Users in the driving seat

The key to any successful e-healthcare programme is the involvement of clinicians and administrative staff from the very start of design and development. They’re the ones who will use it, they know the functionality they will need, and they can say what works and what doesn’t. EMIS, which supplies 56 per cent of the computer systems in UK doctors’ surgeries, believes this is crucial to the way it approaches research and development.

So with Qute, a joint project between EMIS and Huntingdonshire PCT (now part of Cambridgeshire PCT), the end users were involved in development from the very beginning. In fact, it was the clinicians and surgery staff that identified the need for this primary care IT tool in the first place.

Driving the process was Huntscom, a group of GPs in Huntingdonshire that came together to meet the challenge of Practice Based Commissioning (PBC). As GPs move to becoming providers as well as purchasers of healthcare, more and more doctors are forming limited liability partnerships to deliver services that would previously have been delivered through secondary care, such as physiotherapy and podiatry.

A big change

“This is a big change,” says Guy Whitmore, EMIS' project director for Qute – which stands for Query Utility for Enterprises. “But of course lots of things will still be done at the secondary trust level and the big challenge for GPs is how to keep track of those events.

“Until now it’s been a laborious process for GPs who have had to physically sit down with a highlighting pen and two sets of Excel spreadsheets – one containing their own referral record for a patient, the other containing the trust’s record of events for that patient.

“Huntscom wanted something that would make this job easier – and allow them to carry out searches and reports to identify particular types of patients or to filter particular types of events relating to one patient.”

Searching for a solution

Huntscom approached EMIS co-founder and clinical director of EMIS, Dr David Stables, to see if the Leeds-based company could help find a solution.

Crucially, Huntingdon GPs were already using a programme called Quebec, which would ultimately prove essential to the development of Qute. Developed by the Anglia Support Partnership (ASP) – a shared service organisation which supports the PCTs and Mental Health Partnership NHS Trust in Cambridgeshire – Quebec allowed the PCT to produce aggregate reports on secondary care activity.

Guy Whitmore explains: “What practices needed was some way of relating those secondary care events to their own primary care referral record. That’s what we’ve been working to develop in partnership with the ASP team that developed Quebec – and that’s what Qute is.”

Paul King, project manager at ASP says: “We quickly realised the potential of Quebec and it was proving very popular with GPs. But to take the product forward so we could make it fully fit for purpose in the world of Practice Based Commissioning it was essential we found a partner like EMIS who understand primary care data.

“It’s been a really exciting collaboration to work on and together we have delivered an innovative and truly user-driven product which will help GPs negotiate the PBC landscape.”

Qute is web-based therefore it requires no deployment. It seamlessly integrates demographic and clinical data from EMIS (and even non-EMIS practices) with Secondary Care (Clear Net) Data, which is downloaded every six weeks and processed by Qute into a relational database of outpatients, spells, episodes and A & E data sets. Each of the A & E data sets contains details such as specialty, consultant, provider, diagnosis codes, procedure codes, appointment details, outcome, timeline and costings.

Primary and secondary care data on split screen

Users can view both sets of data on a split screen with primary care on the left and secondary care on the right – a specific requirement of the Huntscom panel that the development team was able to incorporate into the design.

“In this way the user can reconcile what they have been charged by the trust with their own referral record,” says Whitmore. “In most cases the patient’s situation has become more complicated and more referrals and complex treatments are required. In others it means the practice may perhaps have grounds for challenging the secondary care record.”

He adds: “As we worked to develop Qute, we continually went back to the end users and they told us what they liked and what they didn’t like. We’d then make the suggested changes and go back to them with the results. It’s meant that we’ve been able to fine-tune Qute along the way to make sure it does exactly what the clinicians and the administrative staff want it to do.”

One crucial user-led function is Qute’s ability to filter the secondary care record so that only particular types of events are listed; a GP can view only cardiac events, for example. Developers also added the ability to carry out searches and reports to identify, for example, high cost patients or frequent visitors to A&E, again in response to user requests. Reports can be exported to MS Word, MS Excel or csv file.

Following the successful pilot of Qute in four practices in the area, EMIS and Cambridgeshire PCT have now formed a commercial arrangement and aim to take the product to market in the New Year.

Guy Whitmore concludes: “What we’ve got here is a truly user-driven product that fits their business processes and workflow. We’re very excited about it and believe it will deliver great benefits to GP surgeries across the country.”