We complete our look back at the HTN Now September 2021 content with a review of a live webcast focusing on integrated care records (ICRs).
For this session we were joined by Danny Roberts, Programme Director, and Jayne Rooke, Programme Manager, to talk about the Coventry and Warwickshire Health and Care Partnership (HCP) ICR.
However, both speakers revealed they “wear a number of hats”, with Danny also the Director of Delivery for South Warwickshire NHS Foundation Trust and “effectively the part-time CIO” and EPR Programme Director for Coventry and Warwickshire Integrated Care System (ICS), too.
Jayne, meanwhile, is Programme Manager at Arden and GEM Commissioning Support Unit, and has been working with Coventry and Warwickshire ICS to set up the programme management around the delivery of the ICR.
“This has been quite a significant piece of work,” Jayne said, “[I] joined a team that had started to progress this work early last year with the idea that we would just wrap a more robust governance around to just bring it all together and speed through what we needed to do.”
Danny then went on to deliver the first half of the webcast and provide an overview of the record. With a population of 910,000, which is expected to grow to 1.2 million by 2030, Coventry and Warwickshire covers five different districts, including places with high levels of deprivation in some inner city areas and towns, as well as a growing elderly population in a number of the rural areas, he explained.
Providing more background, Danny added that the ICR is expected to be a shared care record for a number of ICS partners, including four NHS trusts, an ambulance service, Coventry City Council, Warwickshire County Council, and 123 GP practices.
Possessing the same platform – Intersystems Healthshare – as the ICSs in Birmingham and Solihull, and in Herefordshire and Worcestershire, Danny said the organisations “decided to work together to share expertise, knowledge and experience” and, overall, the shared ICRs have now become known as the Collaborative Care Record. They are also part of the wider West Midlands Shared Care Record, ensuring a three-tied “local, sub-regional and regional record” is in place.
“The purpose of the system is direct patient care, in the first instance…there are aspirations around population health management, as there are in all [these] across the country,” he said.
Danny then passed over to Jayne to discuss the operational elements, who explained the main aspiration of the programme is for “staff to be able to launch the integrated care record through their host EPR systems…[and to] make it as easy as possible [for staff to use].”
“Another element that caused quite a lot of discussion,” she added, was the question around “how should we define who’s able to see what?”
“A concern from health that too much information may be shared with their colleagues in social care – but also there was a concern from social care that, actually, they didn’t want their staff to see too much information that they haven’t been privy to before and may not have the skills or experience to interpret,” Jayne explained.
This led to access and the level of access being defined by roles – with social care workers only seeing what was appropriate. Meanwhile, other challenges faced included COVID-19’s impact on staff capacity, priorities and having time to engage, as well as competing priorities locally, regionally and nationally.
The changing ICS and CCG landscape also brought additional challenges, Jayne said, which lead to a change of host organisations for the ICR programme, with the former host switching to prioritising vaccination centres for Coventry and Warwickshire, thereby handing over to South Warwickshire Foundation Trust instead.
Danny and Jayne then talked through their findings from public engagement, revealing that around 97 per cent of people asked said they understood what the Integrated Care Record was, while 92 per cent felt the ICR was a good idea.
After outlining the many benefits of the system for clinicians and practitioners – which Jayne said include improved safety, decision making and efficiency, as well as a reduction in wasted or missed appointments, and better information on cross-boundary care – the team also covered the positives from a patient perspective.
“I mentioned with the public feedback that they already thought, or think that we should be, talking to each other [through integrated care],” commented Jayne, before going on to highlight that the ICR would mean less repetition of medical history for patients, fewer repeat appointments, viewable test results in a timely manner, a reduction in avoidable overnight hospital stays, and an available medication history leading to a reduction in errors.
Lessons learned from the programme, meanwhile, she added, included taking into account staff burnout due to COVID-19, maintaining momentum and refreshing the vision to remind people about the ICR’s importance and their priorities after COVID.
Jayne also went on to cover their experiences around governance, funding and training, before Danny brought the audience up to speed on where the project is now.
Currently, two of the three acute trusts are feeding data into the record and one mental health trust is consuming that data, with the third acute trust testing its data feeds, Danny explained, with GP data contracts still being finalised.
Finally, looking ahead to what’s next, Danny added that they hope local authorities will be added by the end of 2021, with the roadmap also including development of a business case to add hospices, too.
His top three messages to end the session on were to “absolutely be clear on the scope of the delivery”, “appreciate the complexity” of the implementation and of working across multiple organisations, and the importance of authority and governance in giving the project “a great turn of pace” due to having the “freedom to get on with things” and “agility” to do what they needed.
To watch the full session, view the video below:
