At PPO Serve, we believe every patient’s care journey should be proactively managed and customised for their individual needs, then delivered efficiently and effectively by competent care teams.Dr Brian Ruff
A condition and circumstance driven patient centric workflow management system based on clinical protocols and guidelines
The ICS is a comprehensive workflow system with tasks and clinical decision support for patients that reflects their relative complexity and severity. It supports consistent high-quality delivery of ‘clinical products’ in a consistent manner. Good outcomes for the population being managed is efficiently done. It is cloud based and is scalable to many patients and supports a number of Team products – currently for general population medicine (The Value Care Team), for HIV specifically (The GP Care Cell) and for maternity care (The Birthing Team). It is a unique solution for clinical teams whose priority is better service and outcomes for their patients.
It hosts Scheme claims data for each patient, converted by the Episode Population Grouper (EPG) into current and past medical history ‘labels’; as well as calculating the patients relative risk. The clinical and risk information combination triggers appropriate severity-related care plan tasks – all before the clinician has seen the patient!
ICS clinical workflow supports Multi Disciplinary Teams (MDT) with recommended diagnosis-related tasks in care plans. Tasks are diagnostic, investigations and therapeutic. In the process, it collects new data that refines the care plans and is automatically presented back as key patient summaries. In addition to diagnosis data, it also collects disease severity scores and psycho-social and environment information, all relevant the optimal management of the patient.
The ICS generates outcome performance reports that can guide the Team’s tactical efforts to improve their outcomes. This represents a unique clinical management system that guides and integrates the Team’s work for the population that it is accountable for.
The ICS is a patient management system, designed to be a shared patient-centric platform used jointly by the Teams to manage the patient’s care. The patient-centric architecture of the ICS with specific task allocation by team roles represent a radical and unique departure from the conventional electronic medical record, that typically just records an individual clinician’s interaction with a patient, so the same patient has multiple, unconnected and even contradictory records held simultaneously by unconnected clinicians.
√ The ICS is the vehicle for specific Care Plans, which contain tasks derived from best practice protocols and plans, maintained by PPO Serve based on the experience of the Teams and from new evidence in international literature. Care Plans ensure standardised and proactive care by the whole Team.
√ Risk segmentation tools and risk summary labels establish the individual relative risk, and this is in turn linked to Care Plans that ensure the appropriate intensity of care is delivered.
√ Patient data generated from the ICS is saved to a structured clinical database, along with other data sources. The database is based on a sophisticated health informatics model that uses healthcare specific nomenclature and coding systems to describe diagnoses, investigations and treatments, from which it automatically produces individual patient summary reports.
√ Reports: At a system level, operational information and trend reports for productivity and quality are tracked and provided to management to support decision making. It displays relevant information in tables and graphs and can support scripting and stock control