Information Governance, Electronic Patient Records and Patient Online Access How to Safely Share Data Dr Masood Nazir General Medical Practitioner National Clinical Lead Patient Online Chief Clinical Information Officer Your Care Connected programme Clinical Information Lead & SIRO Birmingham CrossCity CCG Friday 29 th January 2016
What are the benefits of paperless to the NHS? Clinical diagnosis Patient & staff experience Safety Reduce burden & improve efficiency 2 We owe patients a seamless, paperless NHS, but if they want a letter - fine
3
The challenges Over last 10 years: the demand on the NHS has increased significantly increased ageing population increase in GP consultations from 260,000,000 to 360,000,000 per year consultations becoming more complex due to factors such as multiple LTCs and shift of work from secondary care General practice only receives about 7.7% of the NHS budget. www.england.nhs.uk
www.england.nhs.uk
Shared information is a relationship of trust Patients and information are the two most under-used resources in the NHS Dr. Richard Fitton Cartoon with thanks to the British Medical Journal www.england.nhs.uk
Some examples of principles for sharing Local information sharing with an implied consent model (for the enabling of sharing) with later explicit consent/permission to view at the point of care. An implied consent model is needed for maximum patient participation. High patient participation is necessary to secure buy-in from healthcare professionals. Evidence shows that patients are more comfortable with their information being shared locally Data Controllers need to have in place a data sharing agreement with partner organisations. www.england.nhs.uk
www.england.nhs.uk
9
10
Your Care Connected programme A simple, yet quite ambitious aim: To provide a more joined-up NHS service in Birmingham, Sandwell and Solihull To support direct patient care To give those treating patients the information they need when they need it The record will be: Viewed via lookup method no data warehouse or extraction involved Accessed only with the permission of the patient at the point of care, unless they ve opted out Completely auditable
It s been a long road www.england.nhs.uk
The benefits of Your Care Connected The benefits of the system are: Faster and easier access to up-to-date medical information, which could save lives More secure than paper-based access Supports the improvement of the safety and quality of patient care Enables safer delivery of emergency care Less time spent on the phone and fax providing or requesting patient records
Why have we supported the work so far? Most people know their own history but...at times of illness, they can forget information e.g. medication. Vulnerable groups require more support: Complex frail elderly Children who need safeguarding English is not first language Better access to information means timely decisions can be made better for patient care.
A complex second city Provider organisations: Clinicians 318 practices in 4 CCGs + University Hospital Birmingham FT Heart of England FT Sandwell & West Birmingham NHS Trust Birmingham and Solihull Mental Health FT Birmingham Children s Hospital Birmingham Women s Hospital Royal Orthopaedic Hospital Birmingham Community Healthcare NHS Trust WMAS (West Midlands Ambulance Service) Out of Hours GP service providers ( Badger/Primecare)
What is Your Care Connected? Partners GP Practice GP System suppliers GP GP Mental Health Trust EMIS practice EMIS Server GP GP MIG BT Acute Hospitals Vision practice GP Vision server MIG interface BT Filter Emergency Care GP Out of Hours SystmOne practice SystmOne server GP 1.6 million of population will benefit from this approach 318 practices across Birmingham, Solihull & Sandwell 14 partners organisations have been confirmed
Public information programme 1 Preparation development - engagement with patients and stakeholders in creating information and campaign so we know its clear 2 GP Practices awareness raising, engagement events and toolkit to help support practices 3 For patients - awareness raising advertising and PR campaign so patients know they should receive information by post buses, radio, events 4 Opt out - Letter and leaflet to patients informing them of what is happening and how to opt out 5 Ongoing support through helpline for practices and patients through process
GP Record node Only available if data is present on the MIG access controlled by Active Directory group
Consent Continued Once T&C s are confirmed: NB in development awaiting wording from the CCG
Audit trails Access Audit to Your Care Connected Record Details of Access to this patients Your Care Connected Record
What does Your Care Connected show? Information shared via Your Care Connected Allergies Medication Hospital admissions and referrals Vaccinations and immunisations Test results Diagnoses Treatment Medical procedures End of life wishes Demographics (age, gender etc.) Concerns related to abuse of vulnerable children or adults (if applicable) Information NOT shared via Your Care Connected IVF Treatment HIV and AIDS Sexually Transmitted Diseases Gender realignment Termination of Pregnancy Marital status Criminal Convictions Complaints Free text from GP record
Exclusion data set
Your Care Connected and other data sharing initiatives
Over 9 in 10 patients would be happy for doctors and nurses in hospitals and paramedics to view their GP medical record
Implementation Suppliers MDU & ICO update LMCs, CCG, practice manager engagement CSU support Webinars 25
Patient Online programme www.england.nhs.uk
What is Patient Online? Online appointment booking Online repeat prescriptions Online access to records 98.7% of practices offering the service 8.5 million patients signed up 12% of all appointments are made available online 97.4% of practices offering the service 8.3 million patients signed up 4% of all repeat prescriptions requested online 97% of practices offering access to a summary of the record 2.9 million patients signed up 5% of practices offering access to the detailed record 27 www.england.nhs.uk
GMS/PMS regulations 2015/16 From April 2015, practices are required to offer online access to detailed information held in coded form within the patients GP record. www.england.nhs.uk
Detailed coded data example This is an example of categories of information that patients may see. Demographics Allergies/Adverse Reactions Medication (dose, quantity and last issued date) Immunisations Results (numerical values and normal range) Values (BP, PEFR) Problems/Diagnoses Procedure Codes (medical or surgical) and codes in consultation (signs, symptoms) Codes showing referral made or letters received (no attachments) Other Codes (ethnicity, QOF) Some of the information in list above will depend on what your clinical system is able to routinely display. 29 www.england.nhs.uk
Overriding principle The coded record must be MEANINGFUL to the patient
Benefits of using online services Improve safety Look up medical jargon Improve health control Improve knowledge and health literacy Improve access and convenience Reduce errors and duplications Saving time and resources Less pressure on staff Increase use of SMS Save phone calls Increase patient satisfaction Improve communication with patients Administrative time saving Source: http://goo.gl/49od49 31 www.england.nhs.uk
DNA Appointments % DNA traditional % DNA online 5% 4% 4% 3% 3% 2% 2% 1% 1% Number of Appointments DNA 0% Aug Sep 2015/16 % DNA traditional 4.1% 3.6% % DNA online 2.3% 2.3% TOTAL no. of appointments booked 2015/16 Aug Sep STRAWMAN REF 34,355,70 1 41,487,45 1 108 - appointment_scheduled_trans_count TOTAL No. booked online 695,869 759,928 610 - appointment_scheduled_ online_trans_count TOTAL Number booked/cancelled online 893,268 977,331 POMI TOTAL Number booked/cancelled online TOTAL APPOINTMENTS DNA 1,401,574 1,485,267 212 - appointment_dna_appt_count TOTAL APPOINTMENTS DNA ONLINE 16,177 17,580 213 - appointment_dna_online_appt_count % DNA traditional 4.1% 3.6% % DNA online 2.3% 2.3% 32
What NHS England are doing to support practices Engagement (CCG and LMC engagement, workshops for practice managers, training for CSUs/HISs) Developing guidance & policies Answering practice and patients queries Focus on enabling record access Working with EMIS Case studies and videos preparation Building benefits evidence Detailed interviews with patients New practice baselines Promotion to the public 33 www.england.nhs.uk
Ensuring a patient s notes are ready to be shared 34 www.england.nhs.uk
Issues to Consider Third Party Information Must be excluded as required by data protection act and common law duty of practice (same as with Subject Access Requests) Sensitive Codes Examples include sexual & reproductive health, child and adult safeguarding, domestic violence and criminal activity These codes may need to be excluded or discussed with the patient prior to access to avoid upset or harm This is relevant particularly to coercion and proxy access Guidance from the RCGP is due out soon Free Text Whilst not required it can add meaning, especially to blood results. See later slide on free text. From EMIS 5.8 it will be possible to choose which elements of the record have free text e.g. only shown for results. www.england.nhs.uk 35
Our resources www.england.nhs.uk/patient-online elearning.rcgp.org.uk/patientonline 36 www.england.nhs.uk
Links to Resources Main Websites NHS England - https://www.england.nhs.uk/ourwork/pe/patient-online/ RCGP http://elearning.rcgp.org.uk/patientonline Specific Guidance ID Verification - http://elearning.rcgp.org.uk/course/view.php?id=181§ion=2 Coercion - http://elearning.rcgp.org.uk/course/view.php?id=181§ion=1 Proxy Access - http://elearning.rcgp.org.uk/course/view.php?id=181§ion=3 Children and Young People - http://elearning.rcgp.org.uk/course/view.php?id=181§ion=4 This guidance is being updated and new guidance is coming soon Documents and Forms (downloads) http://elearning.rcgp.org.uk/mod/page/view.php?id=4775 www.england.nhs.uk 37
An individual without information can t take responsibility. An individual with information can t help but take responsibility Jan Carlzon, business leader (QuoteDaddy)
Thank you! #patientonline www.england.nhs.uk 40