Gary Culliton spoke with Dr Brian Meade before last weekend’s IMT GP Seminar in Dublin, to discuss the latest developments in electronic referrals, telemedicine and social media usage among GPs.
Dr Meade — Electronic referral applies in regard to lung, prostate and breast cancers — it’s a shame that more cancers cannot be referred in this way
The National Electronic General GP Referral Pilot Project — which has been piloted in two areas — “looks very promising”, according to Dr Brian Meade. “The feedback from GPs and hospitals has been very good. It seems to work.”
Dr Meade, an advisor to the ICGP’s GPIT group, explained that the project enabled GPs to generate and submit electronic referrals to hospital public outpatient clinics.
Speaking to Irish Medical Times ahead of last weekend’s GP Practice Management Seminar at the Herbert Park Hotel, Dublin 4, Dr Meade said one of the main drivers of the project was the Tallaght Hospital GP referral debacle. The objective of the electronic scheme was to find a better way for GPs and hospitals to communicate.
The national electronic referral project is now active: referrals can now be made by GPs to all specialties in the Mercy University Hospital and other Cork hospitals, and it is hoped that all seven hospitals in the Cork region will be able to receive electronic GP referrals by mid-2014.
At present, more than 20 per cent of GPs in Cork and Kerry are using the electronic general referral system. And Tallaght Hospital itself is now using the system for paediatrics.
The referral system uses a standardised electronic referral form that is embedded in the GP software and “pulls in” all of the relevant patient details, making the process a lot easier for GPs and also easier for the consultants to triage, Dr Meade told IMT ahead of the meeting, held in association with Lundbeck.
Web access systems have existed previously. However, GPs have proven less inclined to leave their software package to duplicate consultation notes on a website. This has taken added time.
Now — using the new system — following a patient visit, consultation notes are written up, those notes appear on the electronic referral message to the hospital under the new system, and letters are no longer required.
Name, address, phone number, date of birth, allergies, medications and medical history are all included on the referral form. “That’s the beauty of it from the GP point of view,” said Dr Meade.
“An acknowledgement message is sent immediately to the GP, to show it has been received by the hospital and is being dealt with.”
Cancer referrals
Healthlink is going from strength to strength, Dr Meade explained, with 1,335 GP practices and 34 live hospitals involved.
There has been a steady increase in electronic cancer referrals, though this system is not yet universally used. The total number of electronic referrals sent in 2013 was 11,704 and the total number the previous year was 7,454. The percentage increase year on year is 57 per cent, and the number of GPs using electronic cancer referrals increased by 45 per cent between 2012 and 2013.
Great credit is due to Dr Brian O’Mahony who has been working on this project with the National Cancer Control Programme for some years now, said Dr Meade.
Dr Brian O’Mahony
GPs, however, are sometimes initially reluctant to move away from the way they have always done things. “More GPs are coming on board. Once they have tried this once, they never go back to writing letters,” said Dr Meade. “Again these referrals are completed from within GPs’ software. There is a lot less writing and there are major benefits for the hospital side. Standardised referrals are much easier to assess.”
Electronic referral applies in regard to certain cancers — lung, prostate and breast — and it is a shame that more cancers cannot be referred in this way, in Dr Meade’s view. A standard referral letter, for example, is still required in regard to suspected colon cancer.
Change management
One of the main barriers to the development of electronic referrals is not the technology but the people, the Kilmacud GP believes. Change management within the hospital can be difficult to achieve: consultants must change their work practice to be prepared to deal with the electronic referrals. However, Dr Meade’s view is that electronic referral will eventually prove to be a time saver. “The model is proven. It would be relatively easy to roll that out for other services,” said Dr Meade.
“It makes sense if there is a central office dealing with referrals,” he added. The practice is that electronic referrals should go to a hospital department (gastroenterology, for example) — rather than to a specific consultant. Thus the referral would be handled within a central office.
“In the past, there may have been incidences of GPs sending two letters to different consultants of the same specialty in order to access the quickest appointment for the patient.”
Among other new initiatives, Saint John of God Hospital, Stillorgan, is seeking to develop electronic discharge letters from both inpatient and outpatient services.
In terms of GP software, we are likely to see decision support with embedded clinical guidelines included in GP software in the future. Specific prescribing and other advice is likely to be based on the patient’s age, gender, status (pregnancy, for example), other medications and family history.
Patient demographics
Dr Meade believes there will be much better reporting functions to analyse patient demographics, diseases and trends in the future. There will also be chronic disease protocols to enable nurses to manage chronic disease better.
Meanwhile, the PCRS website now offers an extended range of functions for GPs, including enabling them to renew a patient’s medical card before it runs out; add a new baby to a family’s medical card cover; change the code of a patient on a GMS list; get detailed prescribing analysis; and check GMS eligibility.
Online education is another growth area in the medical world. There is now a wide range of online educational options available to GPs (from ICGP, GP Buddy, GPIT and drug companies). These confer clear advantages for GPs, who find it hard to get to meetings. Interactive sessions are also now more popular where GPs can vote or ask questions, said Dr Meade.
Social media
Social media is now widely used in medicine as a way of communicating, making it possible to gain access to a younger demographic. Potential risks remain, nonetheless — where GPs and practices might neglect to respect boundaries and privacy. Several guidance documents have been produced to help doctors on the use of Facebook, Twitter and other social media.
Some GPs have their own Facebook pages and some use Twitter. Twitter is also used to talk to other doctors — or to join journal clubs or discussion groups on various topics. “If a doctor wishes to make contact with people in the 15- to 35-year-old age group, Facebook is an option,” said Dr Meade. Services in the practice — family planning, vaccinations or cervical smears, for example — can be highlighted. However, guidelines that Dr Meade was due to cite at the seminar last Saturday urge doctors not to get involved in individual problems and not to give advice online.
There is huge interest and investment in the field of telemedicine — both in the UK and the US. Telemedicine is seen as the answer to the problems presented by an ageing population and chronic disease care and has been claimed to reduce hospital admissions and mortality. Critics, however, charge that it adds to anxiety and increases GP workload. Patient selection and clear guidelines are keys to success, said Dr Meade. Telemedicine is also increasingly important in Northern Ireland.
However, Dr Meade told Irish Medical Times that there remained a need for more evidence on the matter. Initial benefits were not as great as initial UK NHS projections — and costs were higher.
IT costs are still quite high, said Dr Meade: electronic devices remain too expensive to make telemedicine cost-effective and widespread at present. However, as costs come down, usage will increase, he concluded.