The pandemic has helped accelerate shared records from information repositories to vital operational systems across whole care ecosystems. Maintaining shared records will aid in truly transforming the integrated care setting. By James Ormonde

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The case for shared care records has been gathering steam and it is now firmly on the national agenda. Shared care records feature prominently in NHSX’s recently published “What Good Looks Like” digital framework for integrated care systems, under success measure two, Ensure Smart Foundations, and are also referred to as a key objective in the NHS long-term plan.

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Many of us will remember how shared care records were being discussed a few years ago. The conversation was focused solely on health and social care workers having access to an individual’s records - to ensure that they could provide people with the best care possible. While this is still important, the dialogue has moved on and matured - with covid proving to be a catalyst.

There are now huge, transformational uses and implications for entire populations. Integrated care systems can use rich data, gathered from across health and care settings, to see exactly where the gaps are in their regions – and plan what to do about them. It is shifting the approach from viewing to doing.

Nationwide adoption of shared care records is picking up pace

Shared care records were thrust under the spotlight last year as local authorities searched for ways to understand what was happening in their populations right now – not last month, or a year ago. It quickly became clear that the ability to have data flow between care settings across whole care systems can have a tangible impact on outcomes and what happens to patients.

NHSX’s end of September deadline for all ICSs to have a basic shared record in place affirmed the commitment and drove the pace of adoption. Almost 90 per cent of ICSs now have a shared care record, with the remainder getting the government support they need to join them. It has laid down the foundation to deliver safe, personalised, and seamless care and now the challenge is for care systems and technology providers to elevate shared records to support system-wide planning and delivery.

We have seen clear evidence of this forward momentum ourselves, both in terms of new records deployed and in adding providers to records already installed. Three systems have gone live with Graphnet’s CareCentric shared care record over the past year, with Kent and Medway being the latest (and one of the largest). In total, we have deployed to integrated care systems covering well over 20m residents. Growth has been steady since we introduced shared care records 20 years ago, but change is in the air, and there’s a new energy and momentum.

Next steps for shared care records – recovery and supporting people

According to a blog written by Ashley Hannah, NHSX programme director for shared care records, the next step is to help ICSs develop their shared care records to bring in other settings such as social care, hospices, pharmacists, dentists, and optometrists. After this, the NHS will look to link the ICSs’ shared care records in a bid to create, effectively, a shared record across England.

It is clear that system-wide planning will be key to the country’s recovery and supporting healthy populations. NHSX’s What Good Looks Like framework recognises that this has long been an ambition but it’s time to put it into practice, now we have the basics in place.

The framework lays out seven measures for success. ICSs must be well-led, ensure smart foundations, safe practice, support people, empower citizens, improve care, and help develop healthy populations (which includes addressing health inequalities).

ICSs that are already ahead of the curve

In response to coronavirus, Surrey Heartlands rapidly accelerated its shared record plans by deploying Graphnet’s CareCentric solution and joining up records across hundreds of care organisations in 12 weeks. Greater Manchester also fast-tracked its shared care record rollout for 2.8 million citizens in a matter of weeks, rather than months.

At the same time, the Greater Manchester team swiftly introduced a Covid Oximetry @Home platform, which records the health status, including pulse oximeter reading, for patients being supported on the virtual wards and incorporates an app for patients to input oximetry readings directly into their electronic record. Graphnet’s population health tool has been overlaid over all of the above to proactively target and enroll covid-positive patients onto the programme.

Local pregnant women are avoiding unnecessary hospital admissions with the development of the MyMaterityCare app for blood pressure and glucose monitoring and premature mortality from cardiovascular disease is being reduced with the use of an app and digital heart failure care plans. Thousands of care home residents are also receiving faster, more targeted support as a result of the Safe Steps Covid Tracker being integrated into the shared care record.

The Greater Manchester Care Record, which is a partnership between the Greater Manchester Health and Social Care Partnership, the 10 Greater Manchester localities and Health Innovation Manchester, has entered a new territory for shared records. Having access to increasingly rich sources of data is enabling them to refine their health and social care strategies, create a more joined-up approach, and continue improving standards of care for the people that need it most.

This includes using de-personalised data in highly selective and world-leading research at Greater Manchester universities. So far, seven research studies have been approved to access the GM Care Record with 15 others under consideration. At the moment, this is purely for covid-19 related research, looking at how different groups within the regions’ 2.8 million citizens have been affected by the pandemic. However, the hope is that in the future information in the care record can be used to explore other health questions and to help create better health policies and services for the GM population.

As Surrey and Greater Manchester ramped up their deployments, the pandemic was shaping the future of shared care records in other parts of the country. In April 2020, two Cheshire and Merseyside covid-19 resilience cells identified the need for a real-time analytics platform to manage the crisis and drive a strong recovery.

Graphnet worked with Cheshire and Merseyside to develop a population health management platform in just three months. The Combined Intelligence for Population Health Action system takes data feeds from the local shared care records and combines it with multiple national data sets to provide a series of real-time and near real-time dashboards to drive decision-making and support operational responses. The dashboards cover three broad areas: capacity and demand, epidemiology, and population stratification.

CIPHA is integral to the smart testing which informs UK policy and helped to play an important part in the national Events Research Programme for safe unlocking after covid-19 restrictions.

Kent and Medway are another ICS that have taken impressive strides with the recent launch of their shared care record, covering 1.9 million citizens. The system brings together information from a growing number of settings, including four acute hospital trusts, three community-based providers, two mental health services, South East Ambulance Service and 198 GP practices, in addition to Kent County Council and Medway Council’s children’s and adults’ social care teams.

In the future, people living in Kent and Medway will be able to access key information from their own care records through the KMCR patient portal, giving them the ability to proactively manage and engage with various elements of their care. The planning for this phase of the project is underway, along with the implementation of population health management tools.

While these initial steps have been very exciting, they are only the beginning.

The foundations are there, and the pandemic has helped to accelerate shared records from information repositories to vital operational systems across whole care ecosystems. We’ve proven that huge digital maturity steps can be taken rapidly when the chips are down, and it is imperative that we maintain that mindset.

The conditions are excellent for shared records to make a huge difference to care systems and their residents. Let’s make the most of this opportunity to aid recovery and truly transform health and social care.

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