We are now familiar with the Department of Health and Social Care’s (DHSC) White Paper ‘People at the Heart of Care’ and the Government’s plans on technology and reform. One key area, which is frequently discussed, is digitalising care records.
At Care England’s #FacingTheFuture conference, the Health Secretary, Sajid Javid, informed delegates that the Government ‘will work with’ social care providers to make sure the sector reaches its target of 80% of providers utilising a digitised care record that can connect to a shared care record by March 2024 – currently that figure sits at 40%. How to get there
For three years now, NHSX has been on a mission to drive the digital transformation of the NHS and social care and, according to NHSX, it has got basic shared care records into every Integrated Care System (ICS) except one, enabling health and care staff to view and edit the same version of a person’s medical history across health and care settings so that they can collectively deliver safer, more joined up and seamless care.
The Care Quality Commission (CQC) said a good records system delivers good outcomes from the point of view of people who use services. These outcomes are the same whether the records are kept digitally or on paper, although what providers need to do to deliver them might vary. Digital care records are widely recognised as improving quality of care and improving effectiveness of care delivery, as well as being the gateway to sharing data across care settings.
There are three main obstacles that are frequently cited for staying with existing paper-based care systems. Cost, operational interruption and change management. Of these, change management is generally the toughest and biggest obstacle.
Many people cling to existing processes as a kind of security blanket and taking that blanket away needs to be managed very carefully and considerately. Sometimes it takes a change of personnel to remove the security blanket, but this is not a feasible way forward for the majority of care providers, so helping people understand and embrace the opportunities that digital technology provides is a necessary process.
A good digital system will provide massive improvements in operational efficiency, so the trick to minimising the operational interruption is to take the advantage of some efficiencies as early in the process as possible. It is normally best to implement the system in functional steps, rather than try to do everything at once, and it is often best to implement one function across all service users rather than all functions for one service user at a time, because this makes the change least confusing for care staff.
Software companies have basically four costs: sales and marketing (or promoting); service delivery; infrastructure costs (often called hosting costs); and software development costs (or research and development). All of these costs need to be paid either by customers or investors, and if paid by investors then the costs still need to be paid by customers, just future customers.
By looking at cost paid for software from the perspective of the company providing the software, it should help to ensure they understand what an appropriate price is to pay. Digital care software is too important to end up with a poor product, and then suffer the need to change later due to poor experience. Negotiate the best price you can, but don’t put price above the benefits that better products can provide.
Whilst all this needs due consideration, the benefits realised having moved to an effective digital system far outweigh the short-term pain. There will be an ongoing cost for a digital system, and, despite recognised improvements in efficiency, this rarely resolves to a reduction in other costs. However, the focus on integration of data, and the financial support now available helps to remove this barrier.
Person Centred Software welcomes the White Paper’s core objectives. In particular, we welcome the recognition that people live well when they are part of a community – an aspect that is at the heart of our digital care product. Part of this is ensuring as much information as possible is shared between organisations, to help people to feel that their care is connected.
Having recently passed the two-year anniversary of the UK’s first official lockdown in response to the coronavirus pandemic, we, as a sector, have come to realise the sharing of information is also necessary to help inform clinical decision making; making the best decisions saves lives. What the pandemic has shown is that, more so than ever, people across health and social care need to share information with those who need it quickly, securely, and efficiently in order that the best decisions can be made, and to provide integrated care for people when they move between services.
The interoperability of data between social care and the NHS in early 2021, for instance, has now really begun to take traction and we hope it continues at pace as we move forward. We believe that the more joined up the different elements of care are, the more likely everyone is to achieve the best outcomes.
Joining up systems
In February 2021 we launched our interface to GP Connect that enables care providers to view residents’ medical needs in real time, which is particularly useful when transferred from hospital to a care home. To have access to GP Connect, care providers need to show their digital maturity by meeting the standards set by the NHS Data Security and Protection Toolkit (DSPT) but having met these standards they will have access to GP records and medical notes, which enable better informed decisions which leads to better care and improved outcomes.
Just over 12 months from the launch of GP Connect, we have seen the bi-directional software installed in 200 locations across the UK. As at writing, we can now provide access to GP Connect for over 30,000 people – the residents at all homes that are DSPT standards met.
For care providers, the timesaving benefits for staff are exponential, as the system improves their knowledge of the individuals they care for. The type of information that is made available through the digital care management system includes: hospital visits, diagnosis, allergies and adverse reactions, acute and repeat medication, referrals, observations and immunisations.
The systematic switch enables authorised clinical staff to share and view GP records and medical notes quickly and efficiently. In addition, staff are granted access to real-time information and get a clearer picture of historic care for residents. The software also helps health and social care providers to deliver the safest and most effective form of care, while simultaneously improving overall decision making.
Mike Armstrong, Managing Director at Havering Care Homes, signed data-sharing agreements for GP Connect. He told us, ‘The key benefits of the integration with GP Connect include our nurses now having access to real-time information as well as a clearer picture of our residents’ historic care. The vast amount of time saved by having instantaneous accessibility is beneficial for not only our nurses but for GPs too, as we no longer need to call them for updates or information.’
Ultimately, this should lead to medication being able to be shared between different settings and, as a result, expensive medication will no longer be disposed of when a person goes from a care home to a hospital.
The cost to the NHS of wasted medication was estimated in 2015 to be £300m per year, with one of the contributing factors being deliberate discarding between care settings. The digital transfer of care home hospital packs directly to hospital systems is another benefit of many digital care systems. In 2019, a steering group was brought together to develop a national product as part of the NHS Pathfinders project to design the eRedBag.
The eRedBag enables advanced care plans to be sent to hospitals in advance of the resident arriving by ambulance, giving doctors and consultants notice of the individual’s care needs prior to being seen. eRedBag care plans that originated from social care records have been accessed by numerous types of people in the NHS, including nurses, doctors, surgeons and consultants, and have improved the treatment of people undergoing emergency transfer to hospital simply by sharing the data held by a care provider.
Building the momentum
With integration allowing for all-important information to be kept in one place and be easily accessible, we expect interoperability to help continue driving improvements across the industry. Indeed, last year was the start of true two-way interoperability. But the pace necessary for 80% of social care providers to have a digitised care record in place by March 2024 will only be achieved with a significantly increased rate of adoption of technology.
As a software provider, we have always strived to make life better for everyone involved in social care. Delivering interoperability is a step change towards the integration of health and social care, improving information flow as people transition between care settings.
The journey to fully integrate health and social care is well underway, and several care providers are already on board – but the momentum must continue and at quite a rapid pace. Any care provider that is not already using one of the digital care systems that are working with GP Connect risks being left behind, and in doing so, compromises its ability to provide outstanding quality to the people it cares for.
While we welcome the direction we are slowly moving towards, it must be reiterated that the need
for all social care providers to adopt digital care systems is urgent.
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