Orion Health, a global provider of healthcare information technology, has been supporting its customers during the Covid-19 crisis through enabling agile adaptations to shared care records built on the company’s technology.
These two key examples provide insight into the value of shared care records and how existing platforms have been adapted for Covid-19 care in the UK. They are the Northern Ireland Electronic Care Record and Connecting Care, which operates across Bristol, North Somerset and South Gloucestershire.
To read detail of how both systems have been adapting during the crisis to best meet the needs of frontline staff and patients, please see below:
Northern Ireland’s Electronic Care Record proves its worth during Covid-19
The Northern Ireland Electronic Care Record is one of the most mature shared care records in the UK. Thanks to its advanced functionality, it has been able to respond quickly to clinical needs during the coronavirus crisis; and to prepare for whatever comes next. Stephen Beattie and Mary McCluskey, lead staff for the system within the Business Services Organisation Information Technology Services (ITS) function explain.
The Northern Ireland Electronic Care Record has really proved its worth during the coronavirus outbreak. Almost every aspect of the clinical response, from creating ‘hot’ and ‘cold’ treatment centres, to enabling remote and paperless working, to sharing information with families, has been supported by functionality in the record, which uses Orion Health technology.
“What struck me during the outbreak was how adaptable this system was and how quickly our teams were able to scale-up and reconfigure for different activities,” said Stephen Beattie, ITS eHealth programme manager at the Northern Ireland Business Services Organisation.
“Our clinical community was coming to us with ideas and we were working with Orion Health to implement them. It was almost like the early days, when we were setting up and working in an agile, innovative way to implement the vision of our users. As we prepared to deal with the outbreak everybody re-engaged and re-committed to doing what needed to be done.”
As services reconfigured, the NIECR moved with them
The Northern Ireland Electronic Care Record is one of the most extensive shared care records in the UK. It launched seven-years ago as a clinical portal, bringing together information from Northern Ireland’s five health and social care trusts and its ambulance service to create a single patient record.
Since then, additional features have been added. Two important elements are the Emergency Care Summary Record, or ECS, which holds demographic and basic medical information about a patient, and the Key Information Summary Record, or KIS, which includes additional details to support end-of-life care.
More recently, the NIECR team has been using Orion Health Coordinate to build a patient pathway that is being used for diabetes patients, but which will be used with other patient groups, and Orion Health Engage to create a patient or citizen portal that is being trialled with people living with dementia.
As planning to deal with the coronavirus got underway, the record had around 25,000 users; but this soon increased significantly, as access was extended to new groups of frontline workers and the independent sector. “One of the main hospitals in Belfast was repurposed as a Nightingale hospital, and that meant the urgent surgery that could no longer be done there had to move into the independent sector,” Stephen Beattie explained.
“So, there was an urgent need for the independent sector to get access to the NIECR, so clinicians working there had information about the patients coming in. There was a question about whether we could really countenance sending patients into the independent sector without access to the NIECR, which shows just how central it has become to patient care.”
Proven functionality found innovative new uses
At the same time, changes were made in the record to support the care of Covid-19 patients. Enabling paperless working was a priority, because porters couldn’t enter Covid-19 wards and, even if they could, hospitals wanted to reduce the risk of transmitting the disease on physical records.
So, new forms were created in the portal for Covid-19 admissions and ward rounds. Meanwhile, Southern Health and Social Care Trust undertook another practical piece of work that was subsequently shared with the other four health and social care trusts in the country.
Because families cannot visit Covid-19 patients, the trust set up a Covid-19 communications team, consisting of two senior medical staff, to call their next of kin and let them know how they are doing. The ‘next of kin’ details are recorded in the shared care summary that is part of Coordinate, and Orion Health created a new ‘progress note’ in pathway software to capture information from ward rounds.
This means the team always has the most up to date information to pass on. Project manager Mary McCluskey says this is a good example of where functionality that was already available in one part of the record has been put to good use in another during the crisis.
“Innovation is not always about inventing something new, it is about making better use of what you have got,” she said. What’s nice about this initiative is that it has been really well received by patients and their families.”
Remote working and virtual consultations were supported
There are further examples of how functionality that was available in one part of the NIECR has been used in another during the outbreak. For instance, GPs were already using e-triage functionality to seek advice about patients and to make referrals to hospital consultants.
As more and more clinicians started to work from home, e-triage was extended to the acute sector, so consultants could continue to assess patients and consult each other remotely. When audiology consultants said they needed a particular report to support their work, it was added to the portal.
Similarly, because many patient clinics and consultations are now being conducted over the telephone, a ‘progress note’ was created to capture key elements of the call and to incorporate them into the patient record. And more clinicians are now being made aware of the KIS and its important end-of-life information.
Building blocks ready for a new digital future
As the coronavirus crisis has played out, and the NHS as a whole has moved rapidly to adopt digital technology, there has been a growing sense that there is “no going back”. Stephen Beattie is convinced that many of the changes made to the NIECR will be retained and, indeed, that there will be a continued interest in using it to drive innovation in areas such as remote patient monitoring.
Mary McCluskey agreed: “I think the biggest changes are remote working and virtual consultation,” she says. “We need to work on how to capture the information from a remote consultation and on how we put it into a management plan to support patient monitoring in the community.
“However, we can progress things like that, and we should be able to do it quickly because people are now thinking ‘can we make it paperless’ and ‘can we do it remotely’.” Also, within the NIECR, Northern Ireland already has a lot of the tools it needs.
“The system is so mature that being able to continue to innovate sustainably is not that much of a challenge,” said Stephen Beattie. “That is what we have proved during Covid-19. Our BSO ITS staff, Trust IT and service staff and Orion Health’s staff worked over Easter to get the first changes in place, but the building blocks we needed were already there; and because of that we are also well prepared for the future, whatever that turns out to look like.”
This case study is one of a series of agile changes to existing regional IT systems managed at portfolio level by Karen Bailey, director of the BSO ITS service and David Bryce, head of BSO ITS which has supported the work of the NI Chief Digital Information Officer Dan West in delivering digital support to health and social care across NI during this pandemic.
Connecting Care expands and evolves in response to Covid-19
The Connecting Care shared care record has been supporting the response to Covid-19 in and around Bristol. Jocelyn Palmer, Connecting Care programme lead, explains how shared care records play their part in the wider acceleration of health tech adoption during this crisis.
Connecting Care was one of the most extensive and mature shared care records in England before the coronavirus outbreak, but it has evolved further to support health and care services during the crisis.
Jocelyn Palmer, Connecting Care programme lead for Connecting Care at NHS South, Central and West Commissioning Support Unit, said that its response had focused on four main areas; ensuring access, adding further information to the record and exploring changes needed for some specific sectors – such as for care homes.
She also agreed that the crisis had accelerated health tech adoption in health and care; and Connecting Care will need to evolve for a new world of integrated care and digital first working.
“Our bread and butter”; ensuring access and extending licences
The Connecting Care programme started in Bristol almost a decade ago. It has used Orion Health technology from the outset, initially to enable a few hundred care professionals to access real-time patient information through a portal.
Since the initial go-live in 2013, it now has over 7,000 users, has added more information feeds, adopted more advanced functionality, and expanded to cover 23 organisations and over 80 GP practices across Bristol, North Somerset and South Gloucestershire.
Jocelyn Palmer said: “Connecting Care is all about making care better, safer and more joined-up. We are very much a shared care record, but we are also a wider interoperability platform, and as part of that we share and deliver hospital documents and we have integrated with personal health records, an area that we are developing.”
“So, for Covid-19, our first area of focus, which is bread and butter for us, has simply been making sure anyone has access who needs access. So support has gone into rolling out licences. Bristol has a Nightingale Hospital that, fortunately, has not been needed yet, and we are ready to support that if needed. But we have also been making sure that any other teams have the licences they need.”
Rethinking delivery to care homes
Before the coronavirus outbreak, the Connecting Care programme had been actively working on projects with local care homes as part of the Digital Pathfinder in Bristol, North Somerset and South Gloucestershire (BNSSG). Pathfinder projects are focused on delivering innovative uses of technology to share information between health and adult social care, in order to achieve better outcomes for people using the services.
Work was underway to reach 50 care homes this year. Jocelyn Palmer said the arrival of Covid-19 had paused some of this work; but had also created time to think-through how best to support care homes at present.
“Some of the work can’t progress as planned at the moment, but we have been looking at the practicalities of making Connecting Care available to care homes – delivered over the internet because that would make it much more accessible,” she said.
Adding value to the record
Throughout the coronavirus emergency, there has been a focus on using technology to identify people who may be particularly vulnerable to Covid-19, and to pick-up and effectively treat people with the disease. Jocelyn Palmer said information had been added to do this.
For example, highlighting vulnerable people at “high risk” of complications from Covid-19 (as published by NHS Digital) is being added to the record. Connecting Care is also now sharing patient ReSPECT forms from North Bristol NHS Trust, so professionals attending an individual know what their care preferences are, if they cannot express them.
A significant piece of work enabled the sharing of evidence-based information on risk of mortality. “This work was led by BNSSG CCG, and we worked closely with the analytics team there” Jocelyn Palmer explained.
The Charlson Score (Comorbidity Index) [1] is now available to view in Connecting Care. This score is a validated way of assessing mortality risk due to a combination of comorbidities and age. It is provided to aid decision-making, and currently of course, particularly in relation to the Covid-19 pandemic.
“This means that we have added some specific evidence-based information into the shared care record to support clinicans. Taking the results of analysis into a shared care record was a first for us”.
“Clearly this is very much the direction of travel, as those working on Local Health and Care Record Exemplar projects will know well – so we were pleased to be able to deliver this locally and I hope it provides support when making assessments on care.”
“Shifting the dial”: pivoting with the NHS pivot to digital
The coronavirus outbreak has led to a significant reorganisation of the NHS and an uptick in the adoption of some kinds of digital technology. Many more health and care professionals are now working remotely, holding digital clinics, and conducting video consultations.
Jocelyn Palmer was asked if she felt Covid-19 had also shifted the dial on shared care records which, outside areas like Bristol, have seen relatively slow rates of adoption and expansion across England.
“Covid-19 has definitely accelerated technologies for remote working and virtual consultation,” she responded. “I think we will all see further shifts, because having key information at people’s fingertips will become increasingly important to health and care services – especially if they are having to work remotely going forward.”
“The question for us is how different systems and personal health records, messaging apps and monitoring devices will become part of the digital ecosystem that will be needed to support clinicians and to enable them to have the dialogue that they will need with patients.”
Connecting Care will need to work with Orion Health to make sure it can adapt to play an effective role in that ecosystem. Or, as Jocelyn Palmer concluded: “We will be evolving; but we were evolving anyway. And things do feel different; much more collaborative and positive – which is great, and as it should be.”
[1] www.mdcalc.com/charlson-comorbidity-index-cci
