Streamlined care cannot be delivered unless clinicians are able to share information easily. Mark Caulfield describes how Tower Hamlets solved the problem with integrated IT

As the repository for vital patient information, IT systems are at the heart of rethinking services in the post-Darzi era.

Involve clinicians from the outset: listen to their needs and take time to understand how services work before you start to think about IT

It is impossible to redesign more streamlined care pathways - with the patient, not the provider, at the centre - without also considering how different healthcare teams can share information to deliver a joined‑up approach.

This is particularly important for patients with long term conditions, who rely on the support of many different healthcare practitioners, who in turn work in a wide range of settings.

Without shared information - for example, details of recent interventions or current medication - consultations become more time consuming and less effective, not to mention frustrating for the patient.

At NHS Tower Hamlets, we have adopted an ambitious IT programme to support the restructuring of our services into eight new networks. In effect virtual polyclinics, the networks combine clusters of GP practices aligned to local community health services.

The aim is to deliver better and more integrated care, closer to home, in one of the most deprived boroughs in the UK.

To support this new way of working, we needed an integrated IT system that was flexible enough to be used by a wide range of clinicians and that would support comprehensive, PCT-wide data reporting.

We decided to continue our history of collaborative work with healthcare systems supplier EMIS to develop its EMIS Web system into a structure that would work across the whole primary care trust.

Single record

The system allows us to create bespoke consultation templates for different healthcare teams - each feeding data into a single patient record, which can be viewed by different practitioners.

We worked closely with different practitioners to create the right template for their particular service and to agree which other professionals could access the data recorded.

For example, we worked with the community matrons to create templates for patients with long term conditions, based on the templates used in general practice. More recently, we worked with the child protection nurse specialist to create a template to record data for vulnerable children.

Both of these templates can be viewed by GPs and community teams - providing a vital overview of care - and the system automatically captures data from different practitioners’ consultations.

Two years into the project and the system is now widely used by 300 community practitioners, from health visitors to district nurses, and will be implemented across all community teams by the end of 2009.

The benefits of this include:

  • Patients’ electronic records are now more comprehensive, with data entered by different practitioners, giving a rounded view of their care.
  • Data capture to support performance reporting is done in seconds, not weeks, and we can now produce electronic 18-week referral reports.
  • Using the system’s powerful search and reports module, we can track all childhood immunisations across the whole PCT and manage call and recall to improve vaccination rates.
  • Services are being delivered more efficiently. For example, by using a streamlined appointment booking service which has removed duplicate data entry, our physiotherapy admin team is saving seven hours a week.
  • We are developing sophisticated care pathways that will allow us to generate tariff information as well as relating this activity to episodes of care defined by specific problems or conditions.
  • Clinicians have adopted the new system with great enthusiasm - far from having to persuade them to change, we are fighting off requests to extend the roll-out of the system.

Integrated patient care does not stop with the PCT. We plan to implement data sharing with a local hospital trust and with the council’s social care services.

How to deliver joined-up IT

  • Involve clinicians from the outset: listen to their needs and take time to understand how services work before you start to think about IT.
  • Focus on the end result: our focus was not on management information but on using IT to help support new care pathways.
  • Don’t assume that different clinicians need different systems: we identified core similarities in how different practitioners approached a consultation, enabling us to develop a central module that could be adapted to meet service-specific needs.
  • Develop rigorous data sharing agreements: GPs in particular need reassurance about who will access the patient record, how and why
  • Retain flexibility: interoperability with other IT systems is essential if you are to link information with other providers, for example in secondary care.
  • Work closely with your IT supplier: having a direct relationship with those designing the system is a tremendous benefit - saving time and ensuring clear communication of users’ needs.