Shared care records in the NHS – embracing the opportunities and overcoming the challenges
The NHS is developing a shared care record to help better join up provision for patients. GGF and knowledge partner Iron Mountain brought together those involved to discuss the opportunities of better coordination – and how to overcome barriers to progress
Digital and data transformation is vital to the future of public services. Across all the areas of modern government delivery, the deployment of better technology is envisioned as key to helping services keep up with demand from citizens – both in terms of increasing volume and growing expectations.
This is particularly true in the National Health Service (NHS), where technology can play a key role in helping people access the care they need quicker and more easily.
Key to this transformation is the development of shared care records, which are intended to integrate information about patients across the healthcare system to help deliver more joined-up care.
Traditionally, every health and social care organisation holds its own set of records about each individual under its care. These records may already be shared, through paper records or phone, when requested, but a shared care record is being implemented to create a safe and secure way to bring a patient’s separate records from different health and care organisations together. These digital records will provide all the information in one place, helping to provide personalised and connected care.
Responsibility for delivering shared care records sits with 42 local Integrated Care Boards (ICB) in England, with each project developed to meet the health and care needs of the local area, and to suit existing systems and future planning considerations.
This means different organisations across the NHS are at different stages of development, so Global Government Forum and knowledge partner, Iron Mountain. brought together senior clinicians for a roundtable to share thoughts and insight on how implementation has progressed.
Progress made so far in shared care records
Paul Curtis, head of healthcare from Iron Mountain opened the discussion by setting out the opportunities from shared care records
“We’re on the precipice of something important – getting the right information at the right point of need,” he said. “There’s synergy in where we think Iron Mountain will be able to assist in holding records – physically, and in some cases digitally – so they could be far more useful and beneficial to patient outcomes.”
Participants in the session said fully establishing shared care records would be a major achievement and would increase the efficiency of the healthcare system.
However, one clinician in the session said “it’s fair to say there have been some hurdles” in the journey of the shared care record, and attendees at the session discussed both the opportunities and challenges in making shared care records happen.
Overall, there was a sense of optimism regarding the development of the record, with progress made across the country.
Most ICBs are working to get different institutions from across the local healthcare system to join up records with GPs, and some have also looked to develop shared records in particular areas of care, such as maternity services.
Embracing the opportunities
Attendees at the session said these records hold the promise of significantly enhancing clinic efficiency and also alleviating a common frustration for patients – the repetition of providing the same information multiple times. “If a single benefit of shared care is that it will stop you giving your information again and again and again, then that’s a great benefit [for patients],” one attendee said.
“There’s so many benefits around having this shared repository,” said another, setting out just one example of where it would help.
A patient has one record with their GP, but they also then use their local hospital, and might have a specialist appointment at another location.
Examples like this are common, they said. “There’s lots of complex cases out there and these people are struggling. In the four walls of an acute hospital there might be hundreds of different systems, but they won’t have access to all that information. So the benefits are clear.”
Another attendee – from a part of the NHS system that is further on in the development of their shared care record – agreed.
“We’ve been focusing on getting our acute [hospitals] connected for sharing information, and we’re just starting a place-based approach to give access to that data to GPs, local authorities, care homes, community pharmacy.”
This location had also focused on maternity services, where they said there is a particular need to join up a patient’s medical history with information about the pregnancy.
“If you’ve ever worked in maternity services, you’ll know that never the twain shall meet,” this attendee said. “Generally it’s even on paper, it’s separate. So getting that a big bonus.”
Another attendee agreed. “What excites me is actually thinking about the potential of what data can do for our patients,” they said.
“Right patient, right data, right time, is what’s going to help drive better and more effective care. This is about continuous improvement journey… but I think it needs a lot of people on that page to see that vision to make that happen and [create] a more reliable, sustainable NHS that does what it says on the tin.”
As David Corbin from Iron Mountain said, examples like this illustrate the key opportunity in shared care records – providing an end to end journey for the patient and the clinician.
“It’s easier to think end to end about the record, and then think about how you’re going to provide that information,” he said. However, this also presents a significant challenge to the system in terms of how “to draw the legacy information together and then present it with the right lens for the person interacting with the system.”
Tackling the challenges
Attendees discussed other implementation challenges, which as well as the collaboration challenge includes barriers related to technology in the NHS.
Areas such as data standardisation, security, interoperability and data integration were named among the issues.
Curtis from Iron Mountain stressed the importance of data standard “foundations” on which to build shared care records, but attendees said the essential building blocks of robust data systems were not in place everywhere.
Achieving uniformity in data formats and structures across diverse systems is an enduring obstacle, even though the NHS Long Term Plan also mandates the use of interoperability.
“It’s comforting and frustrating in equal measure that other people are experiencing the same problems or challenges that you are,” one participant said. “But you also have the support to come together as a louder voice to shout about the main problems we’re all having – and they come down to things like data standardisation and so on.”
Next steps
The NHS has set out four future ambitions for shared care records as they are rolled out across the country.
The first is that health and care staff have ready access to a comprehensive record of the person they are caring for, with integrated records and care plans available across NHS trusts, general practice and social care (including local authorities) along with pharmacists, dentists, optometrists, and voluntary and independent sector providers such as hospices.
The second is that individuals can access their shared care record via the NHS app, and the third is that care plans can be created and shared between individuals, their carers, and authorised health and care staff.
This leads to the fourth ambition – creating a fully connected and interoperable capability, with systems joined up across organisations so that individual records can be securely accessed anywhere across England.
The roundtable attendees said realising these ambitions would require collaborative work across the community of patients, clinicians, administrators, and financial stakeholders.
If this could be achieved, further opportunities lie ahead in visualising patient data in a comprehensive fashion, offering clinicians the ability to interpret a patient’s use of medicines, for example, over a lifetime.
To reach such a system, one attendee said, requires focusing on “the benefit for individual patients”.
They added: “Let’s build things that are not designed for one organisation’s niche requirement, but for everybody’s common benefit”.
Sharing his thoughts on the session, David Corbin said: “This roundtable has highlighted an urgent need for the NHS to standardise a consistent way of managing data. Facilitating faster and easier access to accurate, relevant and timely patient information is crucial to enabling efficient delivery of care and better outcomes.”
The roundtable discussion ‘Joined up thinking: how shared care records can transform NHS and social care’ was held on Thursday 9 November in Leeds, and was attended by:
Dr Bekdash, Sheffield Children’s NHS Foundation Trust
David Corbin, Senior Manager Product – eHealth, Iron Mountain
Paul Curtis, Head of Healthcare, Iron Mountain
Laura Godtschalk, LLRCR Programme Manager, Leicester, Leicestershire, and Rutland Integrated Care Board
Dawn Greaves, Digital Programme Manager, West Yorkshire & Harrogate Health & Care Partnership
Dr Caroline Kerrison, Consultant Paediatrician in Immunology & Infectious Disease & Chief Clinical Information Officer, Sheffield Children’s NHS Foundation Trust
Robert Little, Business Development Director (Healthcare), Iron Mountain
Dr Benjamin Lomas BMBS, MRCPsych, MSc. X2, Consultant and Deputy Chief Clinical Information Officer, Nottinghamshire Healthcare NHS Foundation Trust
Misbah Mahmood, Deputy Chief Midwifery Information Officer, Leeds Teaching Hospitals NHS Trust
Jane Owens, Digital Implementation and Transformation Lead and Implementation Lead for the Derbyshire ShCR, Joined Up Care Derbyshire, Derbyshire Community Health Services NHS Foundation Trust
Richard Power, Business Development Director (Healthcare), Iron Mountain
Andrew Raynes, Chief Information Officer, Royal Papworth Hospital NHS Foundation Trust
Zoe Richardson, Digital Project Manager, West Yorkshire Health and Care Partnership Digital Team
Richard Johnstone, Executive Editor, Global Government Forum (chair)
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