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Principles on Information Systems and Resource Management
Edinburgh. Bogduk, N and Fernando, V (1988). 'Innervation and pain patterns of the thoracic spine' in: Grant, R (ed) Clinics in Physical Therapy. Hockaday, J and Whitty, C (1967). 'Patterns of referred pain in the normal subject', Brain, 90, 481 -496. Physical Therapy of the Cervical and Thoracic Spine, Churchill Inman, V and Saunders, J (1944). 'Referred pain from skeletal Livingstone, Edinburgh. structures', Journal of Nervous and Mental Disease, 99, 660. Bogduk, N and Twomey, L (1987). Clinical Anatomy of the Lumbar Kellgren, J. (1938). 'Observations on referred pain arising from Spine, Churchill Livingstone, Edinburgh. muscle', Clinical Science, 3, 175. Brown, L R T (1988).'Introduction to the treatment and examination of the spine by combined movements', Physiotherapy, 74, 7, Kellgren, J (1939). 'On the distribution of pain arising from deep somatic structures with charts of segmental pain areas', Clinical 347-353. Science, 4, 35. Edwards, 6 C (1986). 'Examination of the high cervical spine (occiput-C2) using combined movements' in: Grieve, G (ed) Maitland, G D (1986). Vertebral Manipulation, Butterworth, London, 5th edn. Modern Manual Therapy of the Vertebral Column, Churchill McConnaill, M A (1978). 'Arthrology' in: Gray's Anatomy, Longman, Livingstone, Edinburgh. London, 35th edn. Edwards, B C (1988). 'The importance of the use of combined movement in the examination and treatment of vertebral joint McCulloch, J and Waddell, G (1980). 'Variation of the lumbosacral myotomes with bony segmental anomalies', Journal of Bone and dysfunction', l.EO.M.T. Congress Papers and Poster Abstracts, Joint Surgery, 62B, 475-480. Cambridge. Elvey, R L (1979). 'Brachial tension testing tests and the patho- McKenzie, R A (1981). The Lumbar Spine. Mechanical Diagnosis and Treatment, New Zealand: Spinal Publications. anatomical origin of arm pain', Proceedings of Multidisciplinary lnternational Conference on Manipulative Therapy, Melbourne, Mooney, V and Robertson, J (1976). 'The Facet Syndrome', Clinical Orthopaedics, 115, 149-156. Australia. Fairbank, J, Park, W, McCall, I and O'Brien, J (1981). 'Apophyseal Twomey, L T and Taylor, J T (eds) (1987). Clinics in Physical Therapy. Physical Therapy of the Low Back, Churchill Livingstone, injections of local anaesthetic as a diagnostic aid in primary lowEdinburgh. back pain syndromes', Spine, 6, 598-605.. Feinstein, B, Langton, J, Jameson, R and Schiller, F (1954). Watson, J (1986). 'Pain and nociception-mechanisms and modulations' in: Grieve, G P (ed) Modern Manual Therapy of the 'Experiments on referred pain from deep somatic tissues', Journal Vertebral Column, Churchill Livingstone, Edinburgh. of Bone and Joint Surgery, 36A, 981. Grant, R (ed) (1988). 'Physical Therapy of the Cervicaland Thoracic White, A A and Panjabi, M M (1978). Clinical Biomechanics of the Spine, Lippincott, Philadelphia. Spine'. In Clinics in Physical Therapy, p 1, Churchill Livingstone,
Principles on Information Systems and Resource Management In 1987, Council published for discussion some general principles on information and budgeting systems. These were (with one minor change) confirmed in 1988. They have recently been reviewed to reflect current developments, and the revised text is set out below. THE Chartered Society of Physiotherapy recognises the importance of management and clinical information systems i n promoting efficient and effective use of health care resources. But such systems need to reflect the basis of practice of physiotherapy. The following principles should therefore guide the application of information systems and resource management to physiotherapy services.
to make best use of these resources. The referring practitioner does not control the type or the the volume of the physiotherapist's intervention.
A. Basis of Practice of Physiotherapy
5. The performance of a physiotherapy service depends on the quality and effectiveness of its clinical outcomes. It cannot be judged solely by efficiency measures described in terms of cost and quantity. Qualitative measures for evaluating outcomes are also required.
1. Physiotherapists are clinicians who make decisions based upon professional knowledge, skills and experience. In assessing patients they use their own clinical judgement on what treatment or intervention, if any, is appropriate for each patient.
2. Physiotherapists receive referrals from general practitioners, consultants, and other health and social care workers. Physiotherapists also undertake work, including patient care and health promotion, not the subject of referral by other practitioners. 3. Physiotherapists are legally responsible for all their professional decisions and for the manner in which they carry them out. Their decisions significantly affect the development and use of resources and they accept the consequent responsibility
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4. Physiotherapy managers are clinicians. As such they are primarily concerned with clinical outcomes and the maintenance of standards. It is their responsibility to ensure that physiotherapy services are used to the best effect.
B. Implications for Information Systems 6. Information systems should contain sufficient data to enable physiotherapists, both as clinicians and as managers, to monitor input and clinical outcomes, and to examine and improve their clinical effectiveness. The information derived from such data must be credible, timely and easily accessible. 7. The workload imposed by data collection and analysis should not detract from patient care. Data for information systems should
flow from the clinical records that are maintained as part of good professional practice. 8. There must therefore be a careful analysis of the purpose, detail and frequency of collection of every data item to ensure that demands for information meet the criteria set out in this document, and to reconcile any conflicts between these principles. 9. Information systems should be clinical and based on complete physiotherapy episodes of care. Information for management and costing purposes should be de-ived from these. Costing based on procedures is inappropriate and misleading.
C. Resource Management 10. Resource management systems should recognise physiotherapy heads as managing clinical budgets for an independent clinical profession. If recharging of costs incurred in hospitals is to apply this would only be workable if the system: 0 treats physiotherapy costs as indirectly influenced by admitting consultants (and not as directly controlled by them); and
0 is applied on a similar basis to that applied to medical colleagues in non-admitting specialties (eg anaesthetics).
11. Physiotherapy managers are the clinicians who should have primary budget responsibility for the remaining parts of the physiotherapy service, particularly services provided to, or in, the community at large. These will include teaching, advisory and consultancy work as well as referrals under open access and other arrangements.
Physiotherapy, February 1990, vol76, no 2
Principles on Information Systems and Resource Management In 1987, Council published for discussion some general principles on information and budgeting systems. These were (with one minor change) confirmed in 1988. They have recently been reviewed to reflect current developments, and the revised text is set out below. THE Chartered Society of Physiotherapy recognises the importance of management and clinical information systems i n promoting efficient and effective use of health care resources. But such systems need to reflect the basis of practice of physiotherapy. The following principles should therefore guide the application of information systems and resource management to physiotherapy services.
to make best use of these resources. The referring practitioner does not control the type or the the volume of the physiotherapist's intervention.
A. Basis of Practice of Physiotherapy
5. The performance of a physiotherapy service depends on the quality and effectiveness of its clinical outcomes. It cannot be judged solely by efficiency measures described in terms of cost and quantity. Qualitative measures for evaluating outcomes are also required.
1. Physiotherapists are clinicians who make decisions based upon professional knowledge, skills and experience. In assessing patients they use their own clinical judgement on what treatment or intervention, if any, is appropriate for each patient.
2. Physiotherapists receive referrals from general practitioners, consultants, and other health and social care workers. Physiotherapists also undertake work, including patient care and health promotion, not the subject of referral by other practitioners. 3. Physiotherapists are legally responsible for all their professional decisions and for the manner in which they carry them out. Their decisions significantly affect the development and use of resources and they accept the consequent responsibility
74
4. Physiotherapy managers are clinicians. As such they are primarily concerned with clinical outcomes and the maintenance of standards. It is their responsibility to ensure that physiotherapy services are used to the best effect.
B. Implications for Information Systems 6. Information systems should contain sufficient data to enable physiotherapists, both as clinicians and as managers, to monitor input and clinical outcomes, and to examine and improve their clinical effectiveness. The information derived from such data must be credible, timely and easily accessible. 7. The workload imposed by data collection and analysis should not detract from patient care. Data for information systems should
flow from the clinical records that are maintained as part of good professional practice. 8. There must therefore be a careful analysis of the purpose, detail and frequency of collection of every data item to ensure that demands for information meet the criteria set out in this document, and to reconcile any conflicts between these principles. 9. Information systems should be clinical and based on complete physiotherapy episodes of care. Information for management and costing purposes should be de-ived from these. Costing based on procedures is inappropriate and misleading.
C. Resource Management 10. Resource management systems should recognise physiotherapy heads as managing clinical budgets for an independent clinical profession. If recharging of costs incurred in hospitals is to apply this would only be workable if the system: 0 treats physiotherapy costs as indirectly influenced by admitting consultants (and not as directly controlled by them); and
0 is applied on a similar basis to that applied to medical colleagues in non-admitting specialties (eg anaesthetics).
11. Physiotherapy managers are the clinicians who should have primary budget responsibility for the remaining parts of the physiotherapy service, particularly services provided to, or in, the community at large. These will include teaching, advisory and consultancy work as well as referrals under open access and other arrangements.
Physiotherapy, February 1990, vol76, no 2