Lincolnshire is using the latest technology to enable healthcare professionals to share patient records
Many of the challenges facing the NHS are writ large in Lincolnshire. The second largest county in England, over half of its population live in rural locations and, with one in ten residents over the age of 70, it has a disproportionately large elderly population. Alongside this, it is having to work harder than ever to make every penny count.
To meet these challenges, in 2013 Lincolnshire’s healthcare partner organisations undertook a major review aimed at transforming its health and social care services and exploring how it could work more effectively with the third sector. Its goal was also to move healthcare out of hospitals, to situate it closer to patients’ homes wherever possible.
“We talked to colleagues across the care service, patients and others to ask the simple question: ‘If we want to deliver care differently, bring care closer to people at home, and to bring about more integrated working, what do we need to be able to do?” explains Liz Jones, Project Manager at NHS Lincolnshire STP. “When we asked this question the biggest issue that came up was the inability to access pertinent information across different organisations – GP practices, hospitals, community and social care providers. By making this change to care delivery it means that patients won’t have to repeat their story every time, and clinicians would have faster access to information to make faster decisions which ultimately means better care.”
In an ideal world the answer would have been to create a brand new, single, overarching patient information system available to all health and care professionals, including its acute trust, its community hospital, its mental health trust, ambulance trust, 85 GP practices, social and community care services. However, cost, time and continuity of care makes this option prohibitive.
Instead Lincolnshire’s healthcare leaders looked at how to bring together the myriad existing systems into a unified patient record, now live and called Care Portal. This meant having to focus on overcoming an increasingly significant challenge facing the health service – interoperability.
The technology powering the Care Portal is provided by InterSystems, a global leader in information technology platforms across health, business, and government. InterSystems had already been providing services in Lincolnshire, and across the NHS, for some time so the company knows the health and care situation well.
Already, access to Care Portal means that clinicians from the major healthcare organisations who are seeing a patient can log into the single, secure portal, and view the relevant history from any of the connected systems. This is particularly important as patients could potentially have a range of conditions such as diabetes, mobility problems and mild dementia.
A community nurse can do the same before visiting a patient and if that patient is admitted to A&E or needs help out of hours the doctors and nurses supporting them are no longer forced to rely on simply asking them questions and hoping that they get the right answers.
“The more information clinicians have, the better decisions they can make,” says Yossi Cohen, Physician Executive at InterSystems. “They can also make them faster. Patients, meanwhile, are already noticing that clinicians are better informed and that they’re not having to repeat information to each person that they see. They spend less time waiting, wondering what’s happening with their treatments.”
The fact that the information isn’t transferred from system to system or one location to another increases security. “It also ticks all the information governance boxes because it’s only accessible to those who have the right to look at it and can claim a relationship with the patient,” explains David Smith, IT Programme Lead at NHS Lincolnshire STP.
The system is also dynamically building up a record of which healthcare professional is involved with a particular patient. This is important because whereas historically a community nurse might, for instance, find themselves needing to speak to the relevant hospital doctor or care worker but would not have any idea of the identity, let alone their contact details of these people. Now, they can get this vital information quickly and easily by looking at who has logged into the system to view the patient’s data.
The system goes further by alerting the care team. For instance, community nurses can be notified immediately if a patient has been admitted to hospital, avoiding wasted home visits. Home visits can then be automatically rescheduled once a patient is discharged as well as discharge letters and outpatient records being created electronically and shared, in real time.
Needless to say, the system is constantly being updated and tweaked in response to feedback from its more than 5,000 users – a figure that has risen tenfold since its introduction last Autumn. “We found that we were getting a lot of information that was repeated because a patient was being seen by two or three clinicians and we had to ‘declutter’ the portal so that information was only given once,” says Liz Jones, Project Manager, NHS Lincolnshire STP.
The scope and capability of Lincolnshire’s ground-breaking Care Portal system is constantly growing. A connection with child protection records will match up hospital visits across the county and over borders to flag up instances where these visits are worryingly frequent.
Another innovation will see the introduction of a patient portal that allow patients themselves to gain more access. This is starting with maternity services, where patients will be able to self-refer using a smart form, speeding up access to antenatal care. Meanwhile, wearable technology will allow health and social care professionals to share essential information about how a diabetes or cardiac rehab patient is recovering, providing alerts immediately when problems might arise.
“The fact that so many clinicians are using the Care Portal system shows how much it’s needed and how keen staff are to engage with it,” says David Smith, IT Programme Lead at NHS Lincolnshire STP. “We have a long list of other systems that people want to have connected now that they’re already seeing the benefits of this kind of interoperability.”