FROM PAPER TO SHARED CARE RECORD SCHEMES

The NHS is sometimes described a one of the last paper-based industries. Yet there are obvious disadvantages to operating on paper or electronic versions of it, such as fax.

Paper-based records can only be seen and maintained by one person at a time; so patients spend a lot of time giving out the same details to different professionals.

Even then, doctors, nurses and social care staff may not have complete or up to date information. Letters and faxes take time to send and receive. Patients and users can only get access to their own information with considerable effort.

These problems show up particularly in out-of-hours services; studies have shown that A&E staff can spend hours calling surgeries or standing by faxes, just to find out what drugs a patient is taking.

They also show up when patients need to move around the system; GPs often complain that they only find out that one of their patients has been in hospital when they turn-up in surgery. Another patient may be stuck on a ward waiting for a social care assessment.

These issues have led some areas of the country to invest in information sharing and shared care record projects. A good example is Bristol, which has been working on a project called Connecting Care since 2011.

Programme manager Jocelyn Palmer explains that the project has been through two phases.The first was a pilot to share GP-held data – such as basic patient details, allergies and medications - with out-of-hours and A&E services.

The pilot, which went live in 2013, fed information from local GP IT systems into a portal.
From there, urgent care staff could see it, as long as their job role gave them permission and patients gave their consent.

The second phase, which started in 2015, scaled the system.
The pilot covered 500 practitioners, most of them working in Bristol's three acute hospitals. Phase two already covers 2,000; with mental health, community services and social care on board.

"We wanted to develop a true shared care record; something that was richer [than the pilot] and that could support care in different ways," Palmer says. "For example, we have been working with three local authorities to include some information from children's digital systems to improve safeguarding."

"The idea is that if you are working in an emergency department you will be able to see some information about a child you are treating; for example that they have been taken to a lot of different A&E departments."

Phase two has also brought in new types of content, such as electronic documents and discharge summaries.
The documents that tell a GP what has happened to a patient in hospital. It will also support some technical changes, such as closer integration with hospital systems.

"We want to enable [hospital staff] to access the record with the click of a button from within the record [they use day to day]," says Palmer. "It should make a big difference, because people to not want to have to log-in to lots of different systems while they are doing their jobs."

Although it is still unusual, Bristol is not alone when it comes to information sharing. Liverpool, Cumbria and parts of London have major projects, built-out from technology that enables access to information in GP systems.

Lincolnshire is another county with a portal, while other areas of the country are looking at the health information exchanges offered by some hospital systems' providers.

Hampshire, Berkshire and parts of Manchester have gone down a different route, creating a new record that different services can access. A less common approach, but one developed in Bradford, is to get all local services onto one electronic record.

At a national level, information sharing was given a boost by the 'Personalised Health and Care 2020' IT framework that was launched in November 2014 to support the bigger financial and reform ideas of the 'Five Year Forward View' for the NHS.

This called for the creation of an 'integrated digital care record' and led to funding for three IDCR exemplars: Bristol, Bradford and Cumbria. Since then, NHS England's focus has shifted back to hospitals, thanks to Professor Robert Wachter's review of acute-sector IT.

But information sharing is still important at a local level. The 44 sustainability and transformation plans that have been drawn up to implement the Forward View all focus on the need to create and build on shared care record projects.

Hampshire is a case in point. It has been working on a shared care record since 2004, when it launched the Hampshire Health Record.

Like Bristol's pilot phase, this was initially focused on providing some basic patient information to staff working in out-of-hours and A&E services and has steadily expanded.

A case study from the South West Commissioning Support Unit says the HHR now provides both health and social care staff with: "care encounters, GP diagnoses, blood and radiology results, current medication, allergies, clinic letters, discharge information, and a growing pool of social care information".

Hampshire's STP puts great emphasis on the record as the foundation for better data and analytics for service planning, for IT that will "enable caring professionals to work from any location" with "real time information to support clinical decision making", and for new patient services.

Dr Mark Kelsey, a Southampton GP who is also the chief clinical information officer for the project, says all three strands will require significant amounts of work [see case study]. But he's also clear that these should generate further efficiencies.

"If you have nothing [in IT terms], then you need to do something, and something like a share care record is a good thing to start with," Dr Kelsey says. "But then you need to plug other layers into it."