Vision 2021: can your specialist diabetes team see everything they need in order to provide timely, high-quality care?
Despite the increase in digital adoption over the last 18 months, the deployment of technology within the NHS – particularly for the enablement of system-wide integration – still lags behind where it should be in order to help improve patient outcomes and reduce variation in care. The introduction of Integrated Care Systems (ICSs) places great emphasis on putting patients at the centre of their care pathways, bringing together NHS, local authority and third sector bodies to take on responsibility for the resources and health of an area or 'system', which requires both joined-up thinking and the capability to share information between multi-disciplinary teams.
The good news is that many trusts are now discovering how innovative information systems can help them provide high quality care for patients with long-term conditions (LTCs). For example, the application of technology within diabetes care – described (pre-COVID) in 2019 as the ‘greatest health crisis facing our nation’ – could be one of the most important advances in reducing the impact of the condition on both patients and the broader healthcare system. However, success may depend on taking a specialist approach.
The struggle for visibility
It is widely recognised that giving HCPs access to accurate and relevant clinical information at the point of care is key to improving patient outcomes. This access is particularly important in chronic conditions such as diabetes, where patient consultations are conducted across a range of clinical settings in primary, community and secondary care. A typical patient journey can feature interactions with a range of HCPs including specialist nurses, podiatrists, dieticians and psychologists. Alongside them, individual treatment plans have historically pivoted around annual outpatient reviews with consultant diabetologists, where full visibility of all clinical engagement is fundamental to their ability to make informed decisions. If that wasn’t challenging enough, today’s situation is made harder by the vagaries of the disease and the challenges introduced by the COVID pandemic: not all diabetes care can be planned, with complications historically responsible for high volumes of emergency admissions – admissions that have been critical to minimise in recent months. Visibility must therefore extend beyond the specialist team to increasingly support HCPs in general settings.
Fundamentally, the long-term management of diabetes is complex and ever changing. If trusts and ICSs want to deliver gold standard care, they must first give their teams a 360° view of every clinical interaction. The value of technology in this regard is unequivocal. NHS England’s Digital Framework for Allied Health Professionals (AHPs) says good use of technology can improve health and wellbeing and help the NHS meet its quality, safety and efficiency goals. The framework cites information as the glue that binds AHPs and healthcare services.
There is no doubt that empowering HCPs with timely information is the best way of maintaining quality care across whole systems and, in the process, reducing unplanned admissions and unwarranted variation in LTCs like diabetes. However, despite technological advances making it easier to connect individuals beyond organisational boundaries, many trusts still struggle to give their teams the visibility they need.
It comes as no surprise that IT teams are increasingly reviewing their diabetes information systems. But as they look for solutions, they know technology alone won’t overcome their challenges; specialist understanding is essential. In complex conditions like diabetes, connecting data isn’t enough – capturing and visualising it in ways that recognise the nuances of the disease, the pathway and the critical indicators of care are key to supporting optimal decision-making. This is why the best EMRs are invariably specialist and always shaped by specific clinical need. One size does not fit all.
Leading NHS organisations think ‘clinician-first’, forming broad coalitions that combine insight from all key stakeholder groups to ensure they tailor the right solution. The most robust EMR strategies are the result of deep and diverse collaboration between specialty teams, business managers, IT, data quality managers, procurement, finance, governance and other non-clinical administration teams. The support of a specialist technology partner that truly understands the diabetes ecosystem is also paramount.
Characteristics of a world-class, specialist EMR
So what do clinicians need? And what does a world-class EMR look like? The complexities of diabetes dictate the need for a specialist solution.
Access to accurate, real-time point of care information
Ultimately, visibility is everything. In busy - and today, vastly overstretched - services, time with patients is limited, so front-line staff need to ensure each consultation focuses on the most important aspect of care for that individual appointment. To do this efficiently, they need accurate real-time information that allows them to hone in on core areas of concern, and helps them quickly determine how patients are managing their condition in general. A good system will capture a detailed, long-term patient record covering the full range of medical history, comorbidities, treatments, test results and other conditions. Moreover, it will put all that information in one place and make it accessible (and usable) by the whole multidisciplinary team, irrespective of setting.
Meaningful visualisation and robust security
Good specialist systems let clinicians filter notes by type, enabling them to review the status of key factors like HBA1c, cholesterol, TSH or eye screening quickly outside of valuable consultation time. They apply traffic light indicators to alert clinicians to the most pertinent issues – and indeed, prioritise those patients that need care most urgently. These attributes can help trusts improve the quality, efficiency and urgency of diabetes services and enhance the patient experience. In addition, data security is critical; solutions need to assure confidentiality, integrity and availability if they are to be adopted and trusted by clinicians.
Beyond visibility of information at the point of care, specialist diabetes EMRs also provide additional long-term value. A good system can help trusts manage mandatory submissions to National Diabetes Audits accurately and efficiently – automating previously onerous paper-based processes and reducing the risk of human error. Similar gains can also be made with submissions for Best Practice Tariff. For instance, the advanced reporting functionality of a specialist EMR recently helped one major trust unlock BPT funding of £800,000 that may otherwise have proved difficult to secure. There are similar examples all over the UK.
Powerful analytics and reporting
The best EMRs fuel powerful analytics that can help trusts and ICSs plan, adapt and redesign services. Robust reporting and intuitive interfaces allow healthcare organisations to identify long-term trends and benchmark performance at the local, regional and national level. This capability helps to reveal the bigger picture, define best practice and address variation in care. A good technology partner will be able to share real world examples that show how their solutions have transformed diabetes care.
Future of diabetes care
As the prevalence of diabetes continues to grow and the number of patients diagnosed late as a consequence of COVID increases, the NHS will undoubtedly need to optimise technology if we are to prevent the disease from becoming ‘the greatest (long-term) health crisis facing our nation’. The need to maintain routine healthcare services hasn’t stopped, and people living with diabetes need the best possible care for the long term. To deliver it, trusts – indeed whole care systems – must empower their teams with the best information and the best tools to ensure the right care is given to the right patient at the right time. Technology is the gateway to clinical empowerment and better patient care within a joined-up acute, primary and community care setting. But to make the most of it in the management of LTCs, it makes sense to deploy specialist solutions that give clinical teams the visibility they need.
Jon Elburn, Product Manager – Clinical Information Systems, Hicom