Our final session at the HTN Now event focusing on electronic patient records, strategy, transformation and change was delivered by Doctor Phil Stamp.
Phil is an A&E Consultant and also the Regional Clinical Safety Officer for the North East and North Cumbria ICS and the Great North Care Record (GNCR).
Phil shared an update on the Great North Care Record, where the programme is to date, what’s coming up, and some learnings and their approach along the journey.
To begin, Phil provided a definition for clinical risk management: “systematic application of management policies, procedures and practices to the task of analysing, evaluating and controlling clinical risk.” It has been a legal requirement for health and care suppliers and organisations implementing health and social care IT systems since 2012.
In terms of what that means for the GNCR, “there is an NHS digital clinical safety team,” said Phil, “who provide and support clinical safety officer training… that trains individuals in the use of tools for clinical risk management, which is my main involvement with the GNCR. It’s a health and social care community of collaboration, there’s CCIOs, CIOs, CSOs, the GNCR team itself, pharmacy staff – just a whole range of people throughout the entire region, helping with GNCR implementation, its integration with EPRs, and raising issues or concerns when there are any.
“I put all that together into a hazard log, which is essentially a RAG-rated controlled document that describes how the GNCR is used and implemented, and any mitigations. I then produce a clinical safety case report which basically is a summary of how it’s used, safely, and then there are weekly meetings between myself and the GNCR team to talk through implementations of new data feeds.”
Phil provided some background to the GNCR. Starting in 2016 with a shared care record for regional primary care data, with the GNCR Health Information Exchange (HIE) going live in 2020.
The GNCR now covers a population of around 3.2 million from more than 400 GP practices, involving all hospital trusts in the region and all CCGs (eight of each), all 13 local authority social care providers, two mental health trusts, the North East Ambulance Service, and eight out-of-hours services.
Phil shared information on the GNCR’s delivery so far; 100 percent of primary care data is being shared across the region and over 200 Community Units are sharing data. As well as the region’s eight NHS trusts contributing data to the HIE, Sunderland City Council and Durham County Council are sharing data as well.
The types of information included in the HIE fall under five categories: GP and community data, such as patient demographics, examinations, investigations and medications; secondary care data such as allergies, correspondence, visits and procedures; mental health data such as referrals, progress notes, appointments and care plans; adult social care data such as safeguarding, service provision, disabilities and practitioner involvement; and North East Ambulance Service Data, which covers crew reports.
“The information has improved iteratively over the years,” Phil said, describing it as a “massive venture in the middle of the pandemic.. the GNCR team have been fantastic in working with suppliers and IG experts to get all this rich information.” Commenting on the inclusion of the ambulance service’s information, Phil said: “It’s really, really essential – when I see a patient who’s been brought in by ambulance in my emergency department, I can go onto the HIE which is integrated into my electronic patient record (EPR), I can click on the EPR form from North East Ambulance Service, and I can see their digital journey – the original call, the details, et cetera.”
The integration with the EPR is “fantastic,” Phil said, “it’s seamless and very easy to use.”
Briefly, Phil shared the deployment plans: currently the team are working on the integration of BadgerNet maternity information (digital maternity notes), with further community data from EMIS ready to deploy. Further along in the summer, additional connections from Newcastle City, Gateshead Council and Hartlepool Council are due to go live.
“Another thing we are currently exploring is lab information,” Phil said. “An interesting feature of labs is that they often don’t use NHS numbers, they’ll use the lab number which is of course unique to that lab but might not necessarily be unique to labs across the UK. Within the GNCR, we’ve noted that we’re not able to see as much lab information as we’d like to see at the moment, because we rely on NHS number and date of birth to tally, so if the system doesn’t have an NHS number at the point that data is sent, then we can’t display that data as it wouldn’t be safe – we wouldn’t know if it was the correct individual. So we’re looking at other ways to work with organisations to ensure that we have that NHS number and date of birth appended to the data source.”
Next, Phil shared an example of monthly statistics showing all of the Cerner health information exchanges from May 2021 through to April 2022. The graph, available to view at 18:38 on the video below, demonstrates how the GNCR routinely sees the highest level of activity each month. “Pretty much month-on-month we’re seeing a rise in activity, a rise in usage,” commented Phil. “Probably as we increase the data more and more, it becomes more useful, and because it’s integrated into the user’s health system, it’s very easy to use. We’re seeing upwards of a third of a million views of a system’s record every month. Each time that’s accessed, that’s an improved care episode because of the rich data source that the GNCR provides.”
The presentation moved onto who has the ability to access the HIE. “Essentially it’s anyone who has a legitimate care relationship,” said Phil. The examples shown include nurses, AHPs, doctors, medical staff, health care assistants and pharmacists.
Next Phil shared an example of what the record looks like; he showed a screenshot of an EMIS system viewing a TPP record of the GNCR in standard view. It can be found at 23:31.
Feedback from users is positive; North Tyneside GP and Clinical Safety Officer Dr Mark Westwood said, “Having access to more information about the patients we care for means that we can have better conversations with out patients, rather than just getting them to repeat the same information over and again.”
An A&E consultant commented: “Some patients can be confused when they arrive in our department. I can access their vital medical information, which means I know for certain which medication they take, and if they are allergic to any drugs.”
A community palliative care nurse specialist from Newcastle Hospitals added: “I find being able to access information about the patients I care for using the GNCR really useful. I used to have to ring the GP practice which wasn’t always easy. Being able to access the right information electronically means I can access this information quickly and easily. In particular, being able to access medication history means I know exactly what my patients have been prescribed and what dosage.”
Phil rounded up his presentation with a summary: “So, essentially, the GNCR is a collaborative approach across the North East and North Cumbria to ensure a continuously improving, safe, stable and highly useful shared care record is available to health and care staff at the point of care.”
Then it was time for a question-and-answer session, which can be viewed from 33:30 on the video below.
Many thanks to Phil for joining us and for sharing his knowledge.
