The use of information technology to support the delivery of community-based haematology services

Results

Electronic advice service: access to specialist advice can decrease the need for formal hospital referral. Access to advice can be difficult and the advice given limited, due to either time constraints or the quality or quantity of the information provided. A direct link was established with the GP electronic health record (EHR) system that facilitated rapid access to specialist advice. The specialist can view the entire patient record, enabling a more comprehensive and appropriate response to be made that can be inserted directly into the record. This on-site consultant-delivered service currently covers two CCGs, 79 general practices and a population of 430,000. It attracted 731 referrals in 2013 from more than 90% of practices. Responses were usually available within 1–2 working days. In less than 10% was an onward referral to secondary care suggested. An independent, external audit showed that responses were of ‘uniformly high quality’.

Anticoagulation and deep-vein thrombosis services: the direct link with the GP EHR facilitates rapid referral of patients to these services. Diagnostic and management outcomes are directly inserted into the patient record. Clinic staff also have access to additional relevant information in the EHR that improves the diagnostic and management process. The anticoagulant clinic uses a clinical decision support system (CDSS) to aid warfarin dosing. There is a direct link to the patient EHR that permits the rapid, accurate transfer of patient data and treatment details from and to the EHR. The CDSS also provides a database that enables regular quality measures of anticoagulation to be accessed, including the mean clinic time in therapeutic range (TTR), a patient's individual TTR and the percentage of patients with acceptable TTRs of >60%. Email links with patients who self-test their international normalised ratio facilitates safe, remote warfarin dosing.