HTN Feature: Sharing Records

In our latest feature we spoke with industry experts to hear how they are progressing with sharing records across their local health economy or STP and what they have learned, achieved and what advice they have to share.

It’s been covered a lot, putting the right information in the hands of doctors, nurses and other care professionals at the right time will save lives. The publication of Local Digital Roadmaps in 2016 across the NHS and Local Government indicated high levels of ambition for making better use of information for health and care, and many local initiatives are pioneering approaches to integrating health and care records.

The Local Health and Care Record Exemplar (LHCRE) programmes are said to “raise the bar” in how the NHS, and its partners, share information safely and securely to help deliver better care for our populations. Each exemplar must adhere to a secure, robust and transparent information governance framework (including the national opt-out framework), demonstrate meaningful and ongoing engagement with the public (based on the principles of ‘no surprises’), and be willing to work with the other exemplar sites and national bodies to co-create a set of standards that will become mandatory for all local health and care Records.

We first spoke to Graphnet to understand how their solution is delivering benefits:

“Graphnet’s CareCentric solution powers a number of shared care records including the oldest (CHIE – formerly Hampshire Health Record) and largest (Greater Manchester covering almost 3 million citizens) in the country. We work with LHCREs to spread best practice and enable greater access to complete and accurate health and social care data across care communities.”

“Our shared record combines data from GPs, acute Trusts, mental health, community care and local authorities and makes it available to authorised uses when they need it. Interoperability is fundamental to providing access which is why CareCentric connects to all major care IT such as GP systems, Electronic Patient Records, as well as social care systems. Many of these connections use a single-sign-on so time constrained users do not need to remember multiple logons for multiple systems. Our large-scale user base holds information on nearly 30m patients.”

In Buckinghamshire, we are providing a shared care record for one of the first Integrated Care Systems (ICSs) in the country.  The software is being used to share information between Buckinghamshire Healthcare NHS Trust, Oxford Health NHS Foundation Trust, Buckinghamshire County Council Social Care and 51 GP practices. Further phases of the programme will add information feeds from Out of Hours services, South Central Ambulance Service NHS Foundation Trust, local hospices, care homes and other third-party care providers.  A link into the Berkshire and Frimley ‘Share Your Care’ record will also form part of the further phases to support the care of individuals in the south of Bucks.”

“While in Berkshire, our software is the basis of an integrated record solution called Connected Care. The system is joining up health and social care providers across Berkshire in the first phase of a project labelled ‘Share your Care’, which, when complete, will be one of the country’s largest shared record solutions. Phase one of the project enables the sharing of resident information across two different STP footprints, covering 98 GP practices, the Royal Berkshire NHS Foundation Trust, Berkshire Healthcare NHS Foundation Trust (a community and mental health trust), two local authorities, and the out-of-hours GP services.”

We asked what the most significant benefit of the solution was?

“The really big benefits will come as STPs use the shared record as a building block to enable further digital transformation. For example, the shared record can be used for Personal Health Records, EPaCCS (end of life) planning and management of long-term conditions such as diabetes and epilepsy. Secure integrated messaging services allow teams, clinicians and even patients to ask advice and collaborate. Task management provides cross care community workflow and automated alerts could let a social worker or community nurse know if a patient is admitted or deteriorates.”

“One of the most significant benefits is population health management. Shared records allow for the analysis of aggregated detailed patient data gathered from across a care community, using tools such as AI. It supports anonymised, pseudonymised and open data, according to permitted use. Care commissioners and providers are able to use insights about patients and populations to act proactively and improve clinical and financial outcomes.”

We heard from Christine Walters, Director of Informatics at St Helens and Knowsley Teaching Hospitals NHS Trust, who are delivering the Shared Care Record project for the LCS, said: 

“This is one of the most important activities that I have ever been involved with. The benefits for the local population of St Helens are immense, this will help to ensure that they receive the right care, at the right time, whether this be through the hospitals, their GP or social care providers. St Helens Shared Care Record will see all agencies truly working in a joined-up way to provide safe and efficient care, when and where needed.”

They are currently undertaking a project to deliver a Shared Care Record project and said “Once testing has been completed and all information governance arrangements are in place to ensure patients data is shared in line with data protection regulations, the Shared Care Record will be rolled out as a phased approach over the coming months, starting with St Helens and Whiston hospitals and St Helens GPs going live with the Shared Care Record in November 2018.The majority of GPs have signed up to the Shared Care Record, with the remainder expected to join in early October. Other local organisations such as community and mental health providers and social care will be live on the Shared Care Record by the end of January 2019.”

“The biggest problem we are tackling is the complex way in which patients and staff access health and social care services. Using a digital platform we are hoping to not only make it easy for a practitioner or clinician to make a single call, but for as much of this as possible to move to being digitally supported through the introduction of a Digital Care Coordination Centre. This will focus on the needs of patients at various levels of the system. Having a single patient record as described above will improve communication and reduce handoffs across the system, resulting in more efficient and timely decisions, a better patient experience and a single version of the truth.”

We spoke with Kate Warner, Programme Director, Royal Liverpool Global Digital Exemplar Programme and Cheshire and Merseyside Digital Revolution Programme to find out more about their programme:

“Across the Cheshire and Merseyside Health and Care Partnership, we have the Share2Care programme which is a joint programme with Lancashire and South Cumbria. We have a HIE which is vendor agnostic and based on open standards. This builds on some of our scaled legacy programmes around information sharing. This will take us to a whole new level in sharing information held in organisational silos at the point of care.”

We asked what advice would you give to other areas looking to share records and provide access to information and what’s planned for the next 12 months?

“Collaborate, work together, focus on patients and patient pathways. As someone very wise once said ‘patients move about’. Our joint work with neighbouring STPs demonstrates a level of maturity and relationship to do the right thing for our population.”

“For Cheshire and Merseyside, the next 12 months is looking really bright. We have a great strategy, Digit@LL, which has empowerment and innovation at it’s core. We want to support all our organisations to get brilliant basics, whilst ensuring our patients have their information shared with those that need it to provide them with seamless, integrated, care. We have many GDEs in C&M and we are excited to see them develop even further than they are now on their journeys to becoming HIMSS 7 and the benefits that will bring to our population. For the Royal Liverpool where I am GDE Lead, the next 12 months is incredibly exciting. We have transformed how we deliver care through digitisation, we have seen significant quality and safety improvements. The next 12 months will see further outcome improvements and developments in technology to improve care and patient experience.”

We asked Graphnet what is the biggest technology challenge at the moment in terms of sharing records?

“A key issue for everyone involved in sharing information across organisational boundaries is the issue of digital standardisation.  This is behind Matt Hancock’s call for “strict, mandated, open standards for interoperability of systems”.  Shared records are obviously all about interoperability, not simply at the technical level (FHIR, HL7 etc.), but also at the semantic level.  Semantic interoperability involves making sure that each system can understand the information it reads or presents without ambiguity and exchange data with unambiguous, shared meaning, and it is a particular challenge in the world of health and social care where there are many different coding systems in use (Read, SNOMED CT, ICD-10 etc.) and where the accuracy of the underlying information conveyed can have life or death implications.”

We heard from John Mitchell, Associate Director of IT (for the CCG’s across the Humber) and asked how the region was providing access to records:

“Traditionally, our focus in terms of sharing records has been towards the summary care record both it’s core functionality and the enriched version. We have over 90% of providers using the core service providing instant information from meds to vaccinations.”

“Across Humber we have seen an increase in people providing consent to share  the enriched functionality through various initiatives as part of our opt-in campaigns, so we can utilise the enriched summary care record more. What we are finding is working well to increase the number of patients opting-in is to ask for consent on every new registration form and to have protocols in clinical systems to ask a patient for consent. We also used technology from MJOG where we can ask for consent through the SMS system. It allows you to Read Code responses from SMS to the list, so we can capture opt ins. We piloted this and one practice and achieved approx. 10% of their patient list opting in overnight.”

“Key to our success is our close partnership with NHS Digital. One of our local Acute Trusts is the largest consumer of the Summary Care Record in the UK and we have been able to be part of the feedback look to support further developments. We feel we have made the most of a national product that’s free for us to use and so if one of our patients visits Cornwall then healthcare professionals can view their SCR.”

“Across Humber as part of the Local Health and Care Record Exemplar programme we required a regional portal, which due to our focus on National products wasn’t in place. We decided to take a multi-agency approach, so not to rip and replace systems but to read all systems and present the best view of that information as one view. Our key drivers were to  present cancer records, end of life and the RESPECT form information. This interoperability approach provides us with the best of both, national systems and a rich multi agency system.”

What have you learned from this project?

“The problem with tech projects is not the tech but engagement . We set-up a digital roadmap board with representation from all providers, commissioners, & Local authorities  and we agreed 4 areas of focus: SCR, e-discharge, e-referrals and child protection. This means we have a management area of focus and clear focus.”

“We have recently completed our child protection project so the group replaced this with our connecting care homes project. Here we want to get care homes up to a standard base of technology  such as internet connection and access to an NHS laptop. This way we can share information and meetings and also district nurses can go in and have access to systems.”

We will continue with this feature over the next few weeks, where we feature Airedale NHSFT, Shropshire, Telford & Wrekin STP, Healthier Lancashire and South Cumbria, Somerset and Cumbria Partnership NHS Foundation Trust.

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