A Technology-assisted approach to integrating healthcare in the community.

The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.