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Welcome to the PCEL message board. This is a forum to discuss topics relevant to primary care.
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Channel Trading Strategy
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ANJUM ANJUM
25th Aug 2010 01:04
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Mens Weight Loss Products!(5499)
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Muhammad Usman
19th Aug 2010 04:15
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Star online jobs franchise opportunity (slvr-660045)
Become star online jobs franchisee & Get 25% to 35% on each refer and 6% on each earned income of your member. With limited investment you can earn unlimited income every month. For detail visit: http://www.staronlinejobs.com
awais malik
24th Jul 2010 08:34
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Ct for Art @ The Royal Institution
Hello People,
I am in need of CT scan data to be used in the production of an artwork to be shown at the royal institution in September.
Would any of you good folk know of a good lead as to where I could lay my hands on some quality data? I'd be immensely grateful for any tip-offs.
Salutations everyone.
quabrid@gmail.com / 07887 870 319
alex bunn
7th Apr 2008 19:22
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AMIA AND AHIMA Release Basic Principles for Ensuring Confidentiality of Personal Health Information
Bethesda, MD, September 7— Basic principles need to be incorporated in all rules, regulations, or laws pertaining to personal health information (PH) if it is expected to flow across organizational boundaries through the nationwide health information network (NHIN), according to a position statement released today by the American Medical Informatics Association (AMIA) and the American Health Information Management Association (AHIMA).
“Public confidence that personal health information will be respected and that identifiable information, to the maximal extent possible, will be used only for authorized purposes is essential to the success of any electronic health information exchange,” states Don E. Detmer, MD, MA, President and CEO of AMIA. “Health information confidentiality and security protections must follow PHI no matter where it resides.”
The Associations release the following principles that organizations accessing or storing PHI should abide:
- Inform individuals, through clear communications, about their rights and obligations and the laws and regulations governing protection and use of PHI.
- Notify individuals in clear language about the organization’s privacy practices and their rights in cases of breaches.
- Provide individuals with a convenient, affordable mechanism to inspect, copy, or amend their identified health information/records.
- Protect the confidentiality of PHI to the fullest extent prescribed under HIPAA, regardless of whether the organization and its employees all comply with HIPAA, state laws, and the policies and procedures put in place to protect PHI.
- Use PHI only for legitimate purposes as defined under HIPAA or applicable laws.
- Prohibit the use of PHI for discriminatory practices, including those related to insurance coverage or employment decisions.
- Timely notification of individuals if security breaches have compromised the confidentiality of their PHI.
- Work with appropriate law enforcement to prosecute to the maximum extent allowable by law any individual or organization who intentionally misuses PHI.
- Continuously improved processes, procedures, education, and technology so that PHI practices improve over time.
“Uniform and universal protections for PHI should apply across all jurisdictions in order to reduce confusion and increase understanding by organizations and individuals,” adds Jill Callahan Dennis, JD, RHIA, president of AHIMA.
To view the position statement, visit AMIA’s Web site at:
http://www.amia.org/informatics/public_policy/index.asp#confidentiality.
About AMIA
The American Medical Informatics Association (AMIA) is an organization of 3,500 health professionals committed to informatics who are leaders, shaping the future of health information technology and its application in the United States and 41 other nations. AMIA is dedicated to the development and application of informatics in support of patient care, teaching, research, and healthcare administration and public policy. For more information, visit www.amia.org.
About AHIMA
AHIMA is the premier association of health information management (HIM) professionals. AHIMA’s 50,000 members are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the HIM profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning. For more information, visit www.ahima.org.
Judas Robinson
8th Sep 2006 09:26
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NAO Report - The National Programme for IT in the NHS
This report was published on 16th June 2006. The comment of the British Medical Association was:
"The BMA supports the greater sharing of healthcare information and recognises that increased investment in IT has the potential to deliver improved patient safety. However, the publication of the National Audit Office report raises a number of concerns.
"The report criticises the National Programme for not doing enough to engage with healthcare workers using the system, a sentiment shared by the BMA. The Association recognises recent improvements in engagement with grass roots doctors as IT systems will only work if the development process involves those who are going to use it.
Judas Robinson
19th Jun 2006 14:17
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Primary Care Informatics Working Group (PCIWG) of the European Federation for Medical Informatics (EFMI)
The working group is holding a workshop during the day on Sunday 27th August 2006; prior to the opening ceremony of MIE 2006 in Maastricht. Working group members and people with an interest in Primary Care Informatics are invited to register for the workshop on the MIE web-site: http://www.mie2006.org
The workshop is entitled:
GP computerised medical records: goldmines for research?
Date and times:
Sunday, 27 August 2006; 9.30 – 16.30 hours
Routinely collected data should be a goldmine for research. Computers offer the prospect of access to vast amounts of data. However, there are also challenges which need to be addressed if these data are to be used for research.
This workshop included presentations, discussions and the opportunity to visit local general practices and see practice IT systems demonstrated and talk to local GPs who use the system.
The workshop also provides an opportunity for GPs and Primary Care professionals and researchers the opportunity to network prior to the MIE2006 conference.
Details of the workshop can be found at:
http://www.mie2006.org/documents/WorkshopMetsemakers.pdf
Register for the conference at:
http://www.mie2006.org
Please book early for this workshop.
Simon de Lusignan
Primary Care Informatics Working Group Chair
slusigna@sgul.ac.uk
Dr Simon de Lusignan
18th May 2006 09:41
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St. Helier GP referral guidelines
Dear All
Attached. Significant changes are:
1) The PTH issue in Stage 3. I think sensible options would include: checking if pt referred (as these most likely to run into probs with fracture/calcification etc); checking if eGFR < arbitary value (eg 40); ignoring. I would favour either of 1st two.
2) Clear mention of relation between "normal" eGFR and age
3) List of conditions where not valid
4) Emphasis on need to compare with old creat when low eGFR 1st detected
5) Emphasis on need to discuss (not necessarily refer) all stage 4
6) Hb target < 10.5
7) Removal of HCO3
I will like to upload these ASAP, as the PTH issue in particular causing some consternation. Could I ask for any comments within a week?
Once we are all convinced these are final final, then may be sensible to issue a brief letter to users pointing out main changes.
Hugh
Dr Hugh Gallagher
5th May 2006 10:56
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St. Helier GP referral guidelines
Hugh
I think the guidelines are significantly improved in terms of content, although they are beginning to risk information overload. There will be a direct correlation between simplicity and usefulness - anyhting that requires many GPs to think more than for a few minutes will probably result in a referral. [Perhaps that would be no bad thing].
Re PTH, agree with the check on referral option (although actually little point at this point, as we will only recheck it anyway...). Probabl;y best not to overorder in primary care, esp as interpretation of results based on old samples may be difficult.
My main concern related to the advice re metformin. I strongly believe that we should not be advising GPs to stop metformin, even at low eGFRs, in type 2 diabetic patients who are overweight (the majority), and who will probably end up on insulin (the majority). The very small risks are far outweighed by the CV benefits of metformin, and there is published evidence to suggest that there is no real increased risk of metformin in ESRF. At the very least, we should leave it open to the GP's discretion - or maybe add a section to the e-guidelines summarising our view/the evidence in more detail for keen GPs or those who would like some reassurance for leaving patients on metformin for longer than currently recommended.
Peter
Dr Peter Andrews
5th May 2006 11:00
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Latest iteration of CKD guidelines
Dear Colleagues,
I agree, the guidelines are getting better all the time...
Something which came up for me yesterday - was whether yearly creatinine in first degree relatives of people with Stage 5 is justified on a yearly basis? Three healthy siblings all in 40s might have to come in annually for hte next 40 years? Is this something to do once or less frequently maybe annually above a certain age? Or depending on the age of the relative with Stage 5 CKD?
Dr Simon de Lusignan
10th May 2006 12:09
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Latest iteration of CKD guidelines
That is an interesting queston. My advice comes straight from the UK document, but an annual check seems OTT if stable. I will amend.
Dr Hugh Gallagher
10th May 2006 12:11
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Parathyroid hormone assay
The Algorithm for the renal QOF for CKD from st Hellier suggests that for every patient who has CKD - which may well work out at 10% of the population- should have various bloods including parathyroid hormone assay. Is this test as expensive as we think and if so should we discuss with St Helliers whether this is appropriate for 10% population.
David Eyre-Brook
27th Apr 2006 11:42
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Parathyroid hormone assay
Dear David,
I would agree with that. I think parathyroid testing can't reasonably part of every primary care assessment of patietns. I will forward your comments to Hugh Gallagher, author of the guidance for his comments as to where this should come in GP assessment (if at all.)
This maybe hightlights the need to establish a renal LIT before the labs and secondary care are overwhelmed with referrals and tests - and the PCT has to pay the bill. Nicola, Hugh, Ruth and I had a useful meeting about this - and I am expecting something to happen soon after we are through the public consultation.
Best wishes,
Simon
Dr Simon de Lusignan
27th Apr 2006 11:50
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Parathyroid hormone assay
Dear David and Simon
Thanks you for your query. This is a very difficult area. National UK Guidance on CKD recommends that all patients with stage 3 should have a PTH measured on 1st diagnosis. However, as you say PTH assays are not cheap. My understanding that at St Helier the cost is around £10 (but the cost to the PCT is actually lower). I am not sure of the figures for RSCH/FPH. There are also issues about getting the sample to the lab - less of a problem with the EDTA tube assay - but perhaps Paulette or Jeff could clarify.
Interestingly high PTH in stage 3 CKD is often due to dietary deficiency of simple vit D (and is treatable with simple vit D) rather than impaired vit D activation (ie dihydroxylation, which is treated with "renal" "pharmacological" alpha-calcidol - which requires fairly intensive monitoring).
For this reason the UK guidelines actually suggest measuring vit D level (an extra £20!) in all with raised PTH, and if vit D low treating with simple vit D!
The other issue if of course what benefit we are likely to gain with treating raised PTH early. We may reduce rates of fracture, and improve cardiovascular outcomes (through less coronary calcification - a major problem certainly with more advanced CKD). But a firm evidence base does not really exist, although there are a lot of strong opinions.
The question is what we should do/recommend in practice, esp in stage 3 CKD - and I have been in dialogue with national figures to try and resolve this. Options include:
- ignore Ca/Pi/PTH/Vit D in all stage 3
- check PTH once; if raised (>7) refer to renal unit - this is on the current iteration of our guidelines
- check PTH once, if raised give trial of non-proprietary Ca/Vit D (but then need to decide what, if any, monitoring is required)
- give non-proprietary Ca/Vit D, or even multivitamins, to all - this is inexpensive, but again need to decide on monitoring etc. Vit D preps available OTC contain small quantities of Vit D - would not need monitoring but ?sufficient to correct deficiency.
- go the whole hog and start measuring vit D levels!! not an option I think.
Safe to say there is no consensus among experts as to the optimal approach.
Certainly the ignore option is easiest (although in the stage 3 patients I see in OP I do check PTH and give simple vit D if raised). I am rewriting our guidelines at the moment and I think this is the most pressing area to address.
I have copied this to a large number, and I would interested to hear views.
Dr Hugh Gallagher
27th Apr 2006 11:59
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eGFR read codes
our local lab has started reported eGFR but currently there are no read codes in existance to help us in preparation for GMS2
National programme for It should get the act together and release Read Codes so GPs can prepare them selves fro the GMS2 and moniter CKD acording to NSF
We are expected to look after patients with CKD but there is no way at the moment to moniter these patients in primary care in the abscense on appropriate Read codes
Could NHS Terminology Service come up with read codes inline with classification of CKD? and come up with this now ?
DRrRavi Seyan
13th Feb 2006 12:17
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BBC Radio 4's Today Programme - Healthcare Broadcasts
Two broadcasts available from the BBC Radio 4's Today Programme dealing with the government's plan for healthcare.
Broadcast 30th January 2006.
http://www.pcel.info/index.cfm?fuseaction=home.indexcard&id=1445
Three minute radio broadcast on the government's healthcare plan for England which proposes fundamental changes in the way patients are offered advice and treatment.
http://www.pcel.info/index.cfm?fuseaction=home.indexcard&id=1446
Eight minute radio broadcast in which The Health Secretary, Patricia Hewitt, talks about the government's healthcare plan for England, which proposes fundamental changes in the way patients are offered advice and treatment.
Judas Robinson
30th Jan 2006 15:56
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Nine new QOF targets announced today
See link top right from:
http://www.nhsemployers.org/pay-conditions/pay-conditions-632.cfm
Nine new areas - totalling138 points - are being introduced:
Dementia 20 points
Depression 33 points
Chronic kidney disease 27 points
Atrial fibrillation 30 points
Palliative care 6 points
Mental health (new) 9 points
Disease register:
Obesity 8 points
Learning disability 4 points
Organisational indicator:
Recording patient ethnicity 1 point
Dr Simon de Lusignan
23rd Dec 2005 01:47
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Podiatry 7
A very warm welcome to Podiatry 7 a new Podiatric forum set up for those involved in the care of the Foot and Ankle
Please take a look at our forum and tell us what you think
http://www.takeforum.com/forum/pod1.html
Mr S. J. Kite
17th Dec 2005 11:07
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Defining the future role for community hospitals
Community hospitals are a well established feature of the NHS. However, my PCT (Guildford and Waverley - http://www.gwpct.nhs.uk/ ) is going out to public consultation on their future. We would like to define a new role for community hospitals and would be happy to learn from the experiences of others elsewhere. I have written a short paper, on the possible future role of community hospitals, and I would be grateful for comments on it. My personal view is that they should be developing a new role supporting intermediate care; where admission to an acute hospital is not needed but community care can't provide sufficient support. However, there are a legitimate range of views about this. I have started this discussion string to get others views - about what the future role of the community hospital should be.
28th Nov 2005 12:02
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The Future of Primary Care - Meeting the challenges of the new NHS market
Users of PCEL are recommended to read Lewis and Dixon's excellent paper on the new challenges for primary care - in the new NHS market (See PCEL Index card No: 1433 http://www.pcel.info/index.cfm?fuseaction=home.indexcard&id=1433 ) Ths encapsulates the dilemmas assocaited with wanting to make the primary care service more responsive to peoples needs - whilst at the same time not wanting commercial pressures to become a block to collaboration. An interesting quote from the paper is:
"Contestability may drive up efficiency but perhaps at the expense of interprofessional and interorganisational collaboration - such collaboration often being a prerequisite for high-quality services."
Judas Robinson
28th Nov 2005 10:15
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Welcome to the PCEL message board
Welcome to the PCEL message board which is intended as a platform for discussion and dissemination of views relating to primary care. Please take the time to register and fill out some basic personal details when you first decide to post a message. Only your username and not your personal details will be displayed on the message board. The board will also accept Word or PDF files and images.
Judas Robinson
8th Nov 2005 10:43
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