Making a Detailed Care Record a reality

NHS Yorkshire and the Humber on the right road.

Setting deployment targets can be a dangerous activity, as NHS Connecting for Health knows only too well. But for the managers at NHS Yorkshire and the Humber, the process has not proved too hazardous.

Aspirations and delivery

Fifteen months ago, the strategic health authority planned to deploy TPP’s SystmOne to 50% of GPs, 75% of primary care trusts and 100% of prisons in its area by March 2008; and 70% of GPs and 100% of PCTs by March 2009.

While not all of those targets have been reached, 100% of PCTs now use SystmOne’s community system. TPP’s child health system has been deployed to most PCTs in the SHA area, and it is expected to be used by all other child health departments by the summer.

In addition, 40% of GP practices also use SystmOne, with another 10% expected to follow by March 2010. Nine out of 16 prisons have also implemented SystmOne, with the other seven in deployment and due to be completed by the summer.

Compared to the roll-out of local service provider primary care systems in the Southern and London clusters, these statistics detail a huge deployment programme.

However, in an exclusive interview with EHI Primary Care, Tony Megaw, head of primary care IT for NHS Yorkshire and the Humber, makes it clear that the SHA will not be sitting on its laurels. He says his organisation is “feeling good” about what it has achieved to date, but that it has plans to go much further.

GP systems

“I think it’s difficult to have targets, but we are making good progress,” he says. “Our expectation is that we will have between 50 and 100 more practices moving to SystmOne in the next financial year, although that depends on what PCT Operating Framework plans say at the end of March.”

Those who have spent the last few years campaigning for GPs to maintain a right to IT system choice have often pointed to the pace of change in the Northern clusters as a cause of concern. However, Megaw claims that the SHA is supporting GP Systems of Choice as well as supporting the LSP roll-out.

He says: “We move practices across where they are prepared to move across, when they see the business benefit.”

However, in areas like North Yorkshire and York, where around 80% of practices use EMIS, plans to move practices to SystmOne have caused alarm. GPs have protested that they are happy with their existing system and already have integration with the local hospital.

Megaw insists that practices are not expected to migrate to the LSP system if this would be detrimental to them, and says that equivalent integration with secondary care would be provided.

Megaw says the SHA’s area has some “very good local clinical systems” but also says that information is mostly held in silos – while the LSP product, SystmOne, is differentiated by the SHA because it offers integration with community and child health systems.

He adds: “It’s almost a Catch 22. The more users you have then the bigger the wealth of information. When a new practice comes on to the system the benefit is greater.”

Megaw reports that the SHA is seeing a “flurry” of GP practices in Bradford signing up for SystmOne, which already has 75% of practices.

He adds: “Even one or two diehards, who two years ago were definitely not going to move, have now decided to do so.”

Integration with secondary care

While the DCR may be taking good shape in primary care, a DCR for secondary care has yet to be delivered. Megaw says the plan in Yorkshire and the Humber is to integrate SystmOne into Lorenzo as part of release three and as part of the roll-out of Lorenzo known as the Penfield programme.

On the SystmOne side, integration is planned for release six. Megaw says “dates have not been confirmed” for when integration will happen, with LSP Computer Sciences Corporation still in renegotiations over its contract.

However Megaw adds: “I have seen some mock ups about how it is going to work and we are confident technically that we can get that integration.”In the event of non-delivery of Lorenzo, Megaw says “the strategy would be to develop interfaces to other secondary care systems.”

In the meantime, the SHA is doing some work with SystmOne on a shared care diabetes record that has been pioneered in Airedale and also on a single integrated record for palliative care in Bradford and Airedale that is accessible by general practice, out-of-hours, community and A&E services.

He says: “The common template for diabetes is delivering all sorts of benefits with remote specialist consultations that enable community staff to get expert advice from consultants which is having the business benefit of reducing the number of outpatient referrals and clinical benefit in supporting rapid diagnosis and treatment for patients with complex conditions.”

Megaw says adopting the same approach to other long term conditions will be another focus of the SHA in the coming year. He adds: “We are getting some fantastic stories now of both clinical and business benefits. We are seeing the vision of the National Programme for IT in the NHS in action.”

Confidentiality

Megaw’s enthusiasm for the DCR and its benefits contrasts with concerns that have been expressed about data sharing both in terms of the impact on patient confidentiality and the impact on the management of records.

Megaw says the SHA’s strategy is to deploy enhanced sharing and integrated records as soon as they are available. He argues that it has always been recognised that the governance around records would change as knowledge develops and says progress is being made on consent and data sharing.

He points to the revised consent model for the Summary Care Record nationally, as well as work the SHA has been doing on defining legal entities for data sharing and developing the DCR’s explicit consent model.

SystmOne’s release three, which changes the way data sharing works for SystmOne users, has been the subject of concerns from GPs and Megaw says it is being released in Yorkshire and the Humber in two parts.

Part one, involving role based access control linked to the Spine and smartcard log-on, will be deployed to all PCTs in the SHA by the end of February. Part two, the data sharing model involving legal entities and explicit consent for sharing of information, has been deployed in North Lincolnshire PCT.

Megaw says plans are now being prepared to continue deployment of part two across the SHA, with North East Lincolnshire PCT due to be the next PCT to deploy release three.

Another aspect of TPP’s SystmOne which has created debate is its ability to take part in the national GP2GP project. It uses Read code version 3, in contrast to EMIS, INPS and iSoft, which are all based on Read 2.

Megaw says release 5.01 of SystmOne, due to begin roll-out in autumn 2009 , is to look at GP2GP as well as delivering mobile working for SystmOne users, providing access to records wherever staff are working.

He says: “There is some central work going on to get mapping of Read 3 to Read 2 which is being reviewed at the moment. Failing that we will have to look to the future and the SNOMED coding system.”

For those sites which are eligible for GP2GP, Megaw says 92% have been enabled in the SHA. He accepts that, without CfH’s GP2GP functionality on SystmOne, there would be less benefit for practices where records are transferred to or from non-SystmOne practices.

He adds: “It is something we are trying to push forward because it will benefit everybody.” NHS Yorkshire and the Humber is also showing enthusiasm for other national projects.

Other national projects

It is involved in the SCR project, with Bradford and Airedale PCT one of the six early adopter PCTs. It has Leeds PCT lined up to be an early adopter for release two of the Electronic Prescription Service. And Bradford also became the first PCT in the country to open a GP-led health centre late last year, using SystmOne.

Megaw says one Bradford practice, Ridge Medical Centre, has successfully uploaded its summary records to the Spine and another was expected to do so last week. He predicts that, subject to PCT Operating Framework plans, roll-out of the SCR will begin after April, with timetables based on where supplier SCR products are available.

Megaw says there is no mandate across the SHA for GP-led health centres to use SystmOne. However, he argues again that the DCR provided by SystmOne makes it an obvious choice, because it provides access to records for patients who are not registered at the centre. He says the benefits of the DCR are at the core of the SHA’s primary care strategy.

He adds: “If you look at lord Darzi’s vision of quality care covering three areas- patient safety, patient experience and the effectiveness of care – we feel it is demonstrable that the DCR is helping to deliver on all of those.”