I’m reaching out to inquire if other organisations are facing challenges related to correspondence, specifically:
Receiving correspondence that is not intended for them.
Not receiving correspondence that should be directed to them.
At Family Planning, we’ve encountered a significant problem in this regard. Despite regularly sending referrals to colp and gynae, there are instances where discharge (D/C) summaries are inadvertently sent to the client’s GP, overlooking us. Conversely, we have been recorded as the client’s GP, resulting in us receiving D/C letters from specialties that should be managed by the client’s GP eg. cardiology.
This issue appears to be widespread across various District Health Boards (DHBs). I’m curious if anyone is aware of any ongoing projects or initiatives aimed at resolving these challenges. Additionally, are there any practical steps that can be taken to mitigate such problems?
One potential solution that comes to mind is the incorporation of a ‘referrer’ and ‘GP’ field in DHB computer systems. This could streamline the communication process and ensure that relevant parties receive the necessary correspondence promptly.
I’m eager to hear your thoughts and insights on this matter.
Misplaced communication is a common theme around getting the right practitioner-role and facility linked at the time of the sending the link.
There is some projects working on directories, but ensuring shared care correspondence is under a different subscriber model of communication that is likely to be solved through Hira, under the event notification programme.
It’s an evolving area as the first use case is for death notifications, but eventually it will be used in your cases.
Hi Sarah,
Thanks for raising this issue.
Managing correspondence is a current pressure point for GPs, so interesting to hear how it is playing out for you as well.
I found some of the recent webinars by GPNZ (soon to be renamed “Primary Care NZ”) helpful for looking at current effort to improve/work around this: https://gpnz.org.nz/events/inbox-management-webinar-series/
primary-care
Perhaps a side issue, but as GPs I think it’s fair to say we feel invisible to hospitals except as the catch-all for delegating paperwork, with no recognition of our own specialist medical work, financial and workforce capacity pressures.
I do think that changes to digital systems will help with some of these challenges - like the Hira project for connecting services to avoid duplicated, non-updated data. Ignoring the issues with mobile workforce & mobile patients, currently in my work setting GPs have to manually update the hospital record for a patient’s registered GP by noticing that it is incorrect on HealthOne, and then sending an ERMS referral to hospital administrators to update these details. So it is messy.
It’s not just a data transfer issue though - it’s also how the data is received into GP PMS systems. I’d love it if, for example, discharge summaries and clinic letters were coded better, e.g. with FHIR-type categories, so that things like diagnoses, medications, tasks and recalls could be automatically pre-loaded from the correspondence into the appropriate categories in our PMS systems. Wading through all the free text and manually adding all these details is a very time-consuming aspect of our job, and difficult to delegate.
Any other suggestions out there on how we should raise this issue?
Kia ora @mca, for highlighting that brilliant webinar series!!! The medico-legal one was especially important to me.
This ‘Results Management’ absolutely needs strong advocacy and should be a top priority for several reasons:
The webinar consistently highlights the impact of result-management on our foundational health system (e.g., General Practice)
Patients’ Rights are at stake → they have a right to access medical services + those medical services should not cause them harm through delayed or erroneous results management.
The impact of our currents system-level failure to prioritize this problem contributes directly to health inequity because the people who have the MOST results, shared across providers, are those with complex chronic medical conditions directly related to contending with negative social determinants of health.
With these reasons of pragmatism (e.g., direct impact on current health system crisis), human rights, and justice, is there a way we (here on eHealthForum) can build a consensus around clinical informatics solutions?
The referenced medico-legal video above has @Anna from Ministry of Health talk about a document that may be available now (I couldn’t find on website, but have sent an email to GPNZ asking about it), that outlines ‘Principals’ to guide ‘Transitions of Care & Results Managements’. This would be a good place to start.
Next, I’m thinking of great discussions I’ve had with @david.vink about the importance of capabilities. Results managements is a core activity of care coordination, my personal passion. Care coordination is a process that occurs when care is transferred between 2 or more providers or services . . . this happens all the time when a script is sent to a pharmacy. However, it really is most seen, and most fails, when someone has complex chronic care with lots of providers and services involved. ‘Follow-up & Monitoring’ is a core care coordination activity, as well as ‘negotiating responsibility’, and ‘information transfer’. I’ll attach below the article Mariana Hudson and I wrote that explains care coordination.
Is there appetite to track down the MoH pending ‘Principles’, and then build consensus around what capability needs to be defined to practically implement the principles?? After having listened to those 3 x webinars, I think addressing and incorporating all those points into a comprehensive capability would be a great start! The framework of care coordination might also be useful.
Hi Emily, the transfer of care document is nearly ready to be published. I’ll link it here once it’s available It would be really good to see it used as the foundation for expectations around transfer of care within the regions.
Very cool, @Anna . Really looking forward to reading that. Does Manatū Hauora/MoH have a plan for how to ‘implement’ this foundation? Can this work be integrated with any of the API work being done via Hira?
It would be really good to see it used as the foundation for expectations around transfer of care within the regions.