Shared records starting to make headway

Sharing records between care settings is starting to become much more commonplace, but is viewing patient and clinical data enough to deliver joined-up care?

Vivienne Raper revisits some of the pioneers of information and record sharing, and examines how they are beginning to use shared records to change how they interact with patients.

In 2013 NHS England set out its vision for trusts to achieve a “fully integrated digital care record [IDCR] across all care settings by 2018”.

The vision first set out in Safer Hospitals Safer Wards: Achieving an integrated digital care record, defined an IDCR as the ability of users in local health and care services to view patient and clinical data in a joined-up manner.

According to Markus Bolton, joint chief executive of shared records specialist Graphnet, real progress has been made in achieving the target. He estimates that around 35% of health communities in England now have what he describes as large-scale solutions.

“We already have 12 million patients on our systems on CareCentric [Graphnet’s shared records software]”, he says. “And we’re expecting to double that in nine months – it’s really picking up pace.”

Bristol builds momentum on Connecting Care

Bristol was among three IDCR exemplars named by NHS England in 2014, building on locally-led developments. Today about 2,500 users share records across GP surgeries, three acute trusts, community providers, mental health and adult social care via a portal supplied by Orion Health.

“We’re still in growth mode,” says Andy Kinnear, Connecting Care programme director. “The plan is to get up to about 10,000 users, and it may go beyond that in due course.”

Most of Bristol’s efforts over the last year has been growing the functionality of the shared record by, for example, allowing document sharing and so-called context launching from within native applications. So, for example, a GP can launch the shared record from inside EMIS rather than logging into a separate system.

Connecting Care is due to add children’s social care this month, and has begun conversations with third sector charities and the police.

Kinnear believes having IDCRs across NHS England by 2018 is entirely plausible. “But I think it depends on how you go about it,” he says.

“I think the areas where it will be more challenging are where the people haven’t yet started, but they can be successful if they join neighbouring programmes and adopt solutions that have worked elsewhere.”

Bradford now able to share records at scale

Bradford, another IDCR exemplar from 2014, now has the potential to share most data of 600,000 citizens. The area’s GP practices, acute trust, adult social care and community services all use TPP Systole and can share information across different modules of the same TPP SytmOne system.

“We have the potential to share everything with those agencies,” says Andy McElligott, medical director and Caldicott guardian at Bradford District Care NHS Foundation Trust. “That functionality simply didn’t exist two to three years ago.”

However, Bradford relies on explicit patient consent to share information on a case-by-case basis. “We’ve still got some work to do in getting the information governance exactly right so we’re confident in a wider sharing model,” McElligott says.

Overcoming information governance challenges

In general, the barriers to IDCR are about people and not technology. There are multiple different stakeholders and organisations who must work together, and agree information governance. In Bradford alone, there are close to 100 GP practices, all controlling data.

“Many people in health and social care think and operate at an organisational level,” says Kinnear. “To make programmes like this successful, you need people to think and act system-wide.”

Managing expectations and providing sufficiently rich data

Another challenge is ensuring the IDCR contains sufficient depth and breadth of information to be worth using. According to Colin Henderson, VP EMEA strategy, solutions and partners GM emerging markets at Orion Health, this explains why Bristol currently has around 2,500 users when the technology is in place for many more.

“The danger of rolling something out without the right information is you can lose the crowds quite quickly,” he says. “If they login, don’t see enough information they expect, then you’ve got to do a retrospective management exercise to get them on board.”

Reaping the benefits of shared records

Time saving is a benefit of the shared record in Bristol, Kinnear reports. Preoperative assessment teams used to work intermittently for four hours on an assessment – calling GPs for information and so on. Now, he says, it takes 90 seconds.

Improvements in Bradford are hard to quantify, McElligott admits, although he believes there have been benefits to patient safety. Airedale GPs are, for instance, now aware of medication changes that occurred while a patient was in hospital, and vice versa, without needing to ring up.

“The other benefit would be in an emergency, such as someone brought into A&E confused or unconscious,” he adds. “The staff treating that patient have immediate access to their full medical history.”

Next steps in use of shared records

David Hancock, client engagement director at InterSystems, explains that – although many areas say they have a shared care record – what this means varies. “Everyone is on a journey,” he says. “And they’re in different places.”

Sharing data may be as simple as viewing GP records in an acute hospital, but – increasingly – more mature IDCRs want to go beyond that. One example is use of analytics: “People increasingly want to do sophisticated analytics to stratify patients based on risk and put them in a programme to manage their condition,” Hancock explains.

Around 7,000 people across Manchester with long-term conditions, such as diabetes and depression, are managed through a care plan co-ordinated using Graphnet’s CareCentric. “These patients end up with an A&E admission if they go into crisis,” says Mark Wright, head of IT at Manchester Clinical Commissioning Group.

Potential to reduce A&E attendances

In Manchester a shared care record is compiled by GPs, paramedics, social workers and other services, and accessed via a single sign-in. According to Graphnet, early analysis of the first 2,000 patients enrolled in the programme showed a substantial decrease in A&E attendances and emergency admissions.

Another new development, according to Graphnet’s Bolton, is cross-care community workflow and alerting. He says: “A GP might ask for advice from an acute doctor via Graphnet’s Care flow software, or a community nurse receive an automatic alert when a patient is admitted to hospital.”

Consolidation of shared records to align with STPs

Going forward, Henderson expects a consolidation of IDCRs spurred on by the 44 Sustainability and Transformation Plans (STPs), which can cross the boundaries of existing shared records. Many of the published STP plans published include shared records as key to delivering joined up care.

“With the STPs you’re going to see a harmonisation of records,” says Henderson. “There’ll have to be interoperability between those regions.”

And it’s this next challenge, to have interoperable regional and local shared records, able to exchange data that looks set to be the next major challenge on shared records.

The other is to get shared records to a tipping point in 2017, and reach the point where the majority of health communities have growing shared records initiatives in place.