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Shared Care Records – Leading The Way With Interoperability


Author: Cerner

The concept of interoperability between health and care providers across a given geography is certainly not a new idea, but perhaps the definition of what we mean and have come to expect from interoperability has evolved. As patients or consumers of health and care services, we have a certain level of expectation that providers will be informed and will know our medical history, whether we are non-smokers, have a penchant for physical activity, or prescribed a list of medications, etc.

The only way they can know this information – whether it has been recorded by the GP, from the visit to the outpatient dermatology three years ago, or collected from the social care referral – is by embracing shared care records and truly sharing pertinent information about a person across traditional health and care boundaries.

The National Health Services (NHS) in England has historically been guilty of bureaucratic boundaries and discrete silos of information. Not only was this hugely inefficient, it can also be unsettling for a patient who is thinking ‘why on earth are you asking me these same questions again?’ However, data liquidity is on the rise – particularly in defined geographies where key stakeholders have come together at a system-level to determine how best to do this.

Two large metropolitan areas of England who have embarked on hugely successful shared care record programmes are The Great North Care Record in the north-east of England as well as OneLondon which, unsurprisingly covers the country’s capital city. These programmes have demonstrated that the technical capabilities to connect data sources is considered the easy part – the challenging part is agreeing to the decision-making process for all contributing parties. By and large, people expect their necessary health data to already be shared between systems and are often quite surprised that this isn’t the default.

London covers 18 acute hospital trusts, 16 community and mental health trusts and around 1500 GP practices and nearly 1900 community pharmacies all contained within 5 Integrated Care Systems (ICSs) that have some responsibility for the distribution of resources and capacity within their parts of London. In east London they have fully embraced the opportunity for shared care records across the patch and have rebranded their local instance of Cerner’s HIE as the east London Patient Record (eLPR).

As with all health systems, the pressure on the acute service can be very intense. The COVID-19 pandemic has illustrated the need for better system integration and data sharing to alleviate an over reliance on hospital emergency departments and distribute the provision of care more effectively. In England, an initiative was started earlier this year called the Discharge Medicines Service (DMS) whereby NHS hospitals refer discharged patients to the DMS at their local community pharmacy. This service aims to provide extra guidance and support for newly prescribed medicines – utilising the skills of healthcare professionals in the local community where an appointment to visit is not required and that is crucial – offering huge value to vulnerable patients or those otherwise struggling to access services.

Having access to the person’s record has been a game changer for community pharmacists allowing them to review important health information and seeing the bigger picture, enabling even basic interactions to be more meaningful and personal.

Raj Radia, chair of the City & Hackney LPC (local pharmaceutical committee) strongly believes that we should consider the person at the centre of everything and to wrap services around them, highlighting the key role that community pharmacy plays. He says, “We’re the only health provider easily accessible, yet we’re not being utilised. And I think we’ve got tremendous potential to really grow this.”

Radia is a huge advocate for harnessing the potential of the eLPR for community pharmacists to play a key role in the health and wellbeing of the local population. His advice to community pharmacy colleagues would be: “You have to get on board as there is such a wealth of information available. If you’re not accessing the eLPR [when interacting with a patient] you are not giving the best care possible for that patient. We are always here to help!”

True transformation relates to a whole-system change across the entire health and care economy that delivers value-based, patient-centric care. Technology is only a small part of the solution - transformation at such scale depends on strong partnerships, common goals, supportive policy, and appropriate data governance and protection models. To deliver real integrated health and care, it should be a fundamental patient right that their data can flow to the appropriate place where it is needed for health or care regardless of provider, vendor or venue.

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