As they prepared to celebrate its seventh anniversary on 4 July, the team behind Northern Ireland’s Electronic Care Record decided to ask users what they thought about it.
They put out a tweet asking for views, and were overwhelmed by the tributes that came pouring in. One comment read: “There is no doubt this software has saved lives. I use it every day, and I am grateful it exists.”
Stephen Beattie, the eHealth programme manager at the Business Services Organisation, which runs the record on behalf of the health and care system in Northern Ireland, told an Orion Health webinar this meant a lot. Not least because it came from a clinician and, as he pointed out, “they do not tend to sugar-coat their feedback.”
Another described the record as “the best thing since sliced wheaten bread” which, Beattie suggested, might be an even bigger accolade “given how fond we are of our carbs in this part of the world.”
A further said: “Undoubtedly the most useful innovation in NI health in my career. Its rapid adoption by so many clinicians so quickly has said it all.”
Addressing familiar challenges
The NIECR has been able to generate this level of enthusiasm by maintaining a clear focus on how it can help clinicians and other users to address the challenges that face them, and by engaging clinicians and patients at every stage.
Beattie told the webinar that from the outset the aim was to address issues that were “similar to those faced by lots of other health systems” – including siloed IT systems that required time-wasting multiple-logins and made it difficult to get an integrated view of a patient.
“The first thing the NIECR wanted to do was to bring everything together into one pane of glass, from where it could be accessed by one password,” he said. “At the same time, we wanted to put the patient at the centre, so we could connect people to their care and make sure the people who care for them are connected to each other.” The NIECR achieved this by pulling information from the systems used by Northern Ireland’s five health and social care trusts and its ambulance service into the portal technology that is now part of the Orion Health Amadeus Open Platform.
This single view of information is still one of the things that is most valued by users, one of whom tweeted “being able to find out what has happened virtually anywhere in the system is superb.”
Layering in additional functionality
However, since then the NIECR has added a lot of additional functionality. Two of the key components of the NIECR are access to Northern Ireland’s Emergency Care Summary, which records a patient’s name, date of birth, gender, address, phone number, medications and known allergies, and the Key Information Summary Record, or KIS.
This adds additional information, such as the wishes of people living with long-term conditions or who are nearing end-of-life. Beattie explained that the KIS is completed by a GP and sent to the NIECR “so it is integrated into the patient care record” and “easily accessible by health and care professionals.”
One twitter user cited the NIECR functionality as cutting down on duplication through inpatient, outpatient and out of hospital letters all being in the same place as laboratory and imaging results, leading to “joined-up medicine,” adding that it was: “Safer and more efficient practice all round.”
More recently, the NIECR has been using Orion Health Coordinate to build a diabetes pathway as a model for pathways that can be used in various health and care settings, including the patient’s home.
The pathway is split into two main sections, a “generic” summary that can be used across pathways, and a diabetes-specific section that can be used to capture medications, assessments, and pregnancy specific data for women with gestational diabetes.
Beattie explained that the different professionals in a multi-disciplinary team can add their own Progress Notes, so everybody can see them, and access lab results in a way that enables them to see changes over time. “It is all a very efficient use of information,” he said. “A good example of right information, right place, right time.”
The patient portal
Beattie used the webinar to update viewers on another “huge project” that is just reaching the final stages of roll-out. This is the creation of a patient portal, which was initially developed with dementia patients.
As he acknowledged, this is a “difficult cohort, because of the information governance issues” – but the team reckoned that if a portal could work for them, it could work for anybody. The portal has been developed in stages to make the most of its Orion Health Engage platform.
The first stage was to give patients access to appointment details, after which the portal added a library of trusted information sources and clinical documents, and then Circle of Care functionality to enable patients to record the details of the professionals and others involved in their care.
The portal also enables professionals and users to set and monitor goals and gives patients access to their diagnostic results. One twitter user said she was really looking forward to seeing the portal “rolled out further” because it could be “a game changer for patients”; while a patient tweeted to say it had already been a game changer for her.
Coming of age in the era of Covid-19
The NIECR continues to grow and evolve. Beattie told the webinar that it now has 60,000 users and is adding 300-500 per week.
It saw a big uptake in use during the early stages of the coronavirus pandemic, when clinicians working in Northern Ireland’s large independent sector were given access so Belfast could split hospitals into Covid and non-Covid sites.
The NIECR was also used to support the effective treatment of patients with Covid-19, virtual visiting, and the roll-out of virtual clinics. All of which has been hugely appreciated by people in the service.
One twitter user wrote: “The NIECR was greatly utilised by some staff during the Covid response [and was] a real asset to continuity of care’. while another went further: “Totally priceless during Covid when reviewing patients in peripheral clinics with access to hard copy notes.”
A new mix of digital and face-to-face interaction looks set to be a feature of the post-Covid landscape, and Beattie said the NIECR was looking to support this, for example by adding forms to the patient portal to collect pre- and post-surgery information.
In response to a question, he said remote monitoring was also a live issue. “At the moment, the closest thing we have is the Covid-scenario of remote clinics, but it is something that we are looking at, and we have seen demonstrations of the Orion Health solution for that.”
However, the seventh anniversary has proved a good moment to look back at where the NIECR has come from. “It is widely used across health and care and with the private sector,” Beattie summed up at the end of the webinar.
“The benefit we have achieved has been phenomenal and a credit to everyone who has been involved to date from our own health and care system, Orion Health, and other colleagues.”
Catch up on Stephen Beattie’s webinar on the Northern Ireland Electronic Care Record celebrating its 7th birthday.