Hammersmith & Fulham Integrate Care Electronically

Nationally, health and social services suffer from a lack of integrated IT systems. However, a few local authorities have started to innovate in linking the two, writes SA Matthieson.

One is the London borough of Hammersmith and Fulham, which has developed a Joint Electronic Transfer (Jet) extranet project, designed to allow doctors to view social services data, make electronic referrals for services and submit corrections to information held in social care records.

“This came out a conversation between a doctor and Tony Ellis, head of IT for social services,” says Tim Rodgers, project manager for Jet. The idea was to provide doctors with a more efficient channel than phoning social services for data, or to make referrals.

The system, which uses secure sockets layer (SSL) 128-bit encryption – the level of security used for online financial transactions, is currently being used for referrals such as for care in the home and the installation of adaptations such as handrails.

Jet passes social care records one-way, from social services to GPs, rather than handling health records. Mr Rodgers says health professionals are very protective of their data, so it makes sense to have data flow in this direction. “It also helps from the trust position. People tend to trust their GPs ahead of their social services department,” he says.

He says allowing medical data to be seen by social services could be useful, although it would throw up formidable questions of data protection. “But in some respects, [social services] waits for a referral to come to you. It’s not something we’ve explored at this time.”

The Jet system allows a GP to collect consent from a patient on social services’ behalf, by asking the patient to fill in a form. “The GP then ticks a box, but we then must receive the form within seven days,” says Mr Rodgers. “You have to trust the GP to take consent in a proper way.” The GP can then review the social services records and make recommendations while the patient is present, involving him or her in the process.

Jet was set up in 2001, and currently handles requests from Richford Gate Health centre, and has plans to connect another health centre soon. “The ultimate aim is to have all surgeries in Hammersmith and Fulham,” says Mr Rodgers, adding that the reason this has not happened faster is due to lack of council resources.

But with a new member of staff now in place, the borough is also considering new users such as the accident and emergency ward at Charing Cross hospital, which lies within the borough.

Jet has so far been exclusively used for adult service referrals, but the borough is now exploring other potential areas it could be applied to. One further area of development being investigated is to use the system to help integrate children’s records – a key recommendation of January’s Laming report into the Victoria Climbie case.

A hospital child protection nurse has asked for online access to the child protection register, and the borough is now investigating how Jet could fit with an already-operational secure email system created by Lambeth, Southwark and Lewisham for social services information.

The borough says it is also open to offers from other authorities which want to use the Jet system. Mr Rodgers says he has had a couple of dozen requests from local authorities for access to a demonstration database, since the web-site opened last month (http://www.jetweb.org.uk.).

In addition to the Jet project Hammersmith and Fulham is also working with the five other boroughs in the West London Alliance to create an electronic clearing house for social services data. The project, Elsid, has central government Pathfinder status, and will allow the secure electronic transfer of social services records between the boroughs when clients move from one to another. The Alliance is involved in similar projects in public sector letting, procurement and customer relationship management systems (see http://www.westlondonalliance.org/).

Elsid will require the six boroughs (Brent, Ealing, Hammersmith and Ealing, Harrow, Hounslow, Hillingdon) to adopt an XML schema to allow data transfer. Mr Rodgers says it should be operational by the end of this year. “It could be multi-service in time,” he adds.

Although this kind of co-operation is a start, local government suffers from the lack of a single secure network, such as NHSnet, the Government Secure Intranet (GSI) or the Criminal Justice Extranet. Until it has one, tying together social services and healthcare – and even tying together neighbouring social services departments – is going to require specific local work.

Link: Electronic Social Care Record To Be Phased 

(c) SA Mathieson 2003