Tag Archives: EPR

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Digital Healthcare Revolution: Harnessing NHS Technology

Digital Healthcare Revolution: Harnessing NHS Technology

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Digital Healthcare Revolution: Harnessing NHS Technology


Join us at the Digital Healthcare Revolution: Harnessing NHS Technology conference, a bespoke event looking at the technological advancements in healthcare delivery and the future potential of digital innovation.

Digital-Healthcare-Revolution-web-bannerThe Five Year Forward View is the vision to provide more power to patients, deliver better outcomes and make the NHS more efficient with greater integration at its core. With increased demand inevitable, removing the barriers and boundaries of traditional practice and embracing new models of working are seen as the drivers to sustaining the NHS into the future. NHS England are committed to the idea that technology and data are key to implementing the necessary changes and ‘harnessing technology’ will have a major part to play in the new ways of delivering care.
A digitally enabled NHS will transform how it operates and generate significant benefits such as improved patient experience, supported clinical interactions and enhanced administrative processes.

At the Digital Healthcare Revolution: Harnessing NHS Technology conference we will discuss the role that technology and data is already playing within the NHS and how future digital innovation will enable the changing landscape of the health and social care system. Our speaker programme of leading experts will share knowledge and exchange opinion on how the progressive and sustained use of digital technologies can benefit a transformed healthcare system. With vertical integration an ambition across the NHS and social care there will be an opportunity to examine how paperless information can be shared appropriately and safely to the benefit of patients and staff. We will showcase a number of initiatives and examples of best practice from throughout the health and social care system and there will be ample opportunity for interactive discussion and networking amongst fellow professionals and peers.

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Who Will Attend

  • Chairs/Chief Executives
  • Chief Information Officers
  • Chief Technology Officers
  • Clinical Commissioning Groups
  • Clinical/Medical Directors
  • Digital Champions/Digital Managers
  • Digital Strategy Leads
  • Directors of Enterprise and Innovations
  • Directors of Information Management / Informatics / ICT
  • Directors of Social Services
  • Directors/Heads of Business Management/Transformation
  • Directors/Heads of Commissioning/Procurement
  • Directors/Heads of Communications
  • Directors/Heads of Digital Inclusion/Engagement
  • Directors/Heads of Efficiency and Improvement
  • Directors/Heads of Information Assurance/Governance/ IT Security
  • Directors/Heads of Modernisation and Performance
  • Directors/Heads of Policy/Strategy
  • IT Directors/Managers
  • Professors of Informatics / Health Informatics / Medicine
  • Professors of Science / Technology / Research
  • Programme/Project Directors
  • Service Managers
  • Web Directors/Managers

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Patient Accessible Electronic Patient Records

Developing Patient Accessible Electronic Patient Records

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In November 2014 the National Information Board released ‘Personalised Health and Care 2020’ which sets out a framework to enable people to make the right health and care choices through ensuring citizens have full access to their care records and access to an expanding set of NHS-accredited health and care apps and digital information services.

This ambitious target will require all health and social care organisations to work together to develop patient accessible electronic patient and care records. This conference through case studies and in depth interactive sessions will share good practice from those who have already developed patient accessible and patient led electronic patient record systems in practice.

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Patient Record Access – A Perspective 2 Years On

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peopleIn May 2012 I wrote an article (Patient access to GP Records by 2015) and offered some immediate thoughts on who would be the primary beneficiaries of this Department of Health mandate, with some thought on identifying the primary element of the patient population, access to medical information should be targeted at.

A little over two years on and with the benefit of additional insight from consultancy engagements with some very innovative and forward thinking solution providers, there remains much to be resolved if the target is to be met, especially with anything like a solution that delivers on the range of benefits that should be secured.

Current Focus Remains Narrow

Technology choice for electronic patient records (EPR’s) and patient record access is wide and varied, from traditional operational patient administration system providers, with these largely focusing on improving visibility and accessibility of clinical patient information operationally, to the more expensive and challenging to implement solutions that can integrate patient data from a wide range of operational clinical systems, from independent solution providers.

For the most parts investment in EPR technologies are currently health sector and organisationally specific, with current early phases of delivery focusing on clinical operational needs (data quality) and business performance improvement (QIPP), largely it is felt because these tend to be business case qualifications (QIPP deliverables) that are easier to define, over alternatives concerning wider benefits of patient engagement.

The technology to enable patient record access exists, and certainly with the right approach and focus, the target for enabling citizen access to at least key parts of their record remains achievable. There are however, some fundamental considerations to be addressed to move thinking beyond current operational focus, and onto the service transformation potential citizen engagement would deliver.

Patient (Citizen) Centricity

Citizen CentricA citizen view servicing “meaningful use”, requires the assimilation from multiple organisations, e.g. primary care, community care, social care, acute care and mental health, as well as systems, such as appointment management solutions, prescribing management systems, patient management systems and healthcare contact systems etc., especially when giving due consideration to the touch points across health and social care for patients for example with long-term chronic conditions.

This means that the maximum benefit to be secured by access to medical information can only realistically be achieved by a strong commissioning lead, and one that is capable of resolving the conflicting interests and competing requirements individual information host organisations will bring to the table.

It remains the case that the greatest benefit to be secured from improving patient engagement through provision of better information will be derived from engaging with those that are suffering from one or more long-term chronic condition, with which engagement succeeds in enabling patients and their carers to better manage the condition(s), to the point of reducing the numbers of calls and escalations occurring that require direct engagement of health professionals and any associated service provision.

Data Ownership Becomes a Concern

However, it remains the case that for this engagement to be most useful, the solution should provide the citizen (owner) with a mechanism by which they can consent access to the information, to members of their personal care circle (friends and family), citizens should be able to refine access according to need, i.e. allow some carers to see more of the record that others.

Inclusiveness, accessibility and security subsequently still also remain primary concerns, given the largest proportion of patients that stand to gain from engagement supported with access to health and social care information are those with long-term chronic conditions, a large proportion of which presently have limited engagement with technology.

Data Protection

Along with the issue of ownership, a further information governance concern arises from delivery of a single unified patient record, built from the assimilation of information from a multitude of operational systems managed by different organisations (data controllers), in that data moved into a new host, creates new data controller obligations and information governance responsibilities that can be difficult to align operationally.

AlertCritically new patient identifiable systems are necessary, such as a “Master Patient Index” for example, that enable different patient coding systems and identification methods to be unified, thus ensuring that data assimilated and presented is relevant to the patient concerned.

Administering a master patient index sitting in between a multiplicity of systems in different organisations would need to involve resources across all organisations, and in the process, would likely lead to an increase the range of access to patient identifiable information above and beyond current organisational focused remits.

Looking ahead, the range of benefits for all concerned increase when integration with social care information is incorporated but as before, concerns for data protection and information governance also increase.

Key to Resolving Ownership and Data Protection

DirectoryEstablishing a maintainable Master Patient Index (Citizen Directory Service) within a safe secure framework capable of accommodating the administration and multiple access requirements with the ability for the citizen to understand and appreciate the range of identifiers associated to them, with an ability to self-maintain appropriate identification attributes would provide for a solid engagement foundation from which service and bi-directional data flows could be managed.

Additional benefits to be derived from a self-maintained citizen directory include:

  • A range of health and social care data management needs that are outside of the current health and social care systems, these include:
  • Details on their personal care circle, family and friends supporting them and what level of care they provide, mentors, and additional support they may have contracted or secured privately from third sector providers and charities, support groups etc.;
  • Extending data flows for care plans, end of life plans, life stories, coping strategies, self-prescribing / medicating information;
  • Scheduling of personal health and wellbeing activities such as keeping fit activities and appointments schedules with third sector providers etc.;
  • Ability to link data associations from assisted living devices, tele-health and tele-care devices and solutions to that again may be acquired by patients by private purchases or through personal engagement with third party service providers.

These representing just some of the additional information that could be sourced directly from the citizen and / or their personal care circle that by virtue of association being known in the “citizen directory service” potentially provided back to health and social care providers to further help inform and shape the care delivery process.

Importantly, at this level the citizen (or person assigned power of attorney) is the data controller and owner of their information, thus resolving a significant data protection cost and engagement challenge for health and social care.

So What’s Likely in 2015?

The country is certainly more than one year away from securing the very significant efficiency, effectiveness and quality service improvements that could be achieved from patient access to medical information.

Perhaps not surprising given that since the announcement on patient access to medical records was made, there has been (and needed to be) a significant focus on the re-organisation of health care, that at best, patients will only be provided in 2015, with fairly rudimentary (read only) level of access to information and likely, primarily from just one source, the GP.

There is consequently the potential for a real and very significant problem emerging ironically from the re-organisation, which materialises from the devolution of control and responsibility for delivery down to a local level.

QueryThis because if it is agreed that a unified master patient index (citizen directory service) is a key foundation to progressing onto and integrated citizen centrically focused and bidirectional process of engagement, then this ought to be implemented to a national standard, and perhaps once?

Concluding Thoughts

With current technology supporting mobility for the population and rapidly emerging to support assisted living, tele-health and tele-care, the very process of caring and engaging in a patients care pathway / process is set to change dramatically.

Care closer to home is set to become a reality, technologies are emerging that can enable patient carers to become more engaged in the ongoing care process and management of conditions, along with technologies that also have the ability to increase levels of confidence for patients to live more independently.

Subsequently care, supported by the technology innovations emerging today, has the potential to become a true joint venture that engages personal care circles of family members, friends and personally engaged third sector charities or private sector providers of services and solutions with public funded health and social care service provision.

It is this potential that delivers the much need reform of the current health and social care model, certainly at a scale with potential to exceed achievement of £20bn of efficiency gains and savings.

Whilst there are benefits to initiatives having a local focus, so that variation in needs across communities can be accommodated there are some core elements that if not delivered as a national hub, must at least be supported by appropriate nationally agreed standards, addressing requirements such as interoperability, data / care pathway workflows to support engagement functioning across localities, however these are defined.

With that said, the patient / citizen user experience is another area for concern. With the potential benefits to be secure from engagement being undermined by patients / citizens experiences being widely different across the country, as features and capabilities vary as a result of variations in approaches.

But see, now this represents a case for some sort of nationally coordinated approach, and we’ve been there with the National Programme for IT (NPfIT), and if you believe everything you read that was a total failure, with nothing of any real benefit delivered.

But then maybe, the NHS SPINE, Summary Care Record and need for unifying the interface to offer citizens consistency in the engagement experience, if only there was an appetite to even consider the potential use of some of the NPfIT investments that did deliver?

What do you think?

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Patient access to GP records by 2015

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The government ‘digital’ plans to provide patient access to GP records by 2015, raise a number of important questions, not least would access to just GP be of significant value to the patient on it’s own?

To explore this fully it is necessary to perhaps try to qualify who would most likely be the initial beneficiaries of online access to medical information, and in the process what, information would be of most value.

In the first instance patients can arguably be categorised into three broad health aware groups:

  1. The Less Active – The rest of us that are not ill, but then not necessarily especially healthy, and only take to visiting the GP under duress from a family member or loved one!
  2. The Pro-Active – Those that have an interest in their health, and contribute greatest to the Lycra industry, frequent exercisers that keep a (reasonably) close eye on their diet to try to remain in a healthy state, can frequently be seen jogging and or cycling.
  3. Long-term Chronic Condition Sufferers – Those with one or more condition, estimates for the number of patients in this category stand at approximately 15 million for the UK.

The Less Active

Hands up all those that feel they fall into this category?

If you could access your medical information online, would you?

Would on-line access to your medical information in itself influence a change in your attitude toward your own health and well-being?

The answer to at least the last two is unlikely, unless access to our information is delivered with something else to secure positive and on-going engagement, a good proportion of this population group might only ever access information out of curiosity.

Stress Free ExcerciseThat is until the transition into the Long-term Chronic Condition group, which a great many would be very likely to do, as a result of their indifference to matters concerning health and wellbeing in the earlier stages of life, when there is time and energy to do something positive about it (NOTE the author falls into this group)!

Pro-active and educational engagement on health and wellbeing as opposed to access to specific health information is perhaps more key for this group, potentially for these to be reached via social networking as the demographic tend to fall into the computer literate group that frequently access the Internet and communicate online.

The Pro-Active

RunnerThis group may access their medical information online, indeed they may want more in respect of an ability to add information into their records themselves, to enable them to track their own improvement derived from their personal investment in trying to stay fit and healthy.

If an individual in this category is unfortunate enough to succumb to illness, worse case the onset of a long-term chronic condition, then they will likely need the least encouragement to engage and make use of medical information online.

Long-term Chronic Conditions

The first group are the prime candidates most likely to derive benefit from improved access to their medical information, especially if this information can be shared and / or accessed by those of their personal care circles, typically made up of family and friends.

The catch with this group is that their touch points with healthcare frequently numerous, as well as having on-going engagement with their GP and other health professionals within the practice. Their care in a great many cases will be more closely monitored and managed by other health and social care organisations, this could include, community care NHS trusts, social care providers and / or dependant on conditions, mental health trusts too.

WheelchairThe GP practice to which the patient is registered may only actually be engaged infrequently; consequently the GP record will not necessarily be the best and most up to date source of all information that is important in respect of helping a patient (and their carers) to manage their condition.

Consequently, access to medical information for this group really needs to encompass all of the potential many touch points they have across health and social care services to be truly effective and beneficial.

However, for this to be achieved a raft of challenges to be overcome, just scratching at the surface on some of the more obvious one:

Assimilation – appointments represents a good and simple example of an assimilation challenge, given the scope of a long-term chronic condition suffers touch points across different health care service providers, the provision of access to an effective online schedule for a patient requires interaction with a wide range of different appointment and scheduling systems.

Contextualisation – to be useful the information presented to the patient needs to be meaningful and understandable, and context represents an important consideration, especially if in the ideal, access to information  helps the patient to understand the need to take appropriate pro-active action to avoid worsening of their condition.

Accessibility – a great many of the current demographic category fall into the group of more senior citizens that are not computer literate and unlikely to have access to the Internet. Consequently it is more likely that it will be younger family member(s) or others (friends) operating in carer roles that will be more pro-active with the patients information online. The issue of consent, privacy, information governance and shared access becomes key concerns to be addressed.

Presentation – will be key if again the information presented is to be usable and accessible, whilst a great majority of senior citizens will not have any inclination to become computer literate and familiar with the ways of the web, there are other ways these individuals can be encouraged to become part of a digital society, some will have smart phones whilst others would be comfortable with using a touch screen tablet device.

Making online medical information accessible across a wide range of devices should be a prime objective, with due consideration given to accommodating impairments, disabilities and multi-language capabilities to ensure no citizen is excluded due to disability, race or culture. Consistency in look feel and approach is also vitally important, otherwise the need to learn a new system every time a patient moves from one locality to another will only serve to undermine engagement and the benefits this should bring with it.

Online Engagement Today

Emergence of web and mobile app based technologies has provided a wide range of options for securing patient / citizen engagement with public services. Today a search of the Apple App Store for “NHS” will return a listing of 176 apps for the iPhone, and 44 for the iPad device, the Google Play App Store returns 155 apps for the IOS platform, some are the same apps, and some are not, a search on either App Store for “healthcare” generates a less than helpful greater return of results.

The range of apps is beguiling, some are location or service provider specific, some relate to general information on services, some are condition specific, some are provider specific etc. etc., and makes for quite a wide and varied experience for the end user, with a wide variation in approaches, addressing accessibility, presentation and most importantly privacy.

On the Internet the experience is just as varied and beguiling, and from an engagement perspective, services such as mainstream social networking platforms (Facebook, Twitter, LinkedIn etc.) are not able to offer the assurances on privacy and data protection required to underpin and maintain engagement, sufficiently to be utilised as engagement and collaboration tools on healthcare, beyond generalised messaging.

There is clearly much less of an appetite for a national approach towards systems with the current government than there was with the previous. However, without some standardisation and change in focus on approaches, the citizen / patient engagement process will continue to evolve through a disparate array of solutions that will only serve to disengage and disenfranchise the majority.

computerThe technology exists to achieve the requirement within the target timescales set forth, with a bit more focus, and setting of standards, the opportunity to transform the health and social care engagement model is within reach. What is needed however is more focus on the production of requirements that set out common standards for engagement solutions that is sufficient to guide the wide range of third party innovators and ensure consistency in approaches.

Patients don’t need (and arguably don’t want) full access to their medical records online, to secure benefits from a digital online engagement process, some of the primary information requirements initially that could / should be available online include:

  • Access to discharge notices and any supporting information necessary to ensure transition out of hospital and servicing of after care is effective and undertaken accordingly.
  • Access to details on prescribed medicines, with perhaps the ability to add additional details on self-prescribed medicines so that this may be validated by a health professional (i.e. to confirm that adverse reactions may not be encountered).
  • Access to care plans and associated information to support wellbeing and management of conditions.
  • Access to a unified schedule of appointments, providing details of those with any health and or social care provider.
  • Integration and meaningful presentation of information from tele-health / tele-care and assisted living devices that help the patient to stay safe and well in their own home.
  • Contact details of primary NHS professional carers and support personal, with the means to communicate electronically on general issues.

And above all else, the ability for the patient to consent access to this information to members of their personal care circle, so that these become better engaged and informed on care needs and provision of assistance working collaboratively with NHS and social care service providers.

The benefit, all round would unquestionably result in improvements in quality of care and confidence that the needs of the patient are better understood through engagement of not just the patient, but those that know them best, their personal care circle.

Most significantly these benefits can be realised alongside significant reductions in costs with a substantial return on investment possibility, but only if the current disparate investments are bought together to address the requirements for consistency and uniformity in approaches that secure economies of scale.

About the Author

Presently in category 1, should be transitioning into category 2, but needs a big push and on-going encouragement, likely to become a member of category 3 in the next 10 to fifteen years.

In his late forties, married with two children and a grandson. Not a heavy drinker, but unfortunately was until recently a smoker (ugh, but now 6 months smoke free!). Grandparents deceased, one from cancer, another sadly suffering decline in later years as a result of dementia.

Was witness to family member’s sufferance of despair trying to care for the dementia patient home until it became no longer possible. Whilst the support services from the NHS and Local Authority cannot be described as poor, they could have been considerably better. Unquestionably online access to help services with better collaboration on health and care planning and service delivery could have been hugely beneficial.

Tele-health / tele-care services and assisted living devices would have offered much too, in terms of respite through reductions in need for 24/7 monitoring and on-hand attendance when conditions permitted.

Would like to see current service transformation to better patient and personal care circle engagement happen as quickly as possible, especially given that the scope of significant benefits extend right across the Quality, Innovation, Productivity and Prevention (QIPP) agenda.

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