Creating a digital version of the old paper system only gets health and care so far; we need to look at workflow beyond any one hospital or organisation, writes Mike Green, chief clinical information officer at South Devon and Torbay NHS Foundation Trust.
We have made some really big strides in sharing information across health and care in South Devon. Our model has been built with the intent of putting the patient at the centre, so she or he only has to tell their story once, and the team can then communicate about the patient – whether that’s in the hospital or any care setting.
As an integrated care organisation we have an advantageous position in South Devon, where our acute trust, community and social care services fall under the same banner. This has helped with addressing information governance. But our challenge for the past six or seven years has still been to connect silos of information at the point of care.
The solution to all this was an information exchange: InterSystems HealthShare – and it has been a huge success. Professionals can access the patient record, order communications and test results.
We can also see GP information. We set up GP information sharing agreements, and use the Medical Interoperability Gateway (MIG), so that when somebody turns up at A&E, doctors can see a GP view of information about that patient.
We have also been able to use HealthShare to link with an external pathology service at Royal Devon and Exeter NHS Foundation Trust, using our information exchange to see results from the nearby trust’s 40-year-old pathology system. With a growing scarcity of pathologists across the region, having access to this external reporting resource from within our own trust in South Devon has been instrumental in allowing clinical service to be maintained.
In working to deliver more joined-up care for the complex needs of a population of 320,000 people, which includes the largest population of over-80s in the country, we have made some significant progress.
But there is still a lot to do. And what I have realised is that sharing information is not enough: digital transformation has to enable workflow, and not only that, we need to be able to innovate with that workflow.
Innovating with workflow
Creating a digital version of any old paper system and its associated workflow means you can end up retaining the old problems and building in new ones.
We have started to move beyond this – creating information flows through our information exchange that didn’t previously exist, and that have provided access to essential data at the point of care.
But we want to do more to radically change workflow through digital information.
Now that HealthShare has provided us with the platform to integrate information, we want to build intelligence into the background, so that someone can be alerted if a patient falls off that pathway, rather than having to manually go into the record.
And we have already started to achieve this. Now, if a patient who has a cardiology condition is admitted to hospital, specialist heart failure teams in the community are alerted and activated, so that we can start to put the necessary care packages in place.
This is about innovating with workflow so that we can prioritise, plan and intervene more effectively. At the sharp end of the acute environment our clinical teams use a combination of HealthShare, and early warning systems to rationalise deterioration. We know when patients need intervention and which patients need to be seen first.
But can we do more to identify vulnerable patients at the population health level – across primary, secondary, community and social care? The question has evolved to how we can use our information exchange to proactively alert individuals in different settings. In reality, I know from experience that a busy professional in A&E may not have the time to review a digital patient record when dealing with the emergency in-front of them. We now have an opportunity to look more closely at that workflow, to see how we can present information more proactively.
And more than that, if we are to genuinely realise patient centricity in our care, patients must experience a seamless journey as they flow from one provider to the next. Our work with Royal Devon and Exeter Hospital is an example of where sharing the records can be a huge advantage. But as we in the NHS and social care collaborate across settings, we have an opportunity to do more than view each other’s information systems. We have the chance to share pathways and eventually to contribute to each other’s records. In the case of two acute hospitals managing different aspects of the same pathway, we need technology to support this ambition by coordinating and updating potentially disparate patient information systems.
Digitising current processes is good, developing new processes drawing on integrated systems is better.
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