Integrating primary and secondary care for the NHS

Felix Jackson


We are setting up a GP advice service with Dr Jacques Mizan form Southwark CCG using DefinitiveDx to share and discuss cases with specialists at Evelina Children’s Hospital (with Dr Claire Lemer), Imperial and Chelsea and Westminster.

Both the GPs and specialists want to reduce the number of unnecessary referrals from primary to secondary care. GPs, like Jacques, are using DefinitiveDx to share cases and get specialist advice so they can continue to manage patients in primary care. This is much better for patients and reduces the healthcare costs.

Similar projects have been run successfully at Imperial and the Chelsea and Westminster Hospital using email. The unique aspect of this program is the use of online case sharing and discussion which simplifies case sharing for GPs and enables the specialists to easily review and follow cases, especially through hand overs across different on calls. 

Outcome measures being include a comparison with existing email-based programs and the clinical outcomes of the paediatric patients shared online.

Maintaining patient privacy is a key concern so there are a number of safeguards that have been put in place.

Firstly, DefinitiveDx is clearly a clinical tool for sharing and discussing patient cases so the purpose and context is clear. We ensure that the doctors’ responsibilities are explained at key points. For example, the need to anonymise patient cases is clearly explained prior to sharing a case or uploading a file.

Secondly, the doctors have complete control over the access to each case down to an individual level. They can control access through individual invites, panel (group) invitations or alternatively letting a case be accessible to all members. This ensures that sensitive cases can only be seen by the right doctors.

Thirdly, we have built DefinitiveDx to high security standards using in transit encryption to ensure that data remains secure.

As we are based in London and many of our members practice within the EU, it is important for us ensure compliance with the EU privacy laws, the most stringent in the world. To this end we also ensure that our data storage and processing policies are transparent, occurs within the EU where possible and that our member’s consent is secured through the Terms of Use and our Privacy Policy.

This project was started in January 2015 so we are currently establishing the project outcome measures. We will present the results at Stanford Medicine X.

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