Acute and community teams are working closer together than ever before, through the integration of IT systems across health and care settings in South Devon.
The NHS in Torbay and South Devon has been at the forefront of healthcare integration for more than a decade. In January 2015 the area achieved NHS England vanguard status for developing joined-up services in acute care, with partners working together to reduce health inequalities in areas of deprivation.
Rapid progress continued and Torbay and South Devon NHS Foundation Trust (TSDFT) became an integrated care organisation in October of the same year. Through merging the acute and community trusts more than 6,000 staff members and dozens of IT systems were brought together.
Tackling the increasing fragmentation of care information has also become a focus of the Trust, as patients may physically pass among primary, acute and community care locations, but their information has been too often withheld in data silos.
Breaking down the barriers to communication and empowering clinicians with the right information is essential for the future of patient care. In 2014 they embarked on creating a region-wide clinical portal – with the help of InterSystems’ HealthShare. HealthShare was chosen to amalgamate all patient healthcare information from across health and social care services and systems, to deliver an integrated digital care record.
Challenging geography, challenging systems
The beautiful area of Torbay and South Devon sits between the two urban centres of Exeter and Plymouth. The area is home to around 375,000 people residing in the larger towns as well as the more rural settings. The challenge of delivering high-quality healthcare for all residents is further compounded by an additional 100,000 visitors flowing into the area during the holiday season.
Within the county, health inequalities are stark. While there are pockets of affluence, the once-thriving industrial region now experiences significant unemployment and economic deprivation, resulting in increasingly complex health needs.
Integrated care in South Devon is about connecting care providers across multiple settings, including social care. Ensuring the transfers of care between providers is informed, patients are involved, and treatment is based on the right information at the right time. An IT strategy that spans organisational boundaries has been necessary to support this.
Breaking down barriers across hundreds of information systems
Bringing together South Devon’s complex, multi-platform health IT infrastructure into a single point of access, is the task of Mike Green, Chief Clinical Information Officer and Gary Hotine, Director of the Health Informatics Service at Torbay and South Devon NHS Foundation Trust (TSDFT).
A shared vision of senior clinicians and management from the start of the project was to develop an integrated care organisation, powered by information and centred on clinical needs. Green explains: “We had a clinical view of where we wanted to be, which was providing integrated health care, integrated social care and shared information between various organisations and IT systems.
“However, with over 100 information management systems, all with individual logins and storage infrastructures, we recognised that we needed some architects to oversee and design this system.”
Challenged with breaking down information silos and providing the seamless exchange of information between multiple systems, TSDFT went to market, and InterSystems HealthShare was chosen to overcome interoperability and information exchange issues, powering the transformation Torbay and South Devon needed.
“We were looking for a flexible and scalable interoperability system that would enable us to support our health and social care integration strategy. HealthShare met all our requirements,” Green comments.
Clinicians played a key role, working alongside InterSystems experts in the development of the clinical portal system, which not only shares information but genuinely transforms care.
As well as being employed as Chief Clinical Information Officer, Green works as an Oncoplastic Surgeon. It explains why he was keen to find a solution that was as popular on the ground, as it was in the boardroom.
Describing HealthShare as enabling “best-in breed” solutions, Gary Hotine outlines what clinicians wanted from the system: “Our clinicians were clear that we needed a single sign-on capability to a system integrating a host of clinical platforms. With more than 100 systems by different providers and installed and implemented at different times, the challenge was vast.
“Ensuring information from disparate sources were available in one place was essential. To achieve our integrated care vision, our clinicians need to feel confident working across existing organisational silos,” Green agrees with Hotine’s assessment of HealthShare’s ability to share information across systems, describing it as “the best solution that covers all areas of interoperability.”
Testing the impact of real integration: alerts for heart failure professionals
A decision was made to introduce the South Devon Clinical Portal, as the system was renamed, to the area’s Heart Failure Team. The team is responsible for the complex task of managing patient care both in the hospital and in the community, keeping track of their care needs as they interact with multiple care professionals and services.
When dealing with such a high-risk group of patients, accurate information is key to ensuring the best patient outcomes, but it wasn’t always easy as patients moved between locations and services. Tracking them is important, with anyone responsible for their care needing to know their prior medical history. The nature of the service made it the perfect test-bed for HealthShare.
Heart failure nurse, Joanne Passmore, has been involved in the initial pilot of the project, working with colleagues to assess the system in practice: “HealthShare alerts us if any of our heart failure patients enter hospital, allowing us to speak with them and their wider care team. We can also review medications and recovery plans. “The system can help clinicians create more informed care while in hospital setting, but this information can also be shared across the whole patient journey: “On discharge, this information is shared across our acute and community teams,” Passmore adds.
For Passmore, the real benefit of HealthShare is with people who are under the care of the Heart Failure Team. She adds: “Impact is being felt by patients too, as their relationship with the clinical team is improved. The Heart Failure Team now has access to all, not just some, secondary care clinical information and can make informed decisions. This can also be discussed with the patient, which enables them to be much more informed and empowered in making decisions about their own care treatment.”
Clinical and cultural impact – acute and community closer than ever
Mike Green is confident about his expectations for the system. “What it is trying to do is share information and drive workflow to make the clinical journey safer and more efficient.”
“The system hasn’t been without its challenges. In practice, the immediate information provided by the system almost proved too successful”, claims Passmore. The alert system within the portal was set up in a way that clinicians found themselves alerted to cases which were unnecessary for them to attend, such as out-patient visits. It’s a teething problem that was quickly fixed as Passmore and colleagues became more familiar with HealthShare.
The original aspiration in South Devon to introduce a system that is shaped by clinicians continues to this day.
Clinicians and technical experts working together have helped to adapt and shape the HealthShare system for Torbay and South Devon. The clinical portal is growing into a comprehensive repository for essential data, enabling acute and community teams to work closer together than ever previously achieved.
The future for South Devon – patient interaction
With initial go-live having taken place ahead of schedule in December 2016, access to the system is now being made available to all clinicians.
Information governance, long a sticking point for information sharing systems, has been challenged in an innovative way. Green has abolished the Trust’s information and governance group, replacing it with a new patient information sharing group.
In fact, patients will increasingly find themselves engaging with the system, being able to edit and amend their own information and care plans through one of the integrated systems – ensuring that it’s not only clinicians who have an up-to-date view of their care.
Gary Hotine is keen to point out how HealthShare is helping the Trust transform the way it works, increasingly embracing a mobile strategy, with HealthShare’s iOS and HTML integration set to be hugely beneficial.
From pilot to full implementation, HealthShare is already reducing duplication, improving communication, powering collaboration and improving outcome for patients. For one of the UK’s most progressive health systems, it is at the heart of integration.