Medical data ‘silos’ hampering the communication link with patients

Set to be trialled in a number of Irish GP offices in the New Year, online platform Sicknosis has already been through some initial tests which estimated its symptoms-checking software gives GPs up to 25 per cent extra time for each appointment.

Developed over the past year by Dublin-based Dr Paul Munsanje and co-founder John Muldoon ("I'm the technical guy"), the platform was "born of frustrations" Dr Munsanje was experiencing in consultations, feeling some of the more repetitive elements of his job could be "automated or streamlined".

What was created was a web portal which allows patients to upload their symptoms at home “or even on their phone while waiting for an appointment”.

“There are some follow-up questions specific to that symptom and the information goes into the doctor ahead of your arrival in the clinic,” says Muldoon, who is getting the platform in shape for the 2014 launch.

“The doctor can eyeball [the data] and then they can move the appointment along,” says Muldoon. “A lot of the information that the doctor usually has to extract through maybe prodding or probing a patient about how long they’ve had a cough, or asking ‘what colour is the phlegm’, etc, that process is all taken care of.”

Set to be sold on a “freemium” pay structure, the product is, Muldoon admits, one of many out there trying to create a greater link between patient and doctor.

Irish Medical Organisation (IMO) president Dr Matt Sadlier told The Irish Times that it "stands to reason" that patients would now want to use apps or online platforms to communicate with GPs or hospitals.

Useful adjunct
Programmes like Sicknosis, he says, can be useful "as an adjunct rather than a replacement" for current medical IT systems. "It's a personal opinion," he adds, "not that of the IMO", though he does feel there is a danger patients may feel too "guided" were a set of symptoms presented before them ahead of an appointment.

Dr Brian O’Mahony, who acts as project manager for the National General Practice Information Technology (GPIT) project, which is backed by the Irish College of General Practitioners (ICGP), was quick to defend current IT structures, saying GPs are already “highly IT-proficient” with “about 92 per cent of practices” using “GP practice software” already.

Such software, he explains, “tracks a patient’s registration details, their past history, their medication, allergies, consultations and lab results,” with all this data available for doctors “in a virtual waiting room”.

“There’s an awful lot of stuff that patients don’t see,” says O’Mahony, who adds “we’re way ahead of the hospitals” in ICT terms.

O'Mahony points to a number of approved vendors creating this software who are listed on the GPIT website such as healthcare informatics company, Socrates, which is currently in the test phase for a "patient portal", which he says in many respects may squeeze ideas like Sicknosis out of the market.

“If you’re a patient of a practice and you want to make an appointment, see your lab test results or you want a repeat prescription, you can log on to the portal and do all that stuff without ringing up and waiting in line,” he says, adding that the real benefits to such a system will be seen should a patient find themselves presenting in an emergency room.

Patient empowerment
"One of the problems in Ireland is that the information tends to be held in silos within the health service and it's difficult for the patient to put it all together," says O'Mahony, " but with the Socrates system, someone can say 'log in to this system, give this password, that's my record'. "It's patient empowerment," he adds.

As for Sicknosis, O’Mahony isn’t quite sure its “form-based symptom review” concept “would be of interest” to GPs, adding that “often people go to their GPs with a cough and the cough isn’t the problem at all”.

Rather the issue, continues O’Mahony, “is the fact that they’ve back pain, a relationship problem, money problems, they’re drinking too much or work is terrible. The symptoms aren’t always that useful.”

However, Derek Richards, clinical research director with SilverCloud Health, a Dublin-based online therapy start-up, sees "merit" in the Sicknosis approach, saying it may be both "cost-effective" and also help root out the very type of underlying issues O'Mahony is concerned by.

“It’s interesting, it could work, and may free up some time for GPs to be more attentive to wider issues in an individual’s life,” says Richards. “People present mental health difficulties in GP [offices] but often it’s not picked up on,” he adds. “A lot of the time GPs are under pressure, with a high caseload, perhaps an app could free up some extra time to pay attention to the patient in front of them.”

For his part, Muldoon makes the point that the Sicknosis platform uses “a box for additional stuff that you might want to ask the doctor” should there be something more on your mind. Though that doesn’t necessarily have to be a medical issue.

“We’re all money conscious these days,” he says, “and [a doctor’s appointment] is a €55 hit, so patients may think ‘I might as well ask about this other stuff while I’m in’ or maybe people have questions about elderly relatives. There’s room for that too.”