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eHealthNews.nz: Features

A personal perspective on patient-centred care

Thursday, 20 December 2018  
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Picture: Northland GP Andrew Miller

 

eHealthNews.nz editor Rebecca McBeth

 

Northland GP Andrew Miller became the clinical director of information services at Northland District Health Board in 2015. At the time he was off work for 16 months after being diagnosed with cancer in his nose in 2014.

 

Andrew Miller’s view of the health system and his role in it is shaped by his experience as a cancer patient, which gave him real insight into how the system operates.

 

“I got treated well in terms of my medical treatment, but there was virtually no patient-centred care,” he tells eHealthNews.nz.

 

He recalls seeing a huge number of different specialists, nurses and allied health professionals, and had no patient portal and no shared care plan.

 

“I had no idea what was going on most of the time as I didn’t really have anyone looking after me,” says Miller.

 

“When that happens you think, is that acceptable to patients and are there ways of making that better?

 

“I struggle to understand why we don’t focus on that: what matters to the patient.”

 

Entering DHB-land

 

Miller has always had an interest in health IT, even before his practice installed the first version of the MedTech practice management system more than 20 years ago.

 

“I’ve been an early adopter in terms of my interest in using IT to enhance both the care of my own patients in general practice, and I’ve done postgraduate qualifications in health informatics because of my interest in this area of the health system,” he explains.

 

However, it was with “some degree of surprise” that he was offered the DHB job, as he is not a hospital doctor, but believes it is because “90 per cent of all interactions with patients don’t occur inside the hospital”.

 

“We have a real interest in Northland to look at how we can engage with patients in better ways and enhance their experience and access to information,” says Miller.

 

Key IT developments, such as the use of patient portals and shared care planning, are areas where his GP and patient experience is of benefit.

 

Clinical leadership

 

Miller and some clinical colleagues are part of an information services steering group that prioritises and assigns programmes of work within the DHB.

 

The group has steadily become more clinical and has agreed some broad principles for how to run a health system supported by IT. These are that technology should enable the system to be paperless, safer for patients, better for providers and interoperable. 

 

“How we then run programmes is weighed up on whether they fit those principles,” he says.

 

Programmes of work have clinical leads, such as a senior doctor who is interested in infrastructure leading the wifi project and one who is focused on enabling better telehealth options and mobility. A different clinician is leading on health records transformation and another on electronic sign-off.

 

“We have powered up inside the DHB the clinicians’ view of how we might better use IT in a way that’s more likely to succeed, because we have got the end users pushing things along,” he says.

 

However, while the programme is moving in the right direction, it is still under-resourced, and Miller says they are struggling to give clinicians time “to step away from their day job to deal with this stuff”.

 

“It’s interesting for a GP to see how varied and ad hoc decisions about IT purchasing is in DHB-land. People can do things without looking at other parts of the system that aren’t integrated or collaborative with other providers,” he explains.

 

A patient-centred system

 

Miller believes the health system needs to be more consumer focused and truly listen to what patients want.

 

He argues that the information held by health professionals is the patient’s information and, while clinicians are custodians of it, patients need access. Giving this access also means patients can help by editing it and fixing errors.

 

“We are hearing noises about being more patient focused, but nothing is actually happening.”

 

Miller says a key issue is that while clinicians are trained in delivering evidence-based medicine, they are not trained to talk to patients about what they want, and therefore they need IT systems that are “overtly patient-centred”.

 

This means patient portals with information that is fully accessible and editable by patients.

 

“If we have a system that does that, we suddenly change the way we work,” he says.

 

He says the new regional collaborative community care system being tendered for in Northland could be a game-changer, and he believes the region needs a patient-centred product.

 

“It’s an incredible opportunity to shift how we do things without people realising that we’ve done it,” he says.

 

The chosen system will ultimately be available to any community provider in the region that wants to use it.

 

He says that while most health IT investment goes into hospital systems, that is not where it should be directed, as most care is delivered in the community.

 

“If you have a system that patients love to use, they could do a lot of their own self-care management and, by keeping people well, everyone does better,” Miller says.

 

“We should focus on a system that’s good for patients and if we do that they will look after themselves wherever possible.”


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Read further Clinicians in Digital Health profiles

 

Kerry Macaskill-Smith

 

Karl Cole

 

Kerry Macaskill- Smith 

 

Bev Nicholls  

 


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