Dr Michelle Crockett is the Clinical Lead and Senior HealthPathways GP Clinical Editor for the WentWest Primary Health Network's HealthPathways project.
HealthPathways began in New Zealand and is an online tool designed to help GPs assess and manage conditions. In addition there is information about local referral options. It is now used in Australia with about 13 sites working on their own pathways. At Western Sydney we began our journey in 2012 starting with the diabetes pathways. Our first batch of pathways went live in November 2013 and we now have over 100 pathways on our live site and 100 more almost ready for publication.
Why is HealthPathways different?
Rather than a guideline, HealthPathways is an agreement between primary and secondary services on how patients with particular conditions will by managed in the local context. Those involved include GPs, specialists, allied health workers and community health workers. Each area tailors the content of the pathways to reflect local arrangements and opinion.
Who uses HealthPathways?
The target audience for HealthPathways is primary care physicians responsible for managing patients in the community and for initiating referrals to other services including hospital clinics. Our GP Registrars love HealthPathways as they find it extremely useful for accessing local referral options as well as an invaluable study tool when studying for their FRACGP exams. In Western Sydney we have also provided a logon for medical students from 3 universities – The University of Sydney, The University of Western Sydney and Notre Dame so that they can use HealthPathways as s study resource. Many pages are also useful for Practice Nurses as well as hospital clinicians
As a GP I often feel overwhelmed by the number of guidelines available. Most are very useful but are often lengthy documents and it can take some time to find the information that you are looking for. In addition they are on different websites and have different formats and structures. Some require subscription.
HealthPathways is a unique resource where information about multiple conditions is available on one site with no user fee. It is accessible via desktop, laptop, tablet and phone. The site is user friendly and the pages are structured in a consistent format so that information is easy to locate. The advice is concise with the use of drop down boxes to include additional information without making the pages long and difficult to navigate.
Pages are divided into clinical and referral pages. Text on the clinical pages is written using evidence based guidelines and local specialist opinion. The structure of the pages - ‘Assessment’, ‘Management’, ‘Referral’ and ‘Information’ make it easy for the GP to locate the information they need. The information section contains ‘Clinical Resources’ that are used if the GP wants to read more about the condition and will take you to an external web page that opens in a new window. Patient information allows the clinician to provide information about the condition that is written for patients. Some pages contain references for facts contained in the pathway.
Referral pages are extremely useful! Included on these pages is information about both private and public referral options. Who hasn’t spent ½ hour on the phone trying to track down an appropriate doctor or clinic to refer a patient too? HealthPathways has the information needed to find the appropriate service. This includes telephone numbers to speak with the specialists on call at local hospitals, lists of private specialists, as well as hospital and community clinics. Clinic information such as inclusion and exclusion criteria, how to refer, what is available, how the appointment is organised is included on the page. Everything the GP needs to know about what is available and how to access it!
In Western Sydney the process of documenting the services available has led to the identification of issues with and gaps in services, so that services are being redesigned to meet the needs of the community. This has opened dialogue between secondary and primary care so that we have a better understanding of each other and can work together to improve health services for the entire community.
HealthPathways and Western Sydney
Western Sydney has a population of over 850,000 with areas of significant disadvantage. Need for hospital care and the incidence chronic disease are growing at a faster rate than our population. We have 4 major public hospitals as well as a tertiary children’s hospital in our area. Having an efficient, cost effective health system is essential to our future. HealthPathways is an integral part of our health plan for the future. It is embedded into our Linked Electronic Health Record, our online-shared care plan for our patients.
Our most visited HealthPathways page is the physiotherapy referral page. This page contains no clinical information, only referral information about hospital physiotherapy clinics. The average session time per visit is about 6 minutes and almost 75% of users are return users.
Personally I find the site has multiple uses. Specific pieces of information can be located quickly during the consultation. For example I was able to locate the contact tracing time for an STI in less than 1 minute. At other times I read an entire page to familiarise myself with a condition I do not see often, review a condition or check that I have not forgotten anything important for a specific patient. Looking for referral information, especially at the local hospitals, has been demystified!
Pathways are reviewed at varying intervals to ensure information remains up-to-date and accurate. Alerts about major clinical changes are distributed throughout the HealthPathways community electronically. Pages such as influenza are updated yearly and most other pages every 2 years.
HealthPathways is password protected so access is restricted to health professionals. We are currently working on a patient site as part of HealthPathways that will have all of the patient resources available for patients to access. This site will not be password protected.
Some unexpected benefits
Working collaboratively with other health professionals has resulted in unexpected benefits. While most GPs have worked in the hospital system, many specialists have never worked in general practice. Working together has improved understanding of the issues and challenges faced both in general practice and hospitals and allowed discussions around potential solutions. Hospitals and other service providers are able to provide information about their service so that GPs have access to information on the full range of services available in their local area.
Communication from general practice has improved in areas where clinic details have been included in the referral section of HealthPathways and the number of inappropriate referrals has reduced. Discussions have begun around improving communication from the hospital to general practice including electronic communication and sharing of pathology and radiology results. Groups who rarely communicate but work in the same area are able to come together to discuss their services with a goal of better utilisation of the services available. Service redesign has occurred resulting in reduced waiting times at our diabetic clinics and the referral of patients back to general practice for long term management.
How to use HealthPathways – save time and improve patient outcomes
Like all new things getting into the habit of using something is the first hurdle. To get the most from the tool I suggest reading through the ‘Using HealthPathways’ section of pages. Learn how to use the search function and familiarise yourself with the layout of the different types of pages. This will allow you to locate the information that you need quickly. Have a link from your desktop to the site and open it at the start of each session. Encourage other staff such as Practice Nurses to become familiar with the site and its content.
There is a feedback button on each page that allows the user to send feedback about the content of any of the pages. You also have the ability to email a link to a page.
With over 700 pages available to be localised, HealthPathways is a fabulous and extensive resource for GPs. The ongoing dialogue between the primary and secondary care will continue to break down barriers with the aim of removing the silos in the system, to improve the patient journey through the health system. The ultimate goal being: the right care, at the right time, by the right person in a system that is integrated, streamlined, cost effective with improved patient outcomes.
For Western Sydney, in the words of my of my esteemed predecessor and 2014 RACGP General Practitioner of the Year, Dr Michael Crampton, HealthPathways is the answer!