Sharing Patients’ Records

Using an integrated care record is helping deliver more joined-up care across a London borough

Many commissioners across the country are striving to find ways to link information across care settings. This is not just a case of responding to central mandates. There is a real and immediate clinical need for integrated records so that, for example, a hospital clinician can see crucial information on the emergency patient in front of them without having to make phone calls to a surgery, or a GP can tell the patient their blood test result without having to wait a week for a letter to arrive.

The Camden Integrated Digital Record (CIDR), created by Camden CCG in London, in partnership with health and social care providers, represents a very real step towards meeting the ambitions of the National Information Board’s 2020 strategy for personalised health and care.

The CIDR system has been in development for more than two years, during which time we have worked to understand the information needs of our varying stakeholders, put in place safeguards and overcome technical challenges. It is now being put into action, making joined-up health and social care a reality in Camden. For the first time, with the permission of patients, we are linking crucial information at the point of care, benefitting potentially thousands of professionals working in GP surgeries, hospitals, mental health and community care settings, and in social care.

The benefits are immense and mean that health and social care professionals can make more informed decisions with and for their patients than ever before. We are working to ensure that the best possible care is delivered at the most appropriate point for the patient, and wherever possible, long before patients reach the stage where they need to receive costly hospital interventions.

Patients are also set to receive information, like their pathology test results, much more quickly as a result of the integrated information now available to GPs. Safety too is improving, with visibility of patients’ medication history by approved individuals in appropriate settings.

All of this is taking place with confidentiality and security of information as the highest of priorities, and the CIDR will soon deliver benefits across North London.

Matching records to make it happen

Making this happen has been a complex challenge – as it would be for many CCGs in England. In Camden we have overcome a core challenge of this integration effort: matching data held in different systems, in different formats and to different levels of granularity and accuracy, across our partner organisations.

In Camden alone, we are linking data from our GP practices with information from social care systems used by our local authority. This too is being linked with information from the Royal Marsden NHS Foundation Trust’s Coordinate My Care system, and from a myriad of databases across our mental health, acute hospital and community partners.

We needed to be able to confidently and accurately match these disparate records to create a joined-up picture of the patient, regardless of how the information had been recorded and stored by our partners’ respective systems.

The rigorous process of checking that the information matches up with the master patient record is now being done so successfully that people using the system don’t even question how it works behind the scenes.

Automated probability matching through a system known as the NextGate Master Patient Index, has enabled us to confidently match records from patients’ different care episodes. This automatically excludes erroneous data and links ab results, prescribed medication and more, against specific patients. This information is then presented to authorised professionals through the CIDR at the appropriate point of care. Solving this back-end, yet vital, challenge has been an essential component to creating an accurate integrated care record. Without it, joining up episodes of care would not have been possible.

Matching patients’ expectations

Our entire CIDR programme has been focussed around meeting patients’ needs. Respecting confidentiality has been a core part of this from the outset. Only authorised health and social care professionals are permitted to access information that has been linked. Additionally, these staff can only view the information at the time of delivering care, and only with consent of the patient to allow records to be viewed in that organisation, or in emergency cases where access is time limited and based on predefined justifications or the patient being unconscious.

By the end of 2016, more than 2,000 health and care professionals in Camden will be using the CIDR system. This will help them better match patients’ care expectations. For the patient, this will mean that they no longer need to repeat their story to different staff in different organisations. They will receive more informed decisions from their providers, based around their individual needs and circumstances. Patients will experience a safer service, with significantly reduced risks around mis-prescribing of conflicting medication, for example. And at a higher level, this will help to deliver the integrated services needed to keep health and social care services sustainable in the future.

Keeping health sustainable

The benefits of a joined up view of individual care expand beyond an improved patient experience too – it will help local services in North London make far more effective use of precious resources. At a time when the NHS is tasked with saving £22bn to ensure its sustainability, services in Camden are now set to realise a wide range of cash-releasing and other cost saving benefits.

In Camden we expect to see a significant decrease in time staff spend generating and processing paper. Correspondence within organisations and between organisations will be relied on far less, in favour of healthcare professionals using the CIDR portal to access information from other organisations. Reducing the need to re-enter patient data at different points of care will also reduce the time burdens of busy staff. Money saved on administrative tasks associated with sharing paper-based information such as printing, document storage and postage can be better spent on the provision of frontline care. There is also expected to be a reduction in the duration of traditionally lengthy initial assessment appointments, which can be far better carried out with immediate access to holistic information on the patient.

Our investment in the CIDR will also mean that duplicate and unnecessary referrals can be avoided, as too can repeat diagnostic testing. We expect to reduce medicine waste and the likelihood over over-prescriptions. And fundamentally, better co-ordinated care will be safer care that is sustainable into the future. This is about creating a health service that can cope with growing demand, can more effectively respond to the needs of the local population, and use existing resources to the fullest extent to deliver the best care possible.

By: Julian Young, Camden CCG’s CIDR programme manager

*This post was originally published in the Summer 2016 issue of The Commissioning Review.