Communication

Facebook , Twitter, the last few years have shown the ease of communication using technology where all aspects of someone can be followed on line and where a person’s once confidential information now seems to be open to the world. Compare that to communication between health care professionals involved in a patients care. This is of particular importance when it comes to diabetes and the multi-disciplinary approach taken including input from doctors, nurses, podiatrists, dieticians, retinal screeners – the list goes on. The information divide is most marked between primary care (where most practices are paperless) and secondary care (where paper predominates or a variety of clinical information tools exist). The major issue from all these different systems is the lack of continuity of care, duplication of care (such as foot screening) and delays in passing on changes to a patients’ management.

Of course primary care systems vary around the country but often in certain areas, a single system may predominate, such as Systmone (http://www.tpp-uk.com). So, how difficult is it to actually share information? The answer is not very, although there are a number of hoops that need to be jumped through especially when considering the thorny problem of consent and data protection. Whilst many patients already feel that their information flows freely between their health care providers, this is not usually the case. In fact agreement to allow data sharing usually requires sign up from a variety of organisations e.g. PCT, CCG and acute trust as well as having a way of documenting it on an individual basis in the patient records.

So, once everyone is using the same system, who benefits?

The patient. Reduced duplication of activity where the practice and specialists are concentrating on the most appropriate aspect of care e.g. BP or glycaemic control.

Primary care. Rapid communication from other health care professionals in the MDT. This includes clinical activity performed elsewhere (useful for QoF) , rapid updating of changes to medication and saving of clerical time scanning letters.

Secondary care. Access to more accurate clinical data including that from other organisations e.g. tertiary centres and a more seamless way of diabetes care. Given the movement of much routine care back to primary care, sharing of clinical records allows specialist team to offer a more refined service. This includes the use of e-consultations – some areas are already commissioning this from the specialist teams.

Thus, the use of technology and communication is readily applicable to the world of diabetes care (and probably other chronic diseases). However the increasingly complex commissioning arrangements of the new world may result in more problems than answers.

Dr Mark Freeman