Health Informatics Programme for Coronary Heart Disease

Never before has the spotlight been placed so squarely on primary care to deliver accurate, timely, appropriate information that demonstrates the level and quality of care delivered. The Secretary of State in his foreword to the National Service Framework for Coronary Heart Disease speaks of helping professionals to give 'better, fairer and faster care' and of making 'the NHS of old unrecognisable by the time we have finished our ten year programme of modernisation'.

This exciting challenge has been picked up and turned into a new programme of action for primary health care, HIP (Health Informatics Programme) for CHD. The aim is to support the clinician at the point of care by enabling appropriate tools to be available at the appropriate time. The outcome will be the objective evidence required for clinicians to measure the effectiveness of their care delivery and in so doing will support the requirements of the NSF for CHD which lays out the definitive milestones and standards.

HIP for CHD is firmly placed in the arena of quality development and is a practical example of clinical governance. Clinical governance is quality development in action. It is about finding ways of doing what you do better than the standard. The organising idea, built into the design of HIP for CHD is that quality problems have multiple causes and the knowledge required to investigate and solve them lie in the minds of a number of different people. To that end, a multi-functional team of people from different professional groups and organisations (including the PPA) together with the private sector in the GP clinical system supplier community bring their particular domain expertise into finding the best solutions to the problems faced. That knowledge and expertise is aimed at solving the technical and professional issues that have arisen already and will arise.

The laudable aims of the Secretary of State for Health have to be seen in the context of everyday general practice for the impact to be fully understood; the average GP consultation time being 7.5 minutes. During this time the GP is involved in clinical problem solving whilst putting today's reason for encounter into context with the rest of the patient's health care needs.

The prime objective of HIP for CHD is to see measurable improvement at the point of care by using currently available primary care health informatics to support clinical activity including rapid feedback. This will enable practices to see which activities in relation to reduction and prevention of CHD, are going well, which have stagnated and which needs to be improved. The key to success here is seen in making certain 'tasks' easier to perform, by the recognition that meeting the standards of the NSF for CHD is everybody's business within the primary care domain and not just the job of the GP and by automating those processes that can be automated.

The technical tools currently under development include those to aid data entry in the form of templates and interactive clinical monitoring guidance; (These exploit the software that currently exists within the GP clinical suppliers systems) a suite of system specific clinical reports for a practice to 'run' as often as they wish;(These include the aggregation of data for 'register' creation and use) and the development of a special toolkit by the PPA which will enable practices, if they so wish, to be benchmarked with one another in a PCG/T. The purpose of benchmarking within HIP for CHD is to stimulate process. Benchmarking is a simple technique which prevents an individual practice standardising towards the mean. It is not a method to weed out the bad apples but a tool that will enable all the apples to be polished, the aim being to shift the whole distribution curve to the right. The data used for the benchmarking will be aggregated, anonymous patient data based on a set of queries run by the clinical system and in the first instance, e-mailed to the PPA. The aggregated, anonymous data will be made available to practices via NHS Net. This reflects the principle that domain experts are the best people to do what they do best! The expertise required to do this undoubtedly lies within the PPA. GP's and their teams are comfortable with and understand PACT data. An example of what this service may look like is shown below. Following feedback from clinicians and new knowledge we expect the tables to change but the underlying principles will stay the same.

HIP for CHD is still in its start-up phase and the graph shows the type of information that may be available.If you would like to find out more then contact Cheryl Cowley by e-mail: