCGPractices National Average
The last time you wanted to see or speak to a GP or nurse, were you able to get an appointment to see or speak to someone?
Comparisons are indicative only: differences may not be statistically significant, particularly at practice level due to low numbers of responses
Base: All those completing a questionnaire: National (815,057); CCG (6,353); Practice bases range from 59 to 122. Data from the Jan 2016 GPPS
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Inconclusive evidence for electronic patient record access
10Jilka et al., JMIR 2015
We found mixed responses to patient related outcome measures as a result of access to electronic medical records.
Evaluation questions
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1
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HCP attitudes: What are HCPs’ attitudes towards the CIE?
Patient experience: To what extent do patients who use the CIE become more engaged with their care?
Utilisation: How does using the CIE alter a patients’ patterns of healthcare utilisation?
Evaluation method
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Recruitment
HCPs
CIE Use
(4-6 months)
Baseline Data Collection
Follow-Up Data
Collection
Opportunity to use
the CIE
(capture CIE usage
data)
Questionnaire
(Patient Activation
Measure)
Online survey
Interviews
Questionnaire
(PAMs)
CIE usage data
Online survey
Interviews
CIE usage data
Patients
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Staff have concerns about the CIE impact
50% of respondents thought that patient access to their electronic medical record would increase a
doctor’s workload
How can we use the survey data?
• This data will help us understand how a HCP’s attitude towards the CIE changes over time.
• Understanding this will help implementation teams assuage concerns and provide the right information to clinical teams.
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The PAM measures patient involvement
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® Insignia Health, LLC © 2013 1
Patient Activation Measure (PAM) 13™
License Materials
© Insignia Health, LLC 2014
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Group PAM Score = 53
Preliminary analysis
How can we use this data?
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• We can use the PAM to investigate if patients become more engaged with their health after using the CIE.
• Therefore we hope to see improved activation scores amongst those using the CIE.
• The PAM can also be used to help guide the discussion between HCP and patient – contributing to the action plan to improve patient self-management.
Conclusions
• The CIE is an ambitious programme attempting to link patients with their medical records across care settings.
• We are evaluating how effective the CIE will be to patients and HCPs to help understand its impact in relation to recent policy levers around patient access to medical records.
• Our evaluation also encompasses an economic analysis.– We will be using the HES data presented earlier to
support the the economic modeling.
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Acknowledgements
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Many thanks to the Sowerby team at the
Centre for Health Policy:
• Mr. Erik Mayer
• Ms. Hester Wadge
• Dr. Matthew Harris
• Ms. Rhia Roy
• Ms. Dilkushi Poovendran
• Prof. Ara Darzi
• The Big Data Analytics Unit (Imperial)
• Imperial College Healthcare charity
• CIE implementation team
• Stephen Janering, John Kelly, Felicia Opoku
• CIE evaluation steering committee
• Health & Social Care Information Centre. @DrSagarJilka