The exchange of information is a key element of effective coordinated care, yet the NHS’s fragmented IT framework creates a host of problems and difficulties, says Veronika Thiel
One of the key findings of the King’s Fund’s report on care coordination for people with complex chronic conditions, published last week, is that measuring impact, particularly through current IT systems, is complicated and requires time, dedicated resources and capacity.
‘There was an overarching sense of frustration at the lack of access to shared electronic records’
Related to that, effective information exchange, one of the key elements of successful and seamless care coordination, is often lacking. During our research project, we worked with five case study sites that are delivering effective care coordination programmes.
We found the sites used a “high-touch, low-tech” approach to information exchange – with face to face or telephone conversations, and secure email and fax. While practitioners especially enjoyed the personal contact with each other, there was also an overarching sense of frustration at the lack of access to shared electronic records, and having to update patient records on different systems was often cumbersome and time-consuming.
The common link between impact measurement and information exchange is, of course, information technology: data collection and care coordination involving multiple providers both depend on compatible IT systems. Health and social care have a fragmented IT framework, with as many systems as there are entities.
Social care, primary care, mental health care, community care and secondary care all use different software, leading to a whole host of problems. These include: duplication of data entry with associated risk of error; differences in the indicators collected making comparison difficult; and incompatibility of data formats. which complicate data exchange. Methods and systems to measure evidence of the impact of care coordination and integration are mostly weak, and policymakers and commissioners are slowly waking up to this problem.
Adapt to local circumstances
Practitioners in our study also highlighted the fact that software could not easily be adapted to reflect local circumstances; a key tenet of integrated care is that it operates best at a neighbourhood level and should therefore use indicators that reflect local demography, health needs, circumstances and socio-economic conditions. Most existing software appears not to be flexible enough to meet these needs.
‘There appears to be an appetite for developing in-house systems, using open source software that can be transferred to providers at little or no cost’
Commercial software is often difficult to adapt, as the source code cannot be manipulated, and, in some instances, the software can limit the amount of data that can be exported to other formats, complicating information exchange and the tracking of patient status.
Some software carrying out predictive risk modelling, which uses patient information from the past to assess the risk of future hospital admission, will not allow users to access details on how indicators are weighted, so that providers cannot be sure if they are targeting the right patients. Furthermore, providers often have contracts that tie them to particular software and so may not be able to switch easily.
As a result of these limitations, there appears to be an appetite for developing in-house systems, using open source software that can be transferred to providers at little or no cost. Open source software allows anyone to access the source code and to adapt it to their own needs.
This is, of course, not without its problems – if too many people in one organisation change the code, it will become difficult to track and understand changes. Changes must therefore be logged meticulously. Nevertheless, data analysts and practitioners appear to value the advantages of local adaptability and transferability, and national policy appears to be moving into the same direction, with the adoption of open source software for centrally provided NHS IT services.
Commissioners need to decide which system will best suit their local care coordination needs. Whichever they choose, they need to make a conscious decision early on in the process − everything from patient identification and care coordination to future upscaling of the model is simplified if suitable IT systems are in place.
Veronika Thiel is and independent policy analyst and researcher. This article also appears on the King’s Fund blog.