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Clinical need drives development of general practice software

Monday, 5 November 2018  
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Picture: Kerry Macaskill-Smith editor Rebecca McBeth


As GP lead for Ventures, the commercial and innovation arm of the Pinnacle Group, Kerry Macaskill-Smith is in the unique position of helping to develop a practice management system that she uses in her own practice. 


Kerry Macaskill-Smith sees her role as “bridging the gap between users and creators”.


She works two days a week at NorthCare Grandview Road practice in Hamilton, which serves a lot of low socioeconomic patients with high care needs. It is also one of Pinnacle Midlands Health Network’s, and the country’s first, Health Care Home practices.


The other three days she spends at Ventures, which in conjunction with IT company Valentia Technologies has commissioned a new cloud-based mobile practice management system called Indici. This supports the HCH approach, which was also developed at Pinnacle.


HCH is a model of care based around a series of core principles, including improving access by offering alternative options for patients via email and telephone, targeting face-to-face consultations to those who need them most and proactive care planning for all patients.


Macaskill-Smith says the Indici system came about because when Pinnacle started developing HCH and introducing it into practices in 2011, it was not well supported by the patient management system in use at the time.


A developing role


Macaskill-Smith was part of the original group of clinicians that got together to discuss what a new system should do, then became more deeply involved, taking the lead in transferring the needs of the clinicians to the technical teams.


“It was also connecting technical staff with the clinical people and trying to be a bridge between those two worlds,” she says.


While she does not have any formal IT training, Macaskill-Smith says she developed the ability to describe things like clinical workflows in a way that developers could understand. She is involved in a lot of testing of the system, along with clinical and administrative colleagues.


Her job is also to sometimes have hard conversations with clinicians, such as saying that a process they want the system to follow is not best practice.


“An IT person would never get away with saying that to a clinician,” she explains.


She has worked as a GP for 16 years, always in the Midlands area and previously as a locum, which has served her well in terms of getting to know the region well.


She believes clinicians working in digital health need to be able to see both the big picture and the details, so they can see the potential future and the detail of how to get there.


“I love working with patients, but I also enjoy taking a step back and asking ‘how can we make this whole thing work better?’,” she says.


“Being part of the bigger picture is really exciting as we can develop stuff that nobody has been able to before,” she says.


Continuing to work in clinical practice means she stays up to date with what is happening out there in the world, as “the need in this area is not for IT technical people, but people who can talk to both sides and help them understand each other”.


What people want


The starting point for developing Indici was getting a lot of doctors, nurses and practice administration people into a room and asking “what do you want?”, explains Macaskill-Smith.


She believes it fits with the HCH model, but also suits the traditional needs of GPs.


Putting the patient at the centre of the record was one of the key driving principles behind development of the system, along with the need for the records to be mobile.


“The whole concept of having the patient at the core of healthcare is that the record needs to follow them,” she says.


“We need a single master patient record – so one patient, one journey – whereas information is siloed at the moment.”


The vision is also for information from different providers to be connected, so Indici incorporates open application program interfaces and the most up-to-date standards for conveying health information, she explains.


Finally, patients needed to have access to their records, making the patient portal aspect hugely important.


Usage of patient portals is higher among patients at HCH practices. An EY report released earlier this year shows that over three months from April to June 2017, 12 per cent of HCH patients accessed their portal, while only one per cent of non-HCH practice patients did the same.


Making it work


Macaskill-Smith says the Ventures Indici team sees technology such as telehealth as the enabler that allows clinical work to happen.


“Virtual consulting is happening all the time in HCH practices but it’s mostly by telephone so we’re looking at what we do to layer video conferencing on top of that,” she says.


She chairs a monthly clinical working group made up of nurses and doctors from various practices already using the system.


“We use this as an opportunity to report on what’s being worked on and as a sounding board for future developments,” she explains.


She says a couple of new practices are onboarding the system every few of weeks.


Tū Ora Compass Health, Te Awakairangi Health Network and Central PHO are committed to rolling out Indici, and ProCare is yet to decide between Indici and Epic.


“There’s a huge appetite for Indici around the country and not all HCH practices which it enables so well,” says Macaskill-Smith.


“It was always intended as an enabler of good quality practice.”

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