Selected care homes which are accessing patient records via TPP’s SystmOne are discovering the power of easier, joined up communications, writes Jennifer Taylor
As a practice manager who is closely involved with her clinical commissioning group, Petra Morgan is well aware of the need to improve communication with care homes. That’s why she and her colleagues at Street Lane Medical Centre in Leeds have welcomed an initiative to allow care homes to gain access to residents’ health records.
Under the new scheme, which launched last month, selected care homes can use TPP’s SystmOne to view data from the shared electronic patient record - with explicit consent from patients, or their representatives as appropriate.
Ms Morgan, who represents practice managers in Leeds North CCG, says it’s an exciting opportunity with the potential to improve “flow” across the health and care system.
“We’ve been working on admissions avoidance for the CCG and have been trying to create better links to coordinate the care of people in care homes,” she says. “There’s a need to improve communication generally and we felt that giving access to some of the patient record would mean that decision making in care homes would be more informed.”
Dr John Parry, clinical director of TPP, which is making SystmOne available to care homes free of charge, says the initiative grew out of a conversation that the company’s CEO had with the health secretary, Jeremy Hunt.
“It was clear that the secretary of state was looking for ways of improving care in nursing homes. Wherever we travel, either in the UK or abroad, we hear the same concerns about care of the elderly, such as the growing numbers of older people, dementia, and frailty.
“It’s becoming clear that we could use better information in the nursing home environment.”
As a GP for many years, he says he knows there are homes providing excellent care for residents, but that communication could be more efficient. “There are routine communications - such as ordering tests, or medication - which don’t really need a direct conversation. Provided there is a well-structured relationship [between the GP practice and care home] then these communications can take place through the electronic patient record.”
The well structured relationship is a vital part of the picture, he says, and it has to be properly thought through. “This isn’t a question of opening the floodgates. It has to be done as a partnership; we have to see what both sides [the GP and the care home] can tolerate. It has to be in the best interests of the patient, and it has to avoid the risk of either party being swamped.”
There are, however, huge benefits to be realised. “This is a new approach, and it’s very important to get it right,” he adds.
“Sharing of the patient record needs full consent of the patient, or of the patient’s representative. To fit with our patient-driven consent models, all parties have to agree.”
‘Wherever we travel, we hear the same concerns about care of the elderly’
Maria Holdsworth, the registered manager of Donisthorpe Hall - one of the largest care homes in West Yorkshire, and one of the first to be involved in the project - is enthusiastic. “It’s early days, but we can already see that it’s going to be very useful,” she says. “It’s good for the residents, good for the GP practice, and it’s good for us at the care home.”
Previously, she says, health information could be slow in following new care home residents. “It was a bit hit and miss. It could take time until we got their health records, but now we can get the information instantly, with the resident’s consent, of course. That’s great because it helps us to do our job in providing high quality care for our residents.”
Residents and their families have been very open and positive to the change, says Ms Holdsworth, who points out that only senior clinical staff at the home have access to the system.
Care home staff can add information to the record, although they cannot alter the information in the record itself. The use of tasks can also flag up the results of a urine test, or blood pressure check, for example. Likewise, staff can check the GP record for results of a resident’s blood test.
She believes the move promotes better integration between care homes and the health service. “I think the healthcare industry is one big family, and we’re part of that,” she says. “Now, access to the health records is a three-way sharing between the residents, GPs and us.”
She believes that the knowledge in the records will help staff to support people at the home, and reduce the risk of hospital admissions, particularly for new residents.
“I also think it will help avoid acute hospital admissions because we can look at the record and see that X, Y or Z is going on, and take it from there,” she says.
John Snowden, deputy manager at Street Lane Medical Centre, says the practice was very keen to be involved. “We’ve been asking for something like this for some time as our practice has a lot of patients who are residents in care homes - anything from 100 to 180 at a time, over five or six sites.
“Previously when they were on visits our GPs or nurses would use laptops to access the patient records, but this could be slow, and the signal kept dropping. Now they can use the PCs at the home itself, which is much quicker and much more efficient.”
Bringing care homes into the healthcare information loop should be good for older patients, says Dr Parry, because they can benefit from future aspects of SystmOne. For example, the system will soon incorporate a frailty index, which has been developed through TPP’s ResearchOne project.
“In our view, the record should follow the patient,” he says. “I think this is a powerful model for the future; the opportunities are here, and we’re at the start of a very interesting journey.”
Why sharing leads to caring
Just under a year ago, health secretary Jeremy Hunt set out new proposals to radically improve care for older people. Claiming that over the last 65 years the NHS had done more to improve lives than any other institution in our history, he emphasised that vulnerable and older people, its heaviest users, are often failed by the NHS.
He said that too often these people ended up in hospital not by design, but simply because they couldn’t get the care they need elsewhere. His proposals to address this included better support for older people, improved access to services, enhancements to out of hours care and - as a fundamental, cross-cutting theme - “better sharing of information”.
I would argue that until the sharing of vital information has been optimised, it will be impossible to transform the way we deliver care for older people, and support them effectively and efficiently so they can maintain their dignity and personal autonomy.
Reliable information should underpin all decisions about care and this is particularly important for those whose frailty and complexity makes this especially challenging.
As a GP in Bradford for more than 20 years, I have welcomed the ability to share clinical data electronically between NHS clinicians who care for complex patients concurrently.
Residential care services, however, usually provided by private organisations, fall outside the traditional NHS loop. This tends to lead to dislocations in care and cumbersome methods of communication between diverse carers.
By deploying TPP’s SystmOne clinical solution into local care homes and training care home staff to use it, truly integrated working is being achieved for the benefit of their older residents. For the first time, care home clinical staff are able to view reliable electronic patient records.
They are starting to use sophisticated functionality which is expected to more reliably deliver the outcomes the health secretary is aiming for around community based, out of hospital care taking into account the particular needs of this important patient group.
Early indications suggest that this initiative, which TPP has decided to offer free of charge, will be welcomed enthusiastically by patients and their relatives as well as by clinicians in care homes, regardless of whether they are employed by the care home or are visiting teams with shared responsibility for their older patients.
John Connolly is clinical lead at TPP and GP at The Ridge Medical Practice