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SRG Meeting 2 - eHealth

The second Stakeholder Reference Group (SRG) for the Moving Forward Together (MFT) Programme took place on Wednesday the 13th of December. The Group of 15 patient, service user and carer representatives (details at the end) heard a presentation and engaged in discussion about the key role that eHealth and Digital services will have in transforming the delivery of healthcare and social care services.

The Chair, Dr Ian Ritchie, opened the meeting and welcomed everyone, reminding them that they are here ask questions on behalf of and help shape how we communicate with the people of Greater Glasgow and Clyde. He established and confirmed with the Group that the commentary of the first meeting produced was an accurate reflection of key points raised and discussion. The group also spoke about the Engagement and Communication Plan that John Barber had circulated and although most felt assured that there was a commitment for extensive engagement outwith the Group; they discussed and felt that they were not representative of all demographics. John, reiterated that invites had been sent to a range of organisations but not all were able to have a representative present; however many of these had agreed to use their channels of communication to circulate information about MFT.

Dr Andrew Winter, a Consultant in Sexual Health and HIV Medicine and the Joint Clinical Lead for e-Health; Dr Keith Mercer, a practicing GP in Glasgow’s East End and an EHealth Advisor; and Denise Brown the Head of eHealth Strategy and Programmes for the Health Board then delivered a presentation to the group about how eHealth can support patients and services. Andrew Winter discussed the advancements that had occurred in recent years with the introduction of a single patient management system across Glasgow and Clyde hospitals and some neighbouring Health Boards. He talked about the benefits to him as a doctor of having electronic systems for referrals, tests, correspondence and easy access to a wealth of information from across different specialities for the last 17 years about his patients leads to safer more effective care

As an example he spoke about was not having to think about or look up what colour of bottle is required for what type of sample as the electronic ordering for laboratories gives clear instructions and prints labels meaning this system has increased efficiency and dramatically cut-down the need for retests. He said that having electronic patient management systems that deal with referrals, correspondences and a range of other things for an organisation this size has been a huge undertaking but immensely beneficial. He did say that although much has been achieved it could be better and for example we need to better share information across the 6 Health and Social Care Partnerships and mentioned how they had done this across the whole of Northern Ireland.

Keith Mercer spoke about paperless systems that GP practices use and how having up-to-date correspondence and being able to see into hospital systems helps him better manage and communicate with people living with or supporting someone with complex long-term conditions – this being an oversight role many GPs have nowadays. He mentioned how new electronic systems for prescribing could check local stock, make recommendations and improve safety by reducing the chance of interactions and errors. He also said that many practices, depending on how they see patients, have provided online access to book and cancel appointments.

Keith then discussed a fictional elderly patient with a range of conditions as an example of the situation and decisions that GPs often face. He outlined that with our current use of technology this can often lead to a range of referrals or interventions and that due to limited information sharing these might not be as well coordinated as they could be. He said that that due to the lack of alternative ways to monitor people’s health often what happens, to reduce risk to the person, is that they are admitted to hospital. However, it is recognised that unless you really need complex care that hospitals can be the worst environment for elderly people as they can quickly loose independence.

Keith and Andy then discussed how in the future technology might be able to provide an alternative way to monitor people at home to support them living independently. This would start with much better sharing of and access to information so a multidisciplinary team approach across services could be implemented in a coordinated joined up way. In addition wearable and in-home technology such as mobility monitors to look at levels of activity, intelligent delivery mechanisms for medicines that record and improve their use and even things like fridge monitors could be used. The combined data from this type of technology can alert services if someone’s health is deteriorating to prevent hospital admission or even notify them that someone might have had an emergency.

The team also spoke about new projects underway that would further improve internal and external communication and improve prescribing and medicine management. In addition future projects will enable better communication between doctors to improve advice or referrals. One example Denise Brown spoke about is the piloting of an online Patient Portal that would allow people to access and amend some of their care details, find advice about their condition and to manage appointments and correspondence. They also touched upon the idea of virtual clinics done via video and how the use of data from devices, systems and new technology might support the decisions people and service might make about their care.

In addition to talking about how eHealth might help provide safer, more effective and person centred services they also discussed the challenges including; information governance and balancing sharing data whilst preserving privacy; how to make changes in complex always on systems that people are more used to; and how major investment is required upfront and that it might be several years before this is recovered. There was also the issue of simply ‘keeping the lights on’ and that new technology is reliant on hardware and software that needs maintaining and protecting to ensure that all the benefits technology can bring are realised and that they are available the 24 hours a day and 365 days a year they are needed.

Throughout the presentation he SRG members asked question and led conversation on a range of topics. One, discussed in-depth, was sharing information across services and although almost everyone agreed that this could have benefits they wanted assurances about confidentiality. They spoke about privacy and raised concerns that some conditions are still stigmatised and wanted to know about; the levels of access to records and how tightly controlled this was; and what information is visible on different systems including text message reminders. Martin said that, with the establishment of Health and Social Care Partnerships, many people probably assumed that services were more joined-up and sharing of data occurred. Ian Good asked why the sharing of information across health and social care services hadn’t been implemented in Scotland as it had in Northern Ireland. Denise Brown said that access issues across   were not restricted by the technology used, but instead were due to permissions and governance.

Betty spoke about how when she was a district nurse that there was an element of mistrust when sharing information externally and even with social services, but that people – patients, service users and carers -  need to be told about integration and why it’s important. Thomas said that people need to be more aware of how their information is used and that ultimately they should be in control of who can access it by choosing to opt in or out. The eHealth Team gave assurances about how records are locked and that only appropriate senior staff are given access to the right level of detail as and when required. Keith Mercer gave the example of how letters and results now come directly to his inbox on his computer and that this was far more efficient and secure than sending a printed version in the post. 

There was feedback about other services that offer personal support with Martin and Susan talking about the key role of the Voluntary Sector with services such as befriending and Link Workers. George said that the Voluntary Sector played an important role in supporting those with mental health with people often relying on them for help. Anne Marie agreed that the voluntary sector does offer many people help, but they don’t need access to as much information as health or social care services. All accepted that more could be done to improve internal health and social care communication and referrals before considering external organisations

There was discussion about the different services available for people to access and why some services were not offered in some areas. Susan asked why some GP practices didn’t offer the facility for online booking of appointments as this would be better for people in work. Jewels agreed and said that almost everything she needs nowadays could be access via her smart phone and this was what she used to organise much of her life. Keith Mercer explained that some services were decided at practice level and might depend on how they organise their appointments and also said that there was funding available and this was leading to some innovative practice. Margaret spoke about the new ways of working in Inverclyde to change how people access primary care services and advice from other specialties often meant not needing to see the GP.

Martin spoke about feedback he had received from other people that nowadays too many members of staff spend more time looking at screens than the person in front of them. This was echoed by many SRG members, although it was noted that some staff previously did this with paper notes. Janet, who used to be GP, said that all this technology is fantastic for improving efficiency and safety; however it should never be a substitute for the relationships that need to be developed between people that enable good advice to be given and for this to be trusted. Everyone agreed with this and there was discussion that as people – both those delivering and those receiving services – become more used to technology that they will work better with it so that it’s not a barrier to effective communication and doesn’t depersonalise care.

Ian Ritchie closed the meeting and thanked everyone for their input and valuable feedback in what they all agreed had been a hugely fascinating topic.

 

In Attendance

 

Dr Ian Ritchie (Chair)

NHSGGC Non Executive Director

John Barber (Facilitator)

NHSGGC - MFT Core Team

Laura Nixon

NHSGGC

 

Presenting

Dr Andrew Winter

Consultant in Sexual Health and HIV Medicine & Joint Clinical Lead for e-Health

Dr Keith Mercer

General Practitioner & eHealth Advisor

Denise Brown

 Head of eHealth Strategy and Programmes NHSGGC

 

Patient, Service User and Carer Representatives

Aileen Hills

 

Alison Stewart

 

Anne Marie Kennedy

 

Betty Graham

 

George Brown

 

Ian Good

 

Janet Nicholls

 

Janice Woodburn

 

Jewels Lang

 

Karen Haldane

 

Margaret Telfer

 

Martin Brickley

 

Morag Cullen

 

Susan McDonald

 

Thomas Cassidy