TP 110 Development of an Automated Online Clinical Consultation with Electronic Antibiotic Prescribing for the Remote Management of Genital Chlamydia Trachomatis Infection within the eSTI2 Consortium

Tuesday, June 10, 2014
Exhibit Hall
Jo Gibbs, MBChB, MSc1, Lorna Sutcliffe, MSc2, Tariq Sadiq, BM, MSc, MD3, Pam Sonnenberg, MB BCh, MSc, PhD4, Richard Ashcroft, MA, PhD2, Voula Gkatzidou, BSc, MSc, PhD5, Kate Hone, BA, MSc, PhD5 and Claudia Estcourt, MBBS, MD6, 1Centre for Immunology & Infectious Disease, Blizard Institute, Queen Mary University of London, London, United Kingdom, 2Queen Mary University of London, 3St George's University of London, 4Department of Infection and Population Health, University College London, London, United Kingdom, 5Brunel University, 6Centre for Immunology & Infectious Disease Blizard Institute Barts & The London School of Medicine & Dentistry, Queen Mary University of London & Barts Health NHS Trust, London, United Kingdom

Background:  Modern rapid microdiagnostic technologies, which have inbuilt capacity to send data through mobile phone networks (as being developed within eSTI2; will enable accurate self and home testing for sexually transmitted infections (STIs) and are well suited to online medical management. However, no UK specific regulatory guidance exists for such online clinical care pathways. Objective: to develop an automated online clinical consultation, meeting existing regulatory and legal requirements, which takes people from diagnosis of chlamydia, through clinical assessment, leading to electronic prescription and partner management.

Methods:  1. Review of legislation, regulations, ethical and perceptual barriers to introducing online clinical care pathways in the UK National Health Service; 2.development of a framework to subdivide the pathway into functional units against which legal and regulatory findings were mapped; 3.development of a prototype care pathway; 4.refinement through an iterative process of expert and user review and comprehension testing.

Results:  Six key functional units form the online clinical care pathway: diagnosis, history taking, decision support, e-prescribing, information exchange and electronic health records.  Within this framework, the automated, online clinical consultation includes risk assessment of sexual behaviour; assessment of safety of prescribing; antibiotic collection from a community pharmacy; and partner referral and epidemiological treatment. A linked telephone helpline supports people with complex medical and psychological needs. We believe we meet current regulatory and legal guidance

Conclusions:  It is possible to develop an online clinical consultation, using robust methods of review, pathway design and testing. In the UK existing legal and regulatory guidance lags behind advances in diagnostic technologies, presenting challenges to adoption of innovation particularly in relation to online management and remote prescribing for STIs. Our pathway will be tested as part of an exploratory trial in 2014. The methodology described has potential for application to different conditions suited to remote care.