A partnership of health and care providers in Wirral, a peninsular in north-west England with approximately 320,000 residents, is seeing dramatic changes in the way they plan and deliver care. As part of their overarching Healthy Wirral programme to tackle significant health and care inequalities, they are moving towards data-driven care, and using information to improve population health and wellbeing.
One of their core tenets is tackling disconnected information between health and care venues, providers and differing IT systems, a long-standing barrier across the NHS and social care to providing more seamless care to citizens.
“Before Health Information Exchange, we were very reliant on the parents, and parents would often sort of question us and say ‘why don't you know these things? The GP’s got all the records, why don't you know?’ And we would just have to explain, ‘unfortunately we don't have access to the GP records.’”
David Lacy, consultant paediatrician, Wirral University Teaching Hospital NHS Foundation Trust
Engagement has been essential to the project success, with members of the care teams across the health and care system involved. The strong resulting partnership between organisations, coupled with Cerner’s Health Information Exchange now means that information can be shared in real time between primary care, acute care, mental health, hospice and community care, with cancer services and Wirral’s adult and children social care service in the process of being connected.
Benefits of Wirral’s Health Information Exchange include:
This flow of information has resulted in clinicians across the care system being able to access up-to-the-minute information about a patient’s medical history, appointments, medications, allergies, scans, procedures, results, discharge summaries, risks and more.
Patients regularly assume that information is shared across the health and care system, whereas in reality, this is still something that is lacking across many parts of the NHS. Wirral and Cerner’s shared commitment to interoperability, and Cerner’s recognised effective technology, is playing a core part in connecting information, improving safety, and the clinical and patient experience.
Such is the value to clinicians across primary care, acute, community and hospice that, in the first fifteen months operation, HIE has been accessed 300,000 times and now regularly exceeds 30,000 uses each month. This upward trend is set to continue as more of the region’s services and professionals are connected.
In a recent survey, the Wirral team asked 163 local health and care professionals how they felt HIE supports the care they deliver. An overwhelming 95 percent majority of respondents1 said that they can provide safer and higher quality care now they have instant access to information. This has direct safety benefits for the patient, as it means clinicians are aware of any changes or conditions discovered in recent investigations.
“We send out an appointment letter to ladies congratulating them on the pregnancy and that we're to do a support visit… but sometimes [we don’t know] that there's been a miscarriage... Using the HIE, I can see there and then if the pregnancy is viable or not. So that letter will or will not be sent out, reducing some stress.”
Debbie Stevens, health visitor, Wirral Community Trust
The survey also shows efficiencies both in the hospital – around a 20-minute reduction per patient per clinician2 – as well as in primary care, saving over £1.5m of equivalent time annually across the region’s 51 GP practices.3 Fax usage has also quickly fallen by 20 percent, contributing to the NHS Long Term Plan’s aim to totally dispense of fax usage for patient and NHS organisation communications from 2020.
Thanks to accessible, real-time information, local GPs say that they are avoiding more than 230 unnecessary or duplicate investigations each week. This reduction in blood tests and imaging orders saves both time and money but contributes to reduced risk and the provision of safer, informed care, as well as improving the patient experience.
There are a number of factors that can result in efficiencies between primary and acute care. In line with a significantly increased usage of HIE amongst primary care professionals since launch, Wirral University Teaching Hospital (WUTH) saw a 51 percent average reduction in direct GP referrals for MRIs and four percent drop in plain x-ray orders between December 2017 (pre-HIE) and December 2018 (HIE live).4 While clearly not the sole reason for this improvement, connecting health and care information can contribute to the success of a region-wide digital strategy.
HIE enables Wirral to share records between multiple providers, and their different electronic systems
Across the CCG, GPs are getting back more time to see their patients. Using HIE to reduce the amount of time spent searching for admission/appointment information, pathology and imaging results; and chasing information from other providers is estimated to be saving at least 790 hours of GP time each week.5
Time for patients is important, but clinicians are also seeing direct benefits of HIE on their own wellbeing:
“If I'm able to save time during the day, when I'm doing my repeat medication requests, when I'm looking through my letters, that then allows me to go home on time, which is really important for my mental health…”
Jamie Barfield, GP, Village Medical Centre
Cerner Health Information Exchange is saving time and money across Wirral’s economy – but importantly it is helping the entire care team to provide a positive experience for their patients, underpinned by safer, more informed and timely decision making.
1 Respondents pre-implementation n=68; post-implementation n=44.
2 Without HIE, professionals spend on average between 32.7 and 47.1 minutes per patient on gathering patient history. Following implementation of HIE, primary care professionals spend on average between 11.2 and 23.6 minutes per patient on gathering patient history.
3 Figures above based on average of 4 GP’s, 2 Practice Nurses, 1 Practice Manager at each of the 51 practices in Wirral. Annual days based on 261 working days per year excluding weekends and bank holidays. Hours saved is based on average per reported metric and is combination of total hours saved. Salary calculated based averages of GP earnings being average of £92,500 (Source: NHS Digital), and assuming average income for practice nurse and practice manager being at mid-point of band 6 on 2018/19 Agenda for Change pay scale, with the addition of 22% for staff on-costs. Hours saved and numbers of staff at practices may vary.
4 Data gathered from WUTH NHS FT, total direct GP diagnostic orders 2017 and 2018. Reductions seen in MRI were 632 (Dec 2017) to 149 (Dec 2018); and plain x-rays from 4,053 (Dec 2017) to 3,903 (Dec 2018).
5 Based on an estimated 158 hours every day (Monday to Friday, excluding weekends).