By Alan Gilbert
Vice President, Business Development
Managed Clinical Networks (MCN) are an important component in the support of better patient access and treatment through a coordinated care approach. The MCN concept was created in Scotland in 1999 by the Scottish Department of Health.
Their definition of MCNs is defined as “linked groups of health professionals and organizations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.”
Like a fine wine, this definition has aged well and seems to translate into the current goals of ACOs.
Some features of a MCN include:
- The application integrates primary, secondary and tertiary care services
- A care plan is established which will serve all network stakeholders
- The care plan has the capability to incorporate evidence-based medical practices
- All participating members of the multi-disciplinary care team will have equality of access to the care plan (access rights can be granted, partly or whole)
- Multi-disciplinary team meetings are facilitated through the telemedicine and teleconferencing. Experts at remote sites are able to discuss the patient review patient notes simultaneously
- Automated generation of referral letters, summary documents and discharge letters
- Educational and patient advice leaflets can be accessed and distributed
A specific client example is a Gynecological MCN for the West of Scotland that was established in 2000 to ensure the highest standard of care for all patients with gynecological cancers across the region. This was to be achieved by enhancing the referral system for specialist opinion and treatment, encouraging a multidisciplinary approach and educating all clinicians involved in the care of these patients by open discussion and debate. Participants would include medical & clinical oncologists, gynecologists, radiologists and pathologists. A weekly videoconference was instituted to enable clinicians from across the region to participate in discussions on their patients. The patient data was redacted so that the care-giver did not know if the patient was in their hospital or one of the other 9 hospitals in the region.
Benefits Realized by implementation of the Gynecological MCN included:
- Reduced travel and delays – The MCN was able to discuss individual cases without extensive travel and patients are able to be referred and seen without delay
- Equitable access to care – Patients are guaranteed that they will receive specialist review regardless of geography and that all clinicians involved in their care participate in establishing and reviewing their care plans
- Improved care delivery – The speed of delivery of the treatment plan has improved as all relevant information such as laboratory reports and pathology is recorded and collated through one central system
- Improved education – Clinicians have benefited from the sharing of knowledge through the cross specialty discussions and the meetings also provide an excellent training ground for junior doctors and other clinical staff who attend
- Improved data quality – through a central repository with better audit trail and introduction of standardization and accountability
I believe that as ACOs continue to form collaborative patient care in a community, that models like Managed Clinical Networks should be studied.