Medical Device Daily and Staff Reports

On the heels of a report that is expected to redefine primary care delivery across England, three providers of clinical information systems reported that they will join up to integrate their products, anticipating adoption of the recommendations by the National Health Service (NHS).

EMIS (Leeds) and INPS (London), the market leaders for general practice software, along with Adastra Software (Ashford), a specialist in systems for connecting primary and secondary care systems for urgent care clinics, said they will jointly develop a system to support a proposed model for GP-led equitable access centers (GPEACs) outlined in the recently completed "Next Stage Review" led by Under Secretary of State Lord Darzi for the NHS.

A colorectal surgeon, Ara Darzi is a consultant at St. Mary's Hospital and Royal Marsden NHS Trust who in 2002 was awarded knighthood for his services to medicine and surgery.

After a series of reports covering each of the eight regions covered by England's Strategic Health Authorities, Darzi in his summary delivered June 30 to the prime minister, chancellor of the exchequer, and secretary of state for health sets out how the NHS can respond to the challenges of the next 10 years.

Those challenges include meeting the rising expectations that are driven by demographics, continuing development of an information society, advances in treatments, and the changing nature of disease.

Among the recommended measures is a focus on accelerating changes "that frontline staff want to make to meet those challenges, [while] continuing to raise standards."

A key assumption, "which remains largely aspirational at present," according to the British Medical Association (BMA; London), is access for NHS staff to information about care, including a new NHS Evidence Service where staff can view through a single web-based portal authoritative clinical and non-clinical evidence and best practice.

Development and configuration of next-generation health informatics already is under way, according to the three collaborating companies, who aim to offer a conjoined system "well before the April 2009 deadline for many GP access centers to go live."

EMIS and Adastra announced a joint project in April to deliver instant access to summaries of patient primary care records for after-hours urgent care clinicians.

The initial pilot was launched for the Gateshead Primary Care Trust, near Newcastle upon Tyne.

The two companies also were cooperating on a project for the Liverpool Primary Care Trust to link link primary and secondary care delivery informatics.

Adastra systems are used in 95% of unscheduled care hubs in the NHS system and the Republic of Ireland, while EMIS systems support more than 56% of GP surgeries.

The third partner, INPS, is part of the CEGEDIM Group (Paris), and provides clinical management systems as well as Vision software, which is compliant with the NHS' Connecting for Health programs Choose & Book, Electronic Prescription Service and GP2GP.

The companies said the new product will build on the components and data of the three existing systems, assuring full interoperability before adding additional functionality to meet next-generation requirements.

Dr. Charlie Stuart-Buttle, chair of the EMIS National User Group, said, "This development reflects the spirit of the times — rather than reinvent the wheel every time the healthcare landscape changes, users want to build on locally successful and popular solutions."

Lynn Woods, Adastra's CEO, said, "Many operational hub services supporting out-of-hours care have integrated with NHS walk-in centers and are starting to intercept primary care traffic. This collaboration offers the potential to better support all urgent and unscheduled care episodes, wherever they present."

Tom Davies, who heads the user group for INPS' Vision software, said he was pleased the three developers chose to cooperate rather than compete, as it "enables us to build on what we have already. This should protect our patients' care in the new world of primary care that we have to work in."

The reforms and recommendations in the report anticipate a new model for care delivery that recognizes demands driven by demographic shifts, primarily the rapid aging of the population.

The BMA devoted considerable discussion in its response to the London proposals released in September 2007 to significant shifts in how primary care will be organized and funded by the NHS in the future, especially the call for polyclinics and a heavy emphasis on community-based care.

Telemedicine, which is dependent on health informatic systems for following a patient through the care system and for follow-on care, drew the wrath of the BMA, which said flatly, "We believe that the introduction of telemedicine for intensive care would have a detrimental effect on outcomes, given that critical care is a 'hands-on' skill and requires a multidisciplinary team approach, both of which telemedicine would not be able to provide.

Another concern of the BMA being addressed by the collaboration among the health IT providers is "the widespread introduction of urgent care centers, accessible by patients both in-hours and out-of-hours, which has the potential to sideline GP practices from the delivery of urgent care.

Using the patient history and medical records held at GPs and primary care team-level help to avoid inappropriate hospital admissions, said the BMA, brings the coordination of patient care that will lead to the best possible health outcomes.

The BMA concludes that Darzi's proposals require "significant advances in information technology and an increased use of electronic data in order to allow continuity of care between providers."

Monovisc in commercial release

Anika Therapeutics (Bedford, Massachusetts) said it has begun shipping Monovisc to European accounts.

The company said Monovisc is a single-injection viscosupplement therapy approved in the European Economic Area for treatment of osteoarthritis symptoms in all synovial joints. It noted that other viscosupplements are indicated for specific joints, and may require up to five injections for the same treatment.

"Monovisc is an important advancement in the care of osteoarthritis," said Mauro Bausani, MD, an investigator in the Monovisc European clinical study. "Our recent clinical study data appears to replicate the safety and efficacy profile of Orthovisc, but in a single-injection regimen."