The NHS has made a significant investment in shared care record systems, first through the local health and care record exemplar programme, and then through the target for all integrated care systems to deploy a ‘basic’ ShCR.
The recent ‘plan for digital health and social care’ indicated that the Department of Health and Social Care and NHS England want to maintain momentum by creating ‘an integrated, life-long health and care record’ by 2024. NHS England has published a roadmap for what this might look like, built around integrating care plans, adding social care and local government data, and enabling access for patients and carers.
In the first of a series of summer webinars, Brian Murray, UK and Ireland sales director, said the roadmap is “driving a lot of the work that Orion Health is doing at the moment.” However, he wanted to address another question: why and how to extend access beyond the primary, emergency, and acute care settings that shared care records have served to date.
“From the clinician’s point of view, this is all about having the information you need to deliver care, in whatever setting you are working in,” he said. “That improves the quality of care you can deliver, but it also makes life easier. It also addresses one of the issues that people just don’t want to deal with every day, which is hunting for information.
“From the citizen’s point of view, the most common complaint that we hear from patients is having to repeat things time and time again. It’s annoying, and people might not be comfortable sharing some of the information they are being asked for. If it’s there in the shared care record, it’s there to be viewed by the people who need it.”
Shared care records are extending access and delivering benefits
Many of Orion Health’s shared care record customers have accepted the argument. On the webinar, Murray showed a slide from Connecting Care in Bristol that lists the 27 organisations that are accessing its shared care record. These include care homes, hospices, charities, and prisons.
Murray said prisons were a particularly interesting use case. When somebody is ‘discharged’ from prison, a discharge letter is sent to their GP; but that GP might be hundreds of miles from where they are living. Being able to access the shared care record can help support services to address health and addiction issues they might not otherwise be unaware of.
However, it’s not just Connecting Care. In Hampshire, the Health and Care Information Exchange has extended access to care homes, making it easier for staff to provide the best possible care to residents and to reassure their families.
In Northern Ireland, the Northern Ireland Electronic Care Record has extended access to community optometrists, so they can help people looking for glasses with queries about their eyesight. In Dorset, the Dorset Care Record has rolled out shared care record access to community pharmacists, so their staff can see prescriptions, medication history, and GP recommendations.
“Often, people can’t always remember what their medications are. So, overall, this reduces risk and optimises the patient experience,” Murray said. “It’s also important for staff satisfaction. It shows that if you deliver benefits to staff, they will pass those benefits on to patients.”
Challenges, and how the RSPB’s core information standard will address some of them
Despite this, Murray acknowledged that there are challenges for shared care records to overcome. He listed a few as: information governance, security, sorting out role-based access, securing sufficient numbers of licenses, managing user accounts, and training.
However, he said solutions are being developed. On security, for example, Connecting Care has been trialing virtual private networks for care home access, while CHIE has rolled out two-factor authentication for care home users, who can use Google Authenticate to obtain a code for one-time access.
On licensing, Murray said that if shared care record customers needed more licenses, they should talk to Orion Health. Across the webinar, he also outlined some of the work that Orion Health is doing with the Public Record Standards Body that should help – a lot – with information governance, role-based access, and account concerns.
“We have been doing a lot of work with the PRSB on the core information standard,” Murray said; just a couple of weeks before the PRSB announced that Orion Health has become the first UK supplier to be assessed as conforming with the huge standard that will now, increasingly, define the content and scope of shared care records.
“The core information standard is driving how we display data but, just as importantly, how people access that data. The PRSB provides a framework for what people should be seeing – what information should be mandatory and what is optional for different users.”
Murray argued that this will help with information governance, because the core information standard will help to define use cases and reassure local organisations about the information that PODAC [podiatry, optometry, dentistry, ambulance and community service] users should be able to access.
And it will help with administration for the same reason: “There will be a level of confidence about what people should be able to see and, from the RBAC point of view, we can support that by creating dashboards and views for specific organisations, that let their users log-in and see things as quickly and easily as possible.”
Focus on improving care and eliminating tedious processes
In the end, though, Murray argued that extending access to shared care records is a matter of mindset. The challenges are real, but they can be overcome, as long as there’s a determination to do that.
“The fundamental question we need to ask is: is there information here that can positively impact citizen care? Is there information here that can have a positive impact on the working environment for professionals – does it remove tedious and time consuming processes to access the relevant information?” he concluded. “If the answer is yes, we just have to look at how to address these challenges.”
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