Guides to specific issues 1 This issues guide is linked to the vignette Much more than a computer. Advances in IT and IT systems have fundamentally changed General Practice and Primary Care. The main uses of IT in relation to primary mental health are: Patient information held on the Patient Management System (PMS). Most GP consultations are conducted using the PMS with clinical information retrieved and added as the patient is seen. Referral to other providers: all referrals are prepared using the PMS. In some instances e.g. referral to private hospital specialist s electronic referral is possible either directly or through electronic fax. At DHB level there should be a focus on developing systems where electronic referral is standard. Some of the existing primary mental health initiatives have embedded templates to aid electronic referral. Many psychological treatment providers do not have computerised patient management systems at the present time. Use of the Internet. The Internet is used to download useful information e.g. psychotropic drug prescribing information, or to provide patients with information about useful websites. Current useful sites include therapy sites such as Moodgym http://moodgym.anu.edu.au/welcome The Journal http://www.ndi.org.nz/index.php?q=content/journal-3 The Lowdown http://www.thelowdown.co.nz/
Guides to specific issues 2 Population level data The current PMS systems have not been designed to gather population level data or interrogate a patient list easily. There is the potential for general practice data to be collated and used for planning purposes in primary mental health, but this has not been realised so far beyond information collected through the primary mental health initiatives (PMHI). The PMHI s utilise a number of different scoring and rating systems which could be used to provide overall measures of prevalence and progress following intervention.
Guides to specific issues 3 Much more than a computer (click here to go back to guide) Sally, the IT manager at the PHO, has been asked to provide an update on current IT issues in Primary Mental Health to the DHB. She is aware of work being done for the Primary Mental Health Initiative in which referrals can be made to the mental health coordinator electronically and also that there is a DHB plan to try and have a single electronic medical record across the whole DHB, though this is some way off. She wonders how to proceed. Questions to consider 1. Who do you contact in your organization when considering IT developments? 2. What is the best way of getting information from them? Sally arranges to visit the mental health coordinator and the GP Chair of the Clinical Governance Group. Rawiri, the mental health coordinator tells her that there are two issues he has been trying to make progress on; the introduction of a guideline decision support tool (DST) and getting referrals and feedback letters organized electronically between the different primary care providers. Uptake of the DST has been low despite a CME evening at which it was introduced, and lunchtime meetings at two of the larger group practices in the District. He suggests that Sally contacts the largest counselling practice with whom the PHO has a contract. When Sally discusses these issues with Tim, the Clinical Governance Chair, she is surprised to find that he is not overly enthusiastic about the introduction of the DST and says that most GP s in the district don t feel the need for electronic mental health guidelines; they only want increased access to psychological services and better discharge summaries from the psychiatric and crisis intervention teams. Furthermore he points out that the Practice Management Systems (PMS) in use are
Guides to specific issues 4 fine for individual patient management, but interact poorly with web based applications. Questions to consider How do you assess what is reasonable in terms of IT provision for clinical service delivery? 3. Who is driving IT developments locally and why? Sally then meets with Siobhan, the lead practitioner of the counselling practice, to discuss electronic referrals between the primary care team. Siobhan says that although they use computers for accounting scheduling, they have not yet moved to electronic notes in the consultation. There is no funding to invest in additional IT within the counselling group or practice. Question to consider 4. What would be your next steps to try and make headway on these issues? Sally prepares a report to the DHB in which she outlines some of the barriers to further IT development, and is asked in return to provide a prioritisation plan. She and Rawiri decide that they should try and gauge more opinion about the barriers to introducing the decision support tool and that a meeting will be arranged between the PHO clinical governance group and the counselling group. Three months later a third of the GP practices have trialled the DST and the PHO has streamlined the referral pathway using the DST hyperlink directly to the mental health coordinator and for secondary care referral.
Guides to specific issues 5 The PHO has also managed to integrate a local directory of counselling services as a hyperlink from the DST and offered trial a direct electronic referral from the largest counselling practice back to the mental health coordinator, who can then pass them back to the GP. Final questions to consider? 5. How much should individual PHOs or DHBs attempt to tailor existing PMS or other IT systems at a local level; or it is more effective to try and coordinate changes nationally? 6. How much are your current IT plans dependent on interacting within a PMS or local DHB software system, and how much on interacting with a common web interface? What are the consequences?