In our latest interview we asked Dr William Lumb, a GP in Cumbria and Clinical Lead for Integrated Services Care Group a few questions about their regional record sharing project.
The Medical Interoperability Gateway was introduced across the region to provide live information and datasets for health and social care, when they need it. Part of a regional record sharing project, live data is now being viewed by health and social care professionals over 90,000 times per month.
Could you tell me a bit about the project?
When we first started years ago, we wanted to deliver, to any relevant individual in health and social care, the shared information they needed to know at the point of care.
This required us to look at our source material and it required us to create datasets – this is so you just share what you need to share.
There were lots and lots of conversation with each organisation or partner in health and social care, this was the social part of the project. You have conversations with people who want to view data, we spoke about what would be useful or un-useful. You talk to A&E consultants to district nurses and you end up with a draft series of datasets to refine and look at the again. Then the datasets become the defined extract.
We have ended up with 5 or 6 different datasets, with the GP record as the main centre for a number of reasons. It is probably where the record is most cleanest, because of human factors in there where GPs get paid for having cleaner records, but also this is where the core record sits, and information finds its way back to the core record.
It also means you are creating a view, rather than moving any data around, and that helps with information governance compliance.
We have now been using the MIG in the region since 2011.
More recently you have added social care datasets as a view, could you tell me about that?
Yes we now have bi-directional social care data sharing. Going from health to social care we provide a view of the core record such as demographics, allergies, medical problems, care plans and end of life datasets. We also have some special patient notes, such as notes for a vulnerable patient, child etc. and we share all that in real time.
Social care datasets also come back towards health and we are currently in pilot for this. We worked with staff in health who work with staff in social services and we wanted to understand what data they needed and what they didn’t. In reality this is quite complex stuff to do, whether technical or designing a dataset.
The integration with Liquidlogic, the system used for social care services in our area means system data can be joined-up. The MIG provides HTML views from the Liquidlogic Adult content store system as a specified dataset. Real time feeds of social care data include patient demographics, allocated case worker, associated carer, disability, risk type and case details.
What has made this project successful?
Relationships matter. So, for example we started off the project having 2 hour face to face meetings each month with teams across disciplines and now we have 30 minute phone calls. As people get more and more familiar, everyone aligns themselves.
Information governance is your friend, not your enemy, and it can be facilitative. You need to manage your information sharing and sharing agreements.
Health and care professionals can now see what is being done elsewhere and what has happened. For users, this is now just business as usual information that they access.
What are some of the benefits?
The benefits are qualitative and quantitative. The qualitative benefits – the individual doing the assessment should know more about the patient and do a better assessment of the patient, be a health or social care professional.
I know this is reducing admissions. For example, in frail elderly patients, the care plans are available through the record, so we know there is a reduction. All our business cases suggest it’s worth doing.
What are some of your learnings from the project?
A lot of the standards and methodologies we developed with Healthcare Gateway are now being adopted by their other shared care record projects.
We now know there are four key things you have to do to have an effective health and social care system. You have to share records appropriately, and each provider needs a good electronic record. You have to have patient facing applications and allow patients to digitally engage with you and you have to also have a flow solution.
Shared Care Records need to be introduced into culture and practice, just that it exists doesn’t mean people will use it. We now have 10,000 staff and one of the challenges is ensuring everyone accesses the shared record when they should. We now have nearly 100,000 views each month, each providing benefits back in to our health and care system.
