Cycling UK Forum

Pendodave wrote: ↑12 Jun 2024, 12:31pm I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?

What an excellent question.

Estonia is worth studying, having started from a very low base with a young government and a lot of young technologists.

Sweden is good at coordination at local level, county in their case, and that includes sharing information with social care and other local government functions. (And they avoided the second big barrier because of that organisational starting point.)

Kaiser Permanente covers primary, secondary and tertiary health care within one organisation and has information systems and functionality that match that. (And they avoided the second big barrier because of that organisational starting point.)

Australia has done better than most on using data standards.

Nobody seems to understand France's recent approach, and I'm not aware of good evaluation.

Many rich countries now look pretty similar to the constituent countries of the UK. But that wasn't always the case for computerisation: primary care in the UK was way ahead of other countries but on a practice-by-practice basis, not on wide-area shared records.

Jonathan

Pendodave wrote: ↑12 Jun 2024, 12:31pm I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?

The organisations that have made any of it work have found some sort of solutions to the two big barriers: finding an appropriate design authority/ scope/ funding model, and making enough progress on managing the dataset.

Jonathan

Pendodave wrote: ↑12 Jun 2024, 12:31pm I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?

(In 2004) When I lived in France I did need to make use of their health service and it was fascinating. I was fortunate in that I got on really well with my GP (seems something I did in the community was socially 110% good). I had a lump that needed investigating so GP write me a prescription for a scan and said I can chose where to go but a convenient place was in <local town> and he gave me their details. So I went there next day with my prescription, that made the scan, told me to wait in the waiting room and 10 mins later came out with two copies of their report, with images, findings, etc. one copy for me, one for my GP. It was my job to give the GP's report to the GP which I did on my way home, he looked it over whilst I waited (no appointment) and then "nothing to worry about, all done".

It was my responsibility to manage the medical record, to see scan report got to the requesting physician, etc.

I had to pay €20 for the GP appointment which was automatically refunded (by CPAM) to my account within minutes. The payment was the same as for any French national, everybody paid and everybody got refunded (though later the refund changed to be €1 less than the payment).

Ian

Psamathe wrote: ↑12 Jun 2024, 12:45pm ...
It was my responsibility to manage the medical record, to see scan report got to the requesting physician, etc.
...

The information flows for investigations vary dramatically between healthcare systems. Of course that has major effects on how they computerise them.

Jonathan

Thanks for these. Fascinating.

Psamathe wrote: ↑12 Jun 2024, 12:45pm

Pendodave wrote: ↑12 Jun 2024, 12:31pm I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?

(In 2004) When I lived in France I did need to make use of their health service and it was fascinating. I was fortunate in that I got on really well with my GP (seems something I did in the community was socially 110% good). I had a lump that needed investigating so GP write me a prescription for a scan and said I can chose where to go but a convenient place was in <local town> and he gave me their details. So I went there next day with my prescription, that made the scan, told me to wait in the waiting room and 10 mins later came out with two copies of their report, with images, findings, etc. one copy for me, one for my GP. It was my job to give the GP's report to the GP which I did on my way home, he looked it over whilst I waited (no appointment) and then "nothing to worry about, all done".

It was my responsibility to manage the medical record, to see scan report got to the requesting physician, etc.

I had to pay €20 for the GP appointment which was automatically refunded (by CPAM) to my account within minutes. The payment was the same as for any French national, everybody paid and everybody got refunded (though later the refund changed to be €1 less than the payment).

The elephant in this particular room is how well it works varies a lot with the patient. If one has a chaotic lifestyle and mental health issues much of the above could have gone very badly wrong, and this is the same reason charging people for missed appointments turns out to be a well intentioned but bad idea. One group that misses appointments have chaotic lifestyles and mental health issues and they miss the appointments not simply because they don't care but they're genuinely incapable of keeping them. And these people, being at the bottom of the heap, can't afford financially to miss them and pay money so they stop making them, but being at the bottom of the heap they also tend to get sicker than most and when they finally get so sick they can't ignore it any more they then get in to care at the point it becomes astronomically more expensive.

Pete.

pjclinch wrote: ↑12 Jun 2024, 1:46pm

Psamathe wrote: ↑12 Jun 2024, 12:45pm

Pendodave wrote: ↑12 Jun 2024, 12:31pm I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?

(In 2004) When I lived in France I did need to make use of their health service and it was fascinating. I was fortunate in that I got on really well with my GP (seems something I did in the community was socially 110% good). I had a lump that needed investigating so GP write me a prescription for a scan and said I can chose where to go but a convenient place was in <local town> and he gave me their details. So I went there next day with my prescription, that made the scan, told me to wait in the waiting room and 10 mins later came out with two copies of their report, with images, findings, etc. one copy for me, one for my GP. It was my job to give the GP's report to the GP which I did on my way home, he looked it over whilst I waited (no appointment) and then "nothing to worry about, all done".

It was my responsibility to manage the medical record, to see scan report got to the requesting physician, etc.

I had to pay €20 for the GP appointment which was automatically refunded (by CPAM) to my account within minutes. The payment was the same as for any French national, everybody paid and everybody got refunded (though later the refund changed to be €1 less than the payment).

The elephant in this particular room is how well it works varies a lot with the patient. If one has a chaotic lifestyle and mental health issues much of the above could have gone very badly wrong, and this is the same reason charging people for missed appointments turns out to be a well intentioned but bad idea. One group that misses appointments have chaotic lifestyles and mental health issues and they miss the appointments not simply because they don't care but they're genuinely incapable of keeping them. And these people, being at the bottom of the heap, can't afford financially to miss them and pay money so they stop making them, but being at the bottom of the heap they also tend to get sicker than most and when they finally get so sick they can't ignore it any more they then get in to care at the point it becomes astronomically more expensive.

Pete.

I agree about the difficulties and shortcomings of missed appointments. I wonder how well the text reminder system introduced over the last few years has helped in cases where people are just disorganised (chaotic lifestyles rather than mental health issues).

When I was in France (until 2008) the GP charge/refund was not related to missed appointments. It was not related to preventing missed appointments. You pay at the appointment in my case after seeing the GP.

When I was there they started introducing GP registration. When I first moved there you could go to any GP for any condition. Apparently problem was some people would go to one GP, get prescription for pills, get pills and go see another next day for same condition, get another prescription, another set of pills, etc. So (from memory) they introduced the idea that you registered with just one GP. You could see go see any GP but you only got the refund for appointments with your registered GP.

Ian

Psamathe wrote: ↑12 Jun 2024, 2:02pm
I agree about the difficulties and shortcomings of missed appointments. I wonder how well the text reminder system introduced over the last few years has helped in cases where people are just disorganised (chaotic lifestyles rather than mental health issues).

It would have saved me one incident of mortifying embarrassment, at least.

I've always considered it just plain good manners to show up on time for stuff, I really make an effort to do that, and we tried to pass on that to our children, particularly where healthcare appointments are concerned. So on one occasion where my son had an out-patient appointment I collected him in good time, we rode up to the hospital and went along to the relevant place in good time. Or what I'd thought was good time: rather than being 10 minutes early it turned out I was 23 hours and 50 minutes late, and absolutely nobody to blame but myself.

Pete.

rjb wrote: ↑10 Jun 2024, 8:38am Dogs first, now Cats, we're next. Here's an idea, if you want to use any NHS service you have to be chipped so your records can be carried with you. Waiting lists will vanish overnight.

Get your medical details tattooed onto you. Apparently when the iceman was found, he carried a number of tattoos linked to his health and treatments...
You could do blood type, date of birth and any thing that you were allergic to... although if they kept changing your medication you could run out of skin...

Having worked in an organisation where it was incredibly easy to have the same person registered and three different addresses (in error) I'm really not sure that a large scale database operated by hundreds of staff with differing levels of understanding and skill could ever be 100% fool proof.

Dogs first, now Cats, we're next. Here's an idea,

One big company issued chips trackers to employees to monitor and encourage people to walk/run more.One employee got sterling results.

PS he cheated,he fitted it to the dog.
****************
I ride Brompton,Hetchins 531

INTERESTING READING..i have a simpler way of understanding whats happened since covid hit us, remember when we had that Eton educated PM who suggested and was imo right.... to have GP's working hours changed that suited anyone who had shifts and didn't work the old 9 to 5 there night and day and over weekends and the waiting lists would come down very quickly...
the 'high heed yins' in the medical care industry started to look at what they would lose, and when Covid hit they secretly got everyone industry health wide to jump on the band wagon and change from seeing maybe 24/30 patients a day to one per hour and take a long lunch, wear medical jump suits, thats what i call their boilersuits, and claim their phones can only handle so many calls take a day every week where they train staff!!! trained by/at same outfit that trained secret police in Eastern pre./Iron states... that means noone can get any appointments ...only a message that we are training staff today. somewhere along the consultants realised that the harder they work the more pension was lost so they have been working slow time since..
And chipping cats, i have 3 and good luck to anyone who thinks my boys will allow chipping, the chipper to stay blood free ...without giving them a total knock out shot, now it was a really wise brain on a hefty salary that thought that one up.. where do they find these people....will

The number of GP appointments in England has increased since the outbreak.

Jonathan

Jdsk wrote: ↑16 Jun 2024, 12:22pm The number of GP appointments in England has increased since the outbreak.

Jonathan

The funny thing is that these days, folks mostly just believe what they want to believe. Thus person A can state the simple case, and have ready if asked a whole stack of data to support their claim, and person B will just ignore them, if it doesn't suit their narrative.
The end result may well be martial law. Coming soon to a country near you...

cycle tramp wrote: ↑14 Jun 2024, 8:53am Get your medical details tattooed onto you. Apparently when the iceman was found, he carried a number of tattoos linked to his health and treatments...
You could do blood type, date of birth and any thing that you were allergic to... although if they kept changing your medication you could run out of skin...

That principle is already in place (in a sensible, easily modified format) via MedicAlerrt.

nosmarbaj wrote: ↑16 Jun 2024, 12:42pm

cycle tramp wrote: ↑14 Jun 2024, 8:53am Get your medical details tattooed onto you. Apparently when the iceman was found, he carried a number of tattoos linked to his health and treatments...
You could do blood type, date of birth and any thing that you were allergic to... although if they kept changing your medication you could run out of skin...

That principle is already in place (in a sensible, easily modified format) via MedicAlerrt.

Highly Recommended.

It's also a very good idea to set up the emergency contacts and data on smart 'phones.

Jonathan

PS: Barcoding patients using eg wristbands is culturally different in Germany from in the UK because of the historic use of tattooing by the government.