It has been an eventful year for Shared Care Records in England. The Covid-19 pandemic gave a new impetus to work that was already underway and then, in July last year, NHS England set a new target.
Outgoing Chief Executive Sir Simon (now Lord) Stevens announced that the integrated care systems (ICSs) to take forward the reforms in the NHS Long Term Plan should have a ‘basic’ Shared Care Record in place by September 2021.
The announcement gave real impetus to the market, and since we have been working hard to support our existing customers while winning new business. In Dorset, where our technology underpins the Dorset Care Record, we have been supporting the development of cross-population Care Pathways, with the Diabetes Care Pathway, while preparing to launch the Dorset personal health record, the Engage based and MyDCR.
In Hampshire and the Isle of Wight, we have moved the Care and Health Information Exchange (CHIE) from its old platform to Orion Health technology. In addition, we have welcomed new customers to Orion Health to develop their Shared Care Records. Derbyshire, to develop Joined Up Care Derbyshire; Devon and Cornwall, for the Devon and Cornwall Shared Care Record; and Cambridgeshire and Peterborough.
Accelerating the Shared Care Record journey
The ambition for Shared Care Records is not recent and goes all the way back to 2006 with the National Programme for IT in the NHS.
More recently, the government set up the local health and care record exemplar programme to show how Shared Care Records could support the joined-up health and care and population health management that ICSs are being set up to support.
Some of the longest standing users of Orion Health technology are deeply embedded in the LHCRE (Local Health and Care Record Exemplars) programme. The pioneering Connecting Care in Bristol is part of One South West; as is our new customer, Devon and Cornwall.
The Dorset Care Record and the Hampshire and Isle of Wight Care and Health Information Exchange are partners in the Wessex LHCRE. Cambridgeshire and Peterborough takes us into the East Accord.
While the Manchester LHCRE uses the Rhapsody integration engine that Orion Health provided as the basis for its ambitious digital programme. These strategically important links helped us to develop a ‘Solution IDCR’ (integrated digital care record) that meets the LHCRE requirements immediately.
What constitutes a ‘basic’ shared care record has never been fully defined, and Matthew Gould, the chief executive of digital agency NHSX has told Parliament there is some “flexibility” around what this entails.
However, we have been able to tell ICSs that if they want a Shared Care Record that meets NHS use requirements, that satisfies security and information governance requirements, complies with market required standards such as DCB0129 for the management of clinical risk, and gives them analytics capability to support future Population Health Management, Orion Health have what they need.
Coming next: a ‘comprehensive’ record by 2024
In its recent data strategy, Data Saves Lives, NHSX has set a further target for ICS’s to work towards the development of a ‘comprehensive’ shared care record by 2024. Again, the terms ‘basic’, ‘comprehensive’ are not fully defined, but in recent presentations NHSX has indicated that it will include the development of an integrated social care record.
This will lead to a definition of a Shared Care Record with contribution across the traditional care health care settings to other care settings such as social care, palliative care, such as hospices, and the independent sector, such as care homes.
While we wait to hear more, we will continue to support our customers and encourage them to work with the development of their Shared Care Record through reference to our record maturity model. The Orion Health team in the UK and Ireland developed the model to map out a strategy for our customers to move from reactive care to predictive care using Orion Health products and technology.
The key consideration when you begin your shared care record journey is to its full use case across direct care and the wider activities of population health management. It is important to consider the requirements from a data perspective and to consider the demand for data to be immediately available, as with direct care, to be available over a long period of time, and persisted to support population health management.
Typically, the early focus is on the availability of data to support direct care with the technological approaches, through Application Programming Interfaces (API’s) to make data available on demand. Whilst this supports the immediate use case it does not persist data within the data platform to support the longer-term objectives of population health management, specifically the ability to analyse the data to recognise trends within cohorts of patients. The Orion Health standardised ‘solution IDCR’ supports both use cases and includes the Discover analytics platform as standard to future proof against the use cases.
More data, more settings, opening a digital front door
When we look to the future, there is no doubt that the new targets are going to accelerate the journey that the NHS is on. The next steps are the use of Shared Care Records in other areas of care. Hampshire and the Isle of Wight, for example, has recently extended the use of CHIE into care homes with over four hundred users now accessing the record through Multi-Factor Authentication technology.
We will also make progress on access and use of new data feeds. I’m excited about the idea of adding police or fire service data to Shared Care Records to give health and care providers a better understanding of citizen interactions with other public services, and to give emergency services more information about the people they encounter in ‘blue light’ situations.
We are also developing the concept of the ‘digital front door’ for patients, service users and citizens, to will give them much more choice about the way in which they use their information to interact digitally with providers; and more choice over the provider they use.
Whilst that is not the use case currently for the English market at the moment we are still seeing plenty of ICSs thinking about ‘basic’ Shared Care Records and Orion Health customers thinking about how to mature them.