Sharing of Care Records

Dr Maureen Baker CBE DM FRCGP

Chair of Council

RCGP

Declaration of interests

• Strategic Safety Adviser to HSCIC• Previously Clinical Director of Patient Safety

HSCIC (NHS CFH)• Led development of NHS ISB safety standards

(ISB 029 and 060)

Record sharing methodologies

• View of Information (Summary Care Record)• Access to electronic record (where view is

governed by sharing model and patient consent)

• Inter-operable records• Full access to full shared record

Principles on record sharing

• Patient safety is paramount• Personal information should be subject to

highest standards of privacy and confidentiality

• Tension between above two must be properly governed (eg Caldicott Guardian)

• Views and entries must be reliably timed and traceable to individual caregiver

Factors to consider• Could be creating long-term record (many years

and multiple episodes of care in multiple settings)

• Major differences from record focusing on one episode of care (eg hospital in-patient)

• Safety dimension in accurately identifying critical information quickly (eg drugs, allergies, results)

• IG dimension in protecting info that patient does not want widely shared

• NHS needs systems as safe as design and forethought will allow

• System designers need to think how technology can support clinicians in safe practice

• Systems need to be tested in 'real' environments

• Safe view (right patient, right information)

• Safe transfer (retention of semantic meaning; right field to right field)

• NHS safety standards must be applied (NHS number; ISB 029)

Designing for safety

• Timely

• Reliable

• Accessible

• Concise

• Coded

• Attributable

• Retrievable

The Holy Grail

• Any data from anywhere in NHS system has potential for commissioning

• Demographics; Drugs; Interventions; Outcomes

• GPs currently have most comprehensive coded datasets over longer periods of time

Data to inform commissioning decisions

• Data quality is a patient safety issue

• Data quality is a commissioning quality issue

• Need a system-wide understanding of importance - but also limitations - of data quality

Rubbish in rubbish out

• Need routine capture as 'by-product' of care process

• Must minimise (preferably eliminate) burden of data capture for clinicians

• Appropriate patient consent models MUST be in place

• GPs and practices need mechanisms to allow patients to enable patients to exercise their choice

Clinical information for commissioning

• Timely discharge information

• Results

• Key events during admission (not always clear, or on discharge summary)

• Drugs at discharge and reasons why any changes made to previous regime

• Follow-up information/requests

What GPs want

• Blank or minimal information

• Vast amounts of detail specific to admission (eg nursing notes)

• Lists of instructions (eg GP to.... – Grrr!)

What GPs DON’T want

• Based on extensive work by national and international organisations

• Endorsed by the DHIDs National Clinical Content and Requirements Board in partnership with the Royal College of Physicians (RCP)

• Contains a check list for Clinical Safety Officers to use when reviewing handover IT systems for use in the NHS

Safety handover guidance

• The data items constitute a core set of issues which must be used in any and every electronic clinical handover

• The core set of issues is necessary but not sufficient for any and every electronic clinical handover – each health care setting will have its own, additional set of essential data items to be transferred in a clinical handover

• The guiding principles and related data items for ensuring safer clinical handovers are additional to, and not instead of, all usual clinical safety assurance measures as set out in Data Set Change Notices (DSCNs) 14/2009 and 18/2009

Guiding principles

• Name (‘last name’ and ‘first name’ as endorsed by the ISB standard 04/2009)

• Date of Birth (DOB)

• NHS Number

• What is wrong with this patient? e.g. Active clinical problems

• What has been done? e.g. Relevant investigations & treatments to date

• What needs to be done? e.g. Action plan – including when and by whom

• Medications – current

• Anything else I should know? (eg. Alerts such as risks, allergies, statuses, disability; resuscitation status; advance directives; next of kin)

• Responsible consultant/team/clinician e.g. GP or nurse making the handover

Data items

• Very few/if any truly integrated records in NHS

• Integrated OR interoperable?

• Local health economies and emerging Integrated Care Organisations should consider options for integrated records

• Basic standards already in place – NHS no., safety standards, electronic handover guidance

Conclusions

Thank you!

@Maureenrcgp