The NHS has come a long way since 2013, when plans were first laid down for a paperless health service. As integrated care pioneers work towards the vision of more person-centred, coordinated care, there are also growing examples where effectively linked data sets are empowering multidisciplinary teams of healthcare professionals with timely access to vital information. In doing so, we are reducing the burden on NHS resources, removing unnecessary administrative duplication and improving the efficiency of healthcare services. The net result is a demonstrable improvement in the quality of care and greater patient satisfaction across the care continuum.
One emerging example of interoperability is Health and Social Care in Northern Ireland (HSCNI), where software and consultancy provider Hicom is delivering interfaces that have overcome historic obstacles to silo’d information, bringing greater accessibility to data and precipitating a shift towards a more modern IT infrastructure which underpins the provision of faster, safer, better care for health and social care professionals.
Healthcare in Northern Ireland
Healthcare services in Northern Ireland are delivered through five Health and Social Care Trusts, responsible for the management of staff, health and social care services on the ground and with their own budgetary control. The five regional Trusts are Belfast Health and Social Care Trust; Northern Health and Social Care Trust; South Eastern Health and Social Care Trust; Southern Health and Social Care Trust; and Western Health and Social Care Trust.
In July 2013, Health and Social Care (HSC) in Northern Ireland introduced the Northern Ireland Electronic Care Record (NIECR), a digital care record that brings together key information from patients’ health and social care records from throughout Northern Ireland in a single, secure computer system.
The NIECR has over 24,000 registered users and around 14,000 active users in any given week. Since October 2015, interfaces from Hicom have enabled NIECR to be populated with data captured through each of the five Trusts’ diabetes information management systems, which incorporate Hicom’s adult diabetes management solutions Diamond.NET. Interfaces for the Trusts’ paediatric diabetes solutions, Twinkle.NET – also from Hicom – are also in the process of being deployed.
As a result, irrespective of their location or care setting, Healthcare Professionals (HCPs) from both primary and secondary care now have real-time visibility of the patient’s entire care record. For example, data captured through the Trusts’ diabetes systems is automatically transmitted to NIECR through standard clinical correspondence processes that follow outpatient appointments. Healthcare professionals across the continuum can monitor the status of individual diabetes patients as they move along the pathway. The outcome is more joined-up, shared decision making, and ultimately improved patient care.
Gary Loughran, eHealth Programme Manager, from the HSC’s Business Services Organisation (BSO ITS), responsible for the delivery of the NIECR system, comments: “With Hicom’s Diamond.NET, we’ve been able to make all adult diabetes information from the past two years quickly available through the Electronic Care Record whenever a patient presents themselves in a healthcare setting, irrespective of where they are in the country. Having this data automatically transmitted to the centralised record is driving significant improvements for the delivery of patient care across the whole of Northern Ireland; it means consultants, doctors, nurses, social workers and GPs can be assured that treatment protocols are being followed in an appropriate and timely fashion, facilitating shared decision making and accelerating the most appropriate intervention where necessary.”
Intelligent Linking: Enabling Interoperability
Historically, technology has been held up as a barrier to the progress of integrated care; however, the NIECR project demonstrates clearly the advances that have been made. Whereas legacy systems were often localised or fixed in departmental or regional silos, advances in web technology have brought greater accessibility to data. Moreover, the best web-based solutions and interfaces are built to deliver operability with adjacent solutions, such as – in Hicom’s case - relevant Pathology reports. With multiple morbidities being particularly common in diabetes patients, the effective sharing of data using interoperable systems can play a significant role in mitigating costs.
Loughran continues, “It’s important that HCPs are able to make clinical decisions based on full knowledge of all clinical factors such as past history, existing conditions and medication regimes. Because Hicom’s solutions are web-based, once a staff member has authorised access to the NIECR network, they can securely obtain all relevant diabetes data whenever they need it. In this way, Hicom is helping us move away from a silo approach to patient care, by facilitating greater connectivity, broader functionality and integrated data intelligence to our workforce. Diabetes is one of the key long-term conditions where patients can benefit from more integrated care; monitoring the status of individual diabetes patients as they move along the care continuum becomes more effective when there is sharing of data using such interoperable systems.”
Northern Ireland HSC Trusts have already received positive feedback from staff across both primary and secondary care who have been using the electronic care record. A survey of 2,300 respondents conducted in February 2015, found that 31.5% of users had gained thirty minutes a day since using the integrated system, in addition to the benefits of shared decision making. For example, the integration has negated the need for GPs and other healthcare professionals to have to print documents such as letters or re-key information between departmental systems. The time saved can now be spent providing additional healthcare services and seeing more patients.
Loughran concludes, “All departments have embraced the system and usage for all GPs in Northern Ireland including our out of hours service is over 80% and is growing every day. It’s a testimony to just how beneficial the system is proving to be.
“All five trusts are experiencing the value of integrated care; we are pleased that productivity has risen. By combining our existing diabetes systems and NIECR with Hicom, we’re successfully closing the patient safety gap and enriching the level of healthcare provision throughout Northern Ireland.”
The road towards integrated care may have been a long one, but despite rhetoric to the contrary, there are increasing examples where barriers to progress are being removed. By partnering with a trusted technology partner, NHS organisations such as Northern Ireland’s HSC Trusts are implementing powerful tools to make the most of existing systems to intelligently link high-value data. As these organisations recognise the operational and patient benefits of sharing information, one thing is becoming clear: integrated care is no longer a vision – it’s already happening.