Commissioning groups' IT needs

CCGs are starting to use IT to meet their goals and ambitions. Fiona Barr reports on their progress.

Dr Peter Rudge, chairman of Sentinel Healthcare CCG in Plymouth, Devon, believes healthcare provision is ‘light years off the pace on IT’ (Photograph: UNP)

GPs are already the most advanced users of IT in the medical world but that is about to step up another notch as clinical commissioning groups (CCGs) use information technology to help achieve their goals.

Names such as iTracker, Audit+ or Patients Know Best may not be familiar to GPs but they are the sort of tools CCGs are deploying alongside traditional GP systems.

Dr Peter Rudge, chairman of Sentinel Healthcare CCG in Plymouth, Devon, says Sentinel, which covers 275,000 patients, plans to make maximum use of IT. 'I believe that we are light years off the pace on IT,' he adds.

Sentinel has at least eight separate IT projects running at the moment (see box below). They include using Choose and Book for all referrals which are sent to its clinical assessment service (CAS).

Sentinel's IT projects
  • Use of Choose and Book by all GPs with referrals directed to the CAS.
  • Use of Map of Medicine to define patient pathways.
  • Use of a portal to connect clinical systems and create a locally available single patient record.
  • Use of middleware to connect GP practices more intelligently to the laboratories and tests ordered in secondary care.
  • Use of telehealth and telemedicine for a community-based crisis response service.
  • Use of population-based risk stratification tools to identify patients at risk of admission.
  • Use of the MCAP settings of care model to understand how the health and social care system needs to be reshaped.
  • Use of web-based patient-held care plans, to empower patients to take control of their illnesses and self manage.
  • Supporting the local authority in the launch of the Plymouth online directory that will help patients, carers, public and professionals to navigate the complex choices for care and support available in the city.

Some of these projects are well under way while others are in the planning stages.

Dr Rudge says the CAS identifies real demand, 'demand we all agree can currently only be met in a hospital', from failure demand, 'demand currently being met in the hospital that could be met somewhere else'.

Map of Medicine
Sentinel is also making use of the Map of Medicine decision support tool. Dr Rudge adds: 'We are using the Map of Medicine tool to agree as a clinical community how the real demand will be met between primary and secondary care - that is defining the pathway or "offer" for patients and clinicians - reducing variability and enhancing the use of evidence-based care.'

Some of Plymouth's other IT projects, such as developing web-based patient-held records, like those offered by software provider Patients Know Best, are still on the drawing board, which is where a lot of CCGs are on IT.

Dr Tony Martin, chairman of Thanet CCG in Kent, says several CCGs in his area covering about 600,000 patients have formed an IT working group.

Ideas in Thanet include looking at how the community trust might use the GP system for its notes recording and developing a joint system for sharing clinical data and managing that data.

Dr Martin says this is 'probably the highest priority' as he believes this is where the most clinical benefit would lie.

Thanet is also interested in how IT might help the CCG manage clinical variation within primary care and Dr Martin says colleagues in nearby Medway are already using a product called Audit+ to look at clinical data across practices.

In Bassetlaw, Nottinghamshire, the CCG has made big strides with an IT tool called iTracker, which it developed in conjunction with its local hospital, the Doncaster and Bassetlaw Hospitals Foundation Trust.

iTracker is a real-time tracking system within the hospital which tells GPs where patients are in the system, which tests were ordered, social services'

involvement and forms completed, expected date of discharge, take home medicines, any delays to the discharge process and so on.

Dr Steve Kell, chairman of the CCG and a GP in Worksop, Nottinghamshire, says: 'The system is important because the biggest challenge is knowing where patients are in hospital and knowing when they are coming out so we can identify blocks in the system and make our systems as efficient as possible.'

iTracker has been deployed in the medical wards at Doncaster hospital and is now about to be deployed on all other wards. Dr Kell says the CCG sees iTracker as a key tool in reducing readmissions and speeding up reablements.

The Bassetlaw group also wants to capture GP information in real time to inform commissioning decisions so that the CCG has up-to-date information rather than using data from the Secondary Uses Services.

Poor data quality
Data quality remains a massive bugbear for CCGs. In Cumbria, Dr Alan Edwards, IT lead for the Carlisle CCG, says he sees little point in investing in risk stratification software at the moment because of poor data quality.

However, the Carlisle group has become the first in the country to use an IT product which takes information from GP IT systems and shares it with other parts of the NHS.

Called the Medical Interoperability Gateway (MIG), the system was developed by GP system suppliers EMIS and INPS and means data from GP systems can be seen by clinicians out-of-hours.

Dr Edwards says: 'Clinicians are enthused about it and the feedback we have had is asking why we haven't done this before.'

Carlisle hopes to go on and use the MIG for information sharing with the local hospital's A&E department.

Like many, Dr Edwards believes CCGs are only exploring the tip of the iceberg on how IT can help improve care. He adds: 'My view is that informatics will need to underpin everything that we do.'

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