The eCHIP project has used concepts (Diag 1) from the CEN European Standards for Health Informatics ETC251 - to develop the model for consistency across all AHP and Community Nurses. AHP Programmes of Care address Problems and Issues identified by the client and AHP. These problems and issues will be resolved by the provision of one or more care plans.

Diag 1

Developing the Programmes of Care
Professional working groups with volunteers from each Health Board area were invited to a profession specific workshop to develop the relevant, Objectives, Health Issue / Problems, Care Groups & Specialties for that profession. The group undertook to share the developing care programmes with their professional group within their health board area and to feedback their comments. Currently Dietetics, Occupational Therapy, Orthoptics, Physiotherapy, Podiatry and Speech & Language Therapy are reviewing their draft programmes of care. During the workshops it became clear that there was a need for further clarification of definitions from ISD and discussions are currently underway and some have been collated under Terms & Definitions paper. Definitions of episode have been pulled from the ISD Data dictionary. Many other definitions and coding standards will become available in the new Health & Social Care Generic Data Standards work. Once the AHP Advisor is in post at ISD (September / October 2004) then much more work can be done on specific definitions.
An action research model has helped to refine the work of the groups and it has now become possible to discuss using the International Classification of Functioning, Disability and Health (Diag 2) as the classification to which all health issues and problems are mapped. Clarity has been agreed around the need to identify medical specialty / diagnostic codes. The medical specialty relates to the area of an institution where a patient may be receiving their care. AHPs are more likely to link the disease process to the impairment in function or restriction in activity. For example, impairment in vestibular function (physio) will lead to restriction in moving around (OT) with a contributing factor (aetiology) of a Fall (classification in ICD10). The speech & language therapy group have also been working on definitions for long term objectives (within this document page 5) and SLT diagnosis (health issues/ problems) and aetiology.

The following tables reflect the output of the working groups, which is within the Scottish Health Service for revision. Some groups have provided an update at the end of August 2004. Further work will be undertaken in considering the use of the ICF across all professional groups. Workshops are still to be organised for Radiography, Arts Therapy and Prosthetics and Orthotics.
Feedback should be made to Health Board AHP eCHIP or eHealth members or alternatively directly to Margaret Hastings, AHP information Development Officer, Primary Care Division, 1 East Rear, St. Andrews House, Regents Road, Edinburgh EH1 3DG Margaret.Hastings@scotland.gsi.gov.uk. Telephone 0131 244 2179

Health Issues & Problems (Reason for Active Involvement / Duty of Care)

OBJECTIVE - the overall aim of the professional programme of care which is provided in response to a health problem / issue.

eCHIP
SPEECH & LANGUAGE THERAPY

LONG TERM OBJECTIVES FOR THE PATIENT JOURNEY

The long-term objective is what we want to achieve for our client by the time of discharge.

RESOLVE:
To help the client reach a level which is within normal limits for their chronological age / pre-morbid state.

MAXIMISE POTENTIAL:
To help the client achieve their maximum potential, where a cure is not possible.

MAINTAIN / SUSTAIN:
To help the client to maintain their current level of functioning for as long as possible where improvement is not expected

PREVENT:
To reduce risk of worsening, or exacerbation of secondary complications arising from an existing problem.

DIAGNOSTIC CONSULTATION:
This objective will only be used where no intervention is required and no other objective has been enacted.
e.g. where your professional opinion is required as part of a multi-disciplinary team or as a second opinion.

N.B. the above objectives will all include assessment and diagnosis

AETIOLOGY / CONTRIBUTING FACTOR (Definitions and Maps to Snomed)

eCHIP
ARTS THERAPIES SUMMARY PROGRAMMES
INITIAL DISCUSSIONS 08/11/2004 -Draft

Arts Therapists Working Group

The summary programmes for the arts therapies episode of the patient journey will be derived from clinical recording and full clinical systems eventually.

The summary dataset will require :-
an overall objective for the whole Arts Therapist episode
a descriptor of the health issue / problem
diagnostic grouping of the aetiology of the health / issue problem.

AHP Summary Programmes
		(eCHIP) The Programmes of Care approach will provide a summary dataset for AHPs that identify the summary reason that a patient / client / group has been on their active clinical caseload and the therapist has undertaken a duty of care.

 

ICF Definitions
Body Functions - are the physiological functions of body systems (including psychological functions).
Body structures - are anatomical parts of the body such as organs, limbs and their components.
Impairments are problems in body functions or structure such as a significant deviation or loss.
Activity is the execution of a task or action by an individual
Participation is involvement in a life situation
Activity limitations are difficulties an individual may have in executing activities
Participation restrictions are problems an individual may experience in involvement in life situations

ARTS THERAPY HEALTH ISSUES / PROBLEMS

Health Issue
(eCHIP) The healthcare problem as identified by the patient / client and recognised and defined by the health care practitioner.

Patients will identify problems in their own language and the clinical reasoning skills of the arts therapists will identify the area of limitation / restriction that the Arts Therapist will work on, using their knowledge and skills competences to identify the specific technique / interventions that will allow them achieve their agreed outcome.

The ICF classification of body functions places impairments in the following chapter / groupings.

Chapter headings		Impairment in
1.Global Mental Function Confidence		Confidence
		Motivation
Specific Mental Function Memory function		Psychomotor impairment
		Emotional function
		Perceptual function
		Body image
2. Sensory Functions & Pain vestibular function		Proprioceptive function
		Pain
3. Functions of Cardiovascular system heart functions		blood vessel function
Immunological system functions
4. Functions of the Respiratory system		Respiration
		Respiratory Muscle functions
		Exercise Tolerance
5. Functions related to digestive system		Weight maintenance
6. Genitourinary and reproductive functions		Urinary Continence
		Procreation function
7. Neuro-musculoskeletal and movement related functions
Functions of joints and bones		Mobility of joint
		Stability of joint
		Mobility of bone
Muscle function		muscle power
		muscle tone
		muscle endurance
Movement functions		motor reflex
		control of vol. Movements
		gait pattern
		sensations related to muscle & movt
8. Functions of the skin		sensation related to skin

Activity and Participation limitations and restrictions are grouped in the following chapters

Chapter headings		ARTS THERAPISTS TERMS
1.Learning & Applying Knowledge
Purposeful sensory experience		Sensory Difficulties or maybe under impairment
Basic Learning
Applying Knowledge
Learning and applying knowledge, other specified		Cognitive problems
Learning and applying knowledge, unspecified		Perceptual Problems
2. GENERAL TASKS AND DEMANDS		Mental Function
Undertaking a single task
Undertaking multiple tasks
Carrying out daily routine
Handling stress and other psychological demands		Emotional Function
General tasks and demands, other specified
General tasks and demands, unspecified
3. COMMUNICATION
Communicating - receiving
Communicating - producing
Conversation and use of communication devices and techniques
Communication, other specified		Communication difficulties
Communication, unspecified
4. MOBILITY
Changing and maintaining body position		Physical difficulties
Carrying, moving and handling objects
Walking and moving
Moving around, using transportation
Mobility, other specified
Mobility, unspecified
5. SELF CARE
Washing oneself
Caring for body parts
Toileting
Dressing
Eating
Drinking
Looking after one's health		Well bring
Self-care, other specified		Risk to Self
Self-care, unspecified		Addictions
6: DOMESTIC LIFE
Acquisition of necessities
Household tasks
Caring for household objects and assisting others
Domestic life, other specified
Domestic life, other unspecified
7. INTERPERSONAL INTERACTIONS AND RELATIONSHIPS
General interpersonal interactions		Behavioural
Particular interpersonal relationships		Interpersonal Difficulties
Interpersonal interactions and relationships, other specified		Psychological difficulties
Interpersonal interactions and relationships, unspecified		Intra-personal diffculties
8. Major Life Areas
Education
Work and employment
Economic life
Major life areas, other specified
Major life areas, unspecified
9: COMMUNITY, SOCIAL AND CIVIC LIFE
Community Life
Recreation and Leisure
Religion and spirituality		Belief Systems
Human Rights
Political Life and citizenship
Community, Social and Civic Life, other specified		Social difficulties
Community, Social and Civic Life, unspecified

Trauma would be an aetiology rather than a health issue

LONG TERM OBJECTIVES FOR THE PATIENT JOURNEY

Health Care Objective (eCHIP)
		The desired ultimate achievement of the specified action or effort of the health care professional to address the health issues / problems identified by the patient / client

The long-term objective is what we want to achieve for our client by the time of discharge. It will be delivered by specific short term goals and care plans.

RESOLVE:
To help the patient reach a level which is within normal limits for their chronological age / pre-morbid state.

MAXIMISE POTENTIAL:
To help the patient achieve their maximum potential, where a cure is not possible.

MAINTAIN / SUSTAIN:
To help the patient to maintain their current level of functioning for as long as possible where improvement is not expected

PREVENT:
To reduce risk of worsening, or exacerbation of secondary complications arising from an existing problem.

EDUCATE:
To provide with knowledge or training related to the identified health issue e.g. ante-natal education;

DIAGNOSTIC CONSULTATION:
This objective will only be used where no intervention is required and no other objective has been enacted.
e.g. where your professional opinion is required as part of a multi-disciplinary team or as a second opinion.

N.B. the above objectives will all include assessment and diagnosis

ARTS THERAPISTS ADDITIONS - DEFINITIONS TO BE PROVIDED

FORMULATION

DEVELOP / IMPROVE SELF AWARENESS

RELIEF OF SYMPTOMS

IMPROVE KNOWLEDGE AND UNDERSTANDING

EXPLORATION OF SELF EXPRESSION

CREATIVE PHYSICAL ENGAGEMENT


AETIOLOGY / CONTRIBUTING FACTOR
Aetiology - the cause or origin of disease / impairment
The SLTs record the aetiology of the health issue / problem they are involved with and there has been general agreement that there is a need to have diagnoses recorded. It would seen appropriate to use a diagnostic term from Snomed or ICD10 to identify causes or origin of the problems.
The perceptual problems may be caused by several different diagnosis, trauma, stroke etc. Systems will allow an Arts Therapist to pick from appropriate lists.

Please supply comments to your local Arts Therapy rep by 24 December 2004.

Argyll & Clyde
Ayrshire & Arran	John Fulton	John.Fulton@aapct.scot.nhs.uk
Borders	Clare Fillingham	Clare.Fillingham@borders.scot.nhs.uk
Dumfries & Gal
Fife
Grampian
Lanarkshire
Lothian	Simon Willoughby-booth	simon.willoughby-booth@lpct.scot.nhs.uk
Forth Valley	Tony Chenery	tony.chenery@fvpc.scot.nhs.uk
Tayside	John McCulloch	john.mcculloch@tpct.scot.nhs.uk
Highland
Glasgow	Tracy Noble	Tracy.noble@glacomen.scot.nhs.uk
Education	Katrina Millhagen	kmillhagen@qmuc.ac.uk katrina.millhagen@virgin.net

 

Margaret Hastings MBA, FCSP
AHP Information Development Officer
08/11/04
Margaret.Hastings@nhs.net