Connecting information with a Health Information Exchange (HIE) has benefits that resonate across the continuum of care. Typically, this could be things like an A&E consultant immediately seeing pre-existing conditions and medication allergies, community nurses accessing test results and scans from their patient’s home, or a GP being able to see that their patient has a specialist appointment soon and equipping them with the right questions to maximise their treatment and get a better outcome.
We can see the positives of coordinated care at St Joseph’s Hospice in East London. The hospice has constantly evolved for over a century to provide the best possible care for the people with life-limiting conditions in the area. The latest step on that journey has been to implement Cerner HIE technology in the form of the East London Patient Record (eLPR).
St Joseph’s is one of the oldest and largest hospices in the country, and it is also amongst the first of its kind to be fully part of a shared care record, making it a real exemplar in its field. As most hospices are charitable voluntary organisations that sit outside of the NHS, connected care is difficult. However, care professionals from St Joseph’s can now access information from patients’ electronic health records (EHRs). This results in joined-up care that can lead to quicker, better decisions that can give palliative care patients and their families the control and reassurance that they want at one of the most difficult times of their lives.
“Having access to the information like this transformed my understanding of my patient’s disease and fundamentally changed the course of her treatment and care.”
— Sam Edward, medical director and consultant in palliative medicine, St Joseph’s Hospice
Alongside improving the patient experience, HIE also supports clinicians’ working practices, and crucially helps them to save time. It may be 2018, but without HIE, information is still being sent by fax and post – the time savings are huge when clinical decisions can be made in the moment, with the patient as part of the choices made.
42 percent reduction in the time spent gathering medication histories for newly admitted patients at Lewisham and Greenwich NHS Trust.
HIE also helps avoid unnecessary duplications – no more repeating tests, no more needless admissions or outpatient referrals – which helps to offer a level of reassurance to patients, as well as cutting the frustration that comes about from having to do and say the same things each visit. Avoiding doing things multiple times also has a potentially significant impact on the provider – it helps to save money.
For accurate savings to be calculated, it’s imperative to pay attention to the collection of pre-implementation baseline data. With this in hand, follow-up surveys for both primary and secondary care figures can be established in order to obtain a true reflection of the return on investment.
That’s not HIE’s only test – it also faces a very human obstacle too: trust. Generally, the public’s perception of sharing data is that it already happens, yet, once challenged, people naturally start questioning who can see what, e.g. “why does an acute hospital need to see my social care record?” It’s a very pertinent question, but it’s worth remembering that people are usually happy to share their banking details and social media activity when it benefits them, so why not their health and care records, when it could help improve their outcomes?
Assurance comes from information sharing agreements (ISAs) that all organisations using our technology are bound by – these put into writing what can and can’t be shared, and with whom. Clinicians and care professionals themselves also have a role to play in providing assurance – they should have faith that the technology enabling interoperability is secure, well protected, and flexible enough to cater for a mix of data sharing requirements.
These considerations are built into the core of our technology, not bolted on, which should help the public feel that their health and care information is safe in an HIE environment.
“I use it every day. It saves me time, it saves my patients time – I don’t know why people wouldn’t use it.”
— Dr Andrew Ross, general practitioner, St John’s Medical Centre, Lewisham
Building towards population health management
By putting in place the right governance groundwork, appropriate ISAs, and partnership working principles, as well as citizen engagement that will help establish the trust of all parties, HIE can be used as a stepping stone towards full population health management. By adding a layer of intelligence across the health and care economies, clinicians can move away from using data in a reactive way to inform decisions at the point of care. Instead, the information can be used to proactively impact on individuals and populations as a whole to reduce the risk of them needing direct care at all.
And we’re certainly on our way to that goal – the functionality of a fit-for-purpose, open-standards-based HIE is starting to be regarded as something of an expectation, rather than what used to be a ‘nice-to-have’. Value is being recognised in different areas of the country, and people are engaged, listening, learning – and realising that HIE is an enabler for more informed decision making, improved and safer care, and better outcomes. It is an essential part of connected care, and its power and value could continue to increase exponentially over the coming months and years.
East London Patient Record – Connected by Cerner HIE
- eLPR connects four CCGs, six acute sites, two mental health Trusts, three sets of community services, one local authority, St Joseph's Hospice, and almost 200 GP practices
- In total, eLPR covers 1.5m people in East London
- 9,400 clinical hours saved per year
- Improved clinician-patient relationships
- 81 percent of clinicians feeling a positive day-to-day effect
- 112 percent return on investment