New, free service for GPs identifies patient harm events

13 May 2020

A new online service that’s free for all GPs can help doctors easily reduce harm from medications for their patients. 

Available to GPs now, Conporto Event Detection & Mitigation (EDM) is software that uses secure technology to detect possible risks for patients based on their medical data, including patient notes. The system has the potential to improve health outcomes, and works seamlessly inside clinical practice, so it doesn’t add to a doctor’s already busy workload. 

At its heart, Conporto EDM is designed to help prevent avoidable harm and hospitalisations of New Zealanders due to medicine and/or treatment-related harms.

How it works:

  • A patient makes an appointment with their GP, which is entered into the clinic’s practice management system.
  • The Conporto EDM software detects if the incoming patient meets the criteria for the specific predetermined harms.
  • Practices receive a secure email notification at the beginning of each day when a patient is booked to attend the clinic and is found to be at risk of serious harm e.g. due to contraindications for existing conditions. 
  • The GP receives the same information in their Patient Management System inbox when the patient presents during the day. It includes a brief description of the detected harm and a hyperlink the GP can click to view the relevant patient data supporting the harm event identification. Where relevant the doctor will also see a link to advice on managing the patient so they can take it into account as part of normal clinical procedure i.e. patient consultation, diagnosis and decisions.
  • Dispensing pharmacies also receive an alert when the patient visits to collect prescribed medicines.

Background

Conporto EDM is already being used by more than 500 GP practices in New Zealand. At its inception in 2018 it went through a month-long trial run by Patients First, Conporto Health and Group Healthcare. The trial involved 96 GP practices and 152 pharmacies. In one month with no training supplied, 100 percent of detected harm events were sent, opened, and reviewed by relevant GPs.

Officials from the Ministry of Health, ACC, Health Quality & Safety Commission (HQSC), PHARMAC, and The Royal New Zealand College of General Practitioners decided to extend the trial as a ‘proof of concept’ following some tweaks made from feedback. 

At the start of the Proof of Concept (POC) phase, nine harm events were programmed for detection. When interviewed GPs reviewed the list of current indicators and three proposed new indicators and there was general agreement that all were useful.

The current nine harm events are: 

  1. Allopurinol prescribed at a dose of >200mg/day to patients with renal impairment (eGFR <30 or CKDA)
  2. Bupropion prescribed to a patient with epilepsy
  3. Metformin prescribed to a patient with renal impairment where the eGFR is ≤30
  4. Methotrexate prescribed without folic acid
  5. Prescription of an NSAID, without co-prescription of an ulcer-healing drug, to a patient with a history of peptic ulceration
  6. Prescription of an NSAID in a patient with chronic renal failure with an eGFR <45
  7. Prescription of a phosphodiesterase type-5 inhibitor, for example sildenafil, to a patient who is also receiving a nitrate or nicorandil
  8. Prescription of clarithromycin or erythromycin to a patient who is also receiving simvastatin, with no evidence that the patient has been advised to stop the simvastatin while taking the antibiotic
  9. Sodium valproate events.

Why is Conporto EDM free?

ACC has funded the software for all general practices in New Zealand because of the seriousness of one of the harms it monitors.  The anti-seizure medication sodium valproate, when prescribed to pregnant women, can cause lifelong health harm for their children, and the severity of impact is indicated by ACC’s estimate that these will cost between $3.5million and $25million dollars each.

Since Conporto EDM began detecting potential for sodium valproate related harm in August 2019 two cohorts of females have been followed over several months through to February 2020. A 77 percent drop in the number of females between 10-49 on sodium valproate has been observed, and a 100 percent drop in the number of patients in this age group initiated onto sodium valproate.  

Based on the evidence of the effectiveness of using technology to proactively alert potential harm events the Ministry of Health encourages health providers to evaluate available solutions, including Conporto EDM, with a view to implementation.

How practices can sign up for free

Any New Zealand GP practice can sign up to Conporto EDM by contacting them through their website www.conportohealth.co.nz/Contact-Us