By Ian Bailey, clinical design director at EMIS Group, district nurse and Queen’s Nurse
We all know it’s better for patients if they’re treated in their own homes rather than hospitals when it’s clinically appropriate. For one thing, it can help prevent or slow down a patient’s deterioration. For another, it’s more cost effective for the NHS. And, perhaps most importantly, it can ensure a better quality of life and experience for the patient.
Multidisciplinary teams (MDTs) in the community are an effective way to provide this type of care. Made up of various clinicians who work together as one cohesive unit, they can ensure that a patient’s clinical requirements are looked at from a holistic perspective and that, ultimately, their clinical needs are cared for in a holistic way too.
There’s a huge population of people who benefit from home care and support from MDTs. What’s more of a challenge is that the provision of this care is, by its very nature, complex. As a member of an MDT you may have to be completely aligned to not just clinicians within your own organisation, but to those who work in other agencies and services too.
As any healthcare professional knows, accounting for every part of a patient’s care is a pretty big hurdle to overcome in any situation; it’s even more complicated when there are multiple moving parts surrounding this care that all have to be coordinated. Yet there’s a way that we can simplify and detangle the important work that MDTs do for people who have all sorts of health requirements: with technology.
Shared electronic records are essential to all types of MDTs
Clinicians working in an MDT need to have instant, electronic access to patient information no matter where they are. This helps them to make informed and accurate choices, have more effective clinical conversations, provide patients with the best experience and truly work in a connected way.
It’s something that can help MDTs of all kinds to work closely together too, no matter if they’re physically co-located or work virtually. If clinicians are all in one room together, they can each use EMIS Web to access and discuss a patient’s full health history in detail. While doing so, they can also individually update information and make notes to that electronic record in real time. On the other hand, six different clinicians in six different locations who are also using EMIS Web can do the exact same thing using video conferencing, without having to sit together in the same room.
In both scenarios, what these clinicians essentially have access to is a shared virtual multidisciplinary team care record, and one that they can use at any time. When they break away from their respective meetings and go out on the road, every member of the MDT not only has all the information that they viewed and updated during their meeting to hand, but can also easily record any new visits and see past details. So no matter how many times, or indeed when, a clinician visits a patient, all of that activity is up to date and recorded in one place, ready to be viewed and edited by anyone who needs to do so.
Clear accountabilities and actions for clinicians
What this shared way of working can really make clear is who is responsible when it comes to care planning and delivery. By creating and using shared care plans within EMIS Web, clinicians can collaboratively devise goals and actions and then assign responsibilities. That means that within one care plan you could have two main goals, but four or five different actions that feed into each. Each action could be assigned a person who has responsibility over it and who can ensure the action’s completion – whether that person is a healthcare professional or even the patient themselves.
When we’re increasingly seeing patients with co-morbidities whose conditions necessitate involvement from multiple clinicians, this technology can really help everyone to track both clinical interventions and future goals. If clinicians within an MDT can know exactly what others have done, what stage a patient is at in their care and what goals they personally have to work to, it’s much easier for them to provide that holistic, all-encompassing support that is so vital to so many people.
Enhancing processes to make connected care more effective
There’s also something to be said about the important role technology can play in supporting MDTs to deliver a more effective service by helping them to improve their processes. Referrals are a great example of one of the areas that can be significantly affected by this.
Electronic processes mean that referrals can easily be sent directly to an MDT. Once the team receives the referral, each relevant healthcare professional within it can triage and then either accept or reject it from within their clinical IT system. Immediately, you go from making three separate referrals to making one referral which can be picked up by all the different healthcare professionals working in their different disciplines.
Being able to work in this way has already had a real-world impact, with Liverpool Diabetes Partnership (LDP) being a prime example. Comprised of healthcare professionals from across disciplines, LDP was founded to improve the prevention and management of diabetes across Liverpool – aims that partly rely on being able to make speedy interventions. By using EMIS Web, the service is now providing more care in the community and is working more closely with secondary care to pick up inappropriate referrals. Not only is it better for patients because they’re receiving care in their homes, but it’s better for Liverpool’s hospitals too: LDP has reduced hospital admissions by 50%, giving acute organisation more capacity to treat serious cases.
I recently spoke with several different clinicians working at the service who explained to me how they’d personally become more efficient by using technology. One clinician in particular told me that he’s saving time with EMIS Web by no longer having to chase down information. With information gathering already taken care of, his clinical, professional discussions are much more fruitful and he’s having much more meaningful discussions when input from other clinical specialities is required.
A better experience for the patient and for the clinician
Really, there’s nothing worse than going in to see a patient and asking them to tell you about themselves, so removing the need to gather this information can also really improve a clinician’s experience. Without it, you could be sat for five minutes in a time-limited appointment while the patient is forced to regurgitate a story that they’ve told dozens of times to all those that have come before you.
It’s much better for you to be able to ask them questions that are directly related to their health and their past history. And that can only effectively happen if clinicians are using shared electronic records. What’s great is that it gives the patient the best experience too, as they know that they have a clinician who understands them and their health, and is making truly informed clinical decisions.
Improving prevention and early intervention
While we may typically think of MDTs supervising the care of patients already living with conditions, technology can actually give us much more scope than that. With it, we can begin to identify which patients are at risk of developing illnesses and shift our care to a proactive model, rather than a reactive one.
By having multiple healthcare professionals all feeding into one record, we’ve got a much richer and complete database in which to start analysing and pinpointing where, in our populations, we need to target and proactively provide care. By doing so, we could get to a point where at-risk patients can be cared for by members of a MDT much more efficiently and cheaply over a period of months before a serious condition develops, compared to if that patient was left without intervention and eventually ended up in hospital.
Improving the long-term health of patients and our healthcare system
In the future, I think we can use technology to expand the repository of information that we use to make more informed decisions about patients even further. We could even use it to the point of empowering populations to better manage their own health and avoid interventions altogether.
How many of us use wearable technology? I know I certainly do. But how many of us are actually making use of that data? Definitely not enough. But when there’s a whole wealth of information on a patient’s health that that we can glean from wearables and which can feed right into health records, really we should be making more of this technology. With it, we’re in a much better place to provide really precise care.
If clinicians have access to this data, they can help to educate, inform and really empower patients to better understand their own wellbeing and what steps they can make to change the course of their health for the better. In some ways, it can make patients something akin to a virtual member of an MDT themselves.
Like with shared electronic records, it’s all technology that’s already available and can be used by MDTs to make a difference now. As we’ve seen, MDTs in the community do fantastic work in keeping patients out of hospital and giving them really expert, tailored care by virtue of the fact that they’re designed to consider every part of a patient’s care. But it’s with this technology that we can give MDTs a truly holistic view of patients in order to make their work easier to complete and their care more effective.