healthdirect
Symptom
Checker
Dr. Trina Gregory
Dr. Kieran Le Plastrier
Healthdirect Australia… who are
we?
o A not-for-profit organisation funded by the Governments of
Australia to provide telephone based and online health
information services
o Our aim is simple – to provide Australians with equitable
access to safe, trusted health information to enable them
to make informed choices about their health
o Our organisation was formed in 2006 as the National
Health Call Centre Network (NHCCN) to provide a nurse
triage helpline
o In the years since inception our organisation has
expanded to deliver a wide range of integrated helplines
and online services:
Healthdirect Australia… who are
we?
We manage a suite of services
which are accessible across the
country:
• 24 hours a day, 7 days a week free helplines and online
services point your patients to
the right service, at the right
time
• We do not diagnose, or provide
a substitute for face-to-face
care
healthdirect
• A helpline service available
24hrs a day which allows
callers to speak with a
registered nurse for information
and advice
• A website which allows your
patients access to trusted
health information and hosts
the healthdirect Symptom
Checker
after hours GP helpline
• Allows callers to the helpline
access to a GP during the after
hours period, when their local
GP may be unavailable
• Particularly relevant for rural
and remote patients
Pregnancy, Birth and Baby
• A telephone counselling service
offering free, confidential
support to pregnant women,
their partners, and new parents
with a baby up to 12 months of
age
• A website with a wealth of
information to assist you in
supporting your patients
mindhealthconnect
• A web based portal providing
mental health information and
advice
• Links to trusted content and
service providers
My Aged Care
• A website and telephone
contact centre providing
information and advice for older
people and their families to
enable them to better navigate
the aged care system
Get Healthy
• Free advice and coaching for a
healthier lifestyle
National Health Services
Directory
• A national database of health
services and provider
information
Symptom Checker…why build it?
Healthdirect Australia identified the need for a clinically sound online tool
to assist consumers in making health choices because:
o Over 80% of Australians are seeking health information online*
o Over 60% of Australians are seeking information and symptoms and
disease online*
o Dr Google is not a trusted source of information!
* Market research conducted by Objective Digital in June 2013
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Warm Up
Scenario 1: 50F, calling to ask advice on her 56 year old husband’s nose
bleed. Started 10 minutes ago and hasn’t stopped.
Scenario 2: 68M, ESL with accent, In hospital recently for 2 nights with
infected right leg on IV anti-b’s, Now on oral anti’s, but worsening pain
and redness over 24 hours.
What do you want to ask?
Why are you asking these questions?
What outcome is appropriate for these
callers?
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Symptom Checker…a safe
alternative
Stop your patients googling it! Encourage your patients to
‘healthdirect it!’ to find trusted information on
symptoms they may be experiencing.
13
Clinical Panelists’ Perspectives
14
An online symptom checker for patients
o Good clinical information that will safely direct
patients where they need to go
o User friendly and with assurance that the information
they get from the internet is accurate, safe and
clinically sound
15
Works with the principal of a patient's
“medical home”
o Encourages a person to help themselves where
appropriate, but also to discuss and involve their
"usual GP" where ever possible and appropriate
o Aimed to work with GPs, not as a substitute to GPs
16
For all Australians
 Anyplace
 Anywhere
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 Anytime
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What it is not…

Not a diagnostic tool

Not a replacement for face to face consultation

Does not undermine or compete with relationship a GP has with their
patients; aimed at enhancing this.

Not about saving money, un blocking beds or freeing up EDs
Encourages consumers to take responsibility for their health and
improve health literacy
18
What about after hours?
o What do patients currently do if they are worried?
o What would you like them to do?
o What is best for everyone?
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Background
o
Long time requirement of funding agreement
o
Researched various options
o
Study tour to UK to review NHS Direct HaSCs
o
Licenced – early 2013
o
41 HaSCs
o
Undertaking an “English to Australian” translation
o
Went live with 20-24 early July
o
Remainder over following 9 months
o
Spare for pandemics
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What we have completed so far:

Head injury

Burns and scalds

Chest and back pain

Chest injury

Colds and flu

Rashes and skin problems

Diarrhoea and vomiting (adult)

Pregnancy problems

Diarrhoea and vomiting (paeds)

Hay fever and minor allergy

Abdominal pain (adult)

Wounds

Abdominal (paeds)

Limb injury

Breathing problems

Bites and stings

Leg pain

Back injury

Joint pain and swelling
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What we are working on:
o
o
o
o
o
o
o
o
o
o
Headache
Neck pain
Swallowed and inhaled
substance
Foreign body
Urinary problems
Rectal bleeding
Eye problems
Earache
Dizziness
Confusion
o
o
o
o
o
o
o
o
o
o
o
o
Collapse
Female health & STI’s
Men’s health & STI’s
Mental health
Diabetes
Mouth problems
Dental problems
Nose bleed
Facial injury
General illness (adults)
General illness (child)
Contraception
22
Adaptation to Australian Context
Evidence Review and Gap Analysis
o
o
o
Undertaken by NHS Direct
Based on list of Australian authoritative sites;

e.g. NHRMC, NICS, DOHA and Content Partners,
eg Cancer Council, Heart Foundation,
Professional Colleges
Focus on guidelines rather than underlying evidence – basis
of healthcare professional advice
Simple
Moderate
Complex
Monitor head injured patient for 2 days ‐ UK 1 day ‐ AU
Different care advice to UK.
AU research into local guidelines and standards.
Discussion with UK re inclusion in Gap and content. eg Hydration advice for adults and infants
Significant research AU standards / guidelines.
Significant discussion with UK re inclusions in Gap
eg Bites and stings – multiple inclusions
eg Mental Health –
completely rewritten.
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Content
Clinical Assessment Panel



Currently 24 members
Every panel consists of – ED physician, GP, ED nurse, Pharmacist,
Paediatrician, Ambulance rep.
Some panels also include SME’s. Some SME’s include:
 Sexual health nurse
 Urologist
 Obstetrician
 Midwife
 Psychiatrist
 Mental Health Nurse
Review 5 documents





•
Visio Logic Flow
Self Care advice
Flow points
Change log (changes identified in Gap analysis)
Dispositions
UK review - Some acceptance of risk
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Dispositions. More than end points.
Disposition review
o
Dispositions are the end point – the recommendation of appropriate
care.
o
UK -120
o
so far 22 in Australia
o
Expect to have more as we progress through to specialist dispositions.
o
Reduced due to context of Australian health system
o
9 UK call backs reduced to 1 in AU (ring - healthdirect)
o
Speak to your GP
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Evaluation and monitoring
Internal data collection
Analytics
Questions yet to answer: impact on telephone service; impact on
GPs if any; improved appropriateness of attendances at ED
and/or GP
We have UK experience as a guide; Australian modelling

Service Improvement and Development Committee (SIDC) –
Quality review and improvement

Benchmarking – with UK

Longitudinal prospective study
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What do you think?
Demonstration and discussion
http://www.healthdirect.gov.au/
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Example Scenarios for Symptom Checker
A. School child with gastro symptoms
A. 28F with pleuritic chest pain for 2 days
1.
2.
3.
4.
5.
Find the appropriate checker
Follow the script as shown to find the disposition
Are you satisfied with the advice?
What might you do differently, and why?
What are your views on the end-point summaries as you view
them?
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Thank you
Questions?