Bolton Care Partnership

Access to Clinical Correspondence within a Shared Care Record

Briefly describe the initiative/ project/service; please include your aims and objectives

Delays in accessing patient records and not having all the information needed about a patient’s condition, previous medical history and any medication upon presentation in an acute hospital setting was having a direct impact on our ability to treat patients as quickly and effectively as we would have liked. The Trust and partners in the Bolton health and care system collaborated to introduce a system that allowed sharing of clinical information across all partners for the benefit of patients. Bolton has become the first locality nationally to adopt a system which enables all clinical correspondence to be viewable across health settings.

Building upon the success of the Bolton Integrated Care Record (now part of the Greater Manchester Care Record) Bolton procured the add-on ‘Docman Share’, an Advanced product, which enables clinical letters to be shared within the borough. Put simply, a patient can attend Royal Bolton Hospital and the clinician responsible for their care can access any letters sent to their GP, including referrals, discharge notes, screening and other diagnostics. The project has been through many challenges to come to fruition but also to progress to the place it is in today – a national first, and a constantly developing system that supports all partners. Ease of use, security and speed for the end user were amongst the aims of the project, but the ultimate goal is improving patient care by providing timely access to information which, prior to this solution, they wouldn’t have immediate access to, especially during the out-of-hours period. In order to achieve this, partner organisations had to work closely together, to agree principles of sharing with appropriate levels of data security. Bolton Care Partnership has developed a system that is achieving its goals and being seen as best practice amongst peers in Greater Manchester. The aim is to expand this reach further and share our knowledge and experience with localities outside of our region.

What are the key achievements?

Implementing the DocMan Share solution has enabled partners to provide a service that many patients would have assumed was already in place across the NHS. The Share functionality allows GP practices in Bolton to choose which letters they wish to share, so it is not a blanket share.GP Practices can select correspondence to include using set criteria and keywords, or by setting an excluded words list. The Share feature also allows health care professionals in Bolton to directly view GP letters within the record via an API integration. It means, there is now no need to phone, fax or email GP practices, but supports decision making, and releases time to deliver direct patient care. This improves both patient experience and patient safety.

Speed of access to clinical letters and discharge summaries has changed from potentially days during a bank holiday weekend, to just a few seconds. Other time saving mechanisms include reduced calls and enquiries to GP practices looking for missing or incomplete information, saving time for both those who would otherwise be making or receiving the call. It also provides a robust audit trail of who has accessed information and when, and that they are entitled to do so via role based access – something that wasn’t as visible when using telephones. For the user, clinicians can view correspondence in context through one unified system, without having to log into the records and systems and/or request information as it is integrated into the electronic patient record.

Feedback has highlighted ease of use, both in terms of uploading clinical correspondence and in terms of accessing and reviewing this information. A respiratory medicine consultant noted improved delivery of care and quality of consultations, with a decrease in delays in clarifying medications as some of the many benefits of the system. One example which really highlighted the benefits of this system was when caring for a patient who moved to Bolton in their last few weeks of life to live with family, due to rapidly progressive lung disease. The consultant was able to quickly access the summary of care provided by another trust through GP correspondence, meaning he could be seen quickly, we had all the information needed for his appointment and there was no duplication. A consultant Acute Physician commented that he accesses the system almost daily. When reviewing a patient at the weekend, he could view a discharge summary from a neighbouring trust, giving access to valuable information such as radiological investigations and discharge medication, which the patient was unable to recall. In addition, community teams have realised similar benefits; being able to view and act upon the correct medication information and have a full picture when assessing and implementing a treatment plan. Being able to see letters containing detail such as screening appointments plays a huge part in safely caring for patients with diabetes, to name one example. As we move more closely towards integrated health and social care systems, this way of working supports inks with partners across the system and has improved communication and team working within these other health networks. This overall is ofgreat benefit to staff, who are time poor with heavy caseloads, but the benefit has to be greatest when we think of the improvements to patient care and experience – the ultimate goal when it comes to any NHS improvement or transformation project.

How innovative is your initiative?

Bolton is the first locality in the UK to deploy DocMan Share, using the shared care record, supplied by Graphnet to access clinical correspondence. As such, we believe this initiative is truly innovative. As a result of the deployment, clinical documents are now visible to other Health Care partner organisations such as hospices, out-of-hours services, trusts and tertiary centres to improve and support direct patient care.

To achieve this, the concerns of stakeholders had to be addressed and there was a need to break down historic boundaries to information sharing. The Professional Reference Group (PRG), with representation from the Acute Trust, CCG, Mental Health, Social Care and GP out-of-hours services worked collaboratively to explore each other’s concerns and the very real advantages for patient care that this project brings. Whilst some partners were cautious about sharing data, by keeping the patient central in the narrative it was possible to build a consensus. Concerns were expressed regarding breaches of data, but as all users are bound by professional standards, it was agreed that users should be trusted to abide by these and the risk should be accepted. It was felt that the low likelihood of a data breach was far outweighed by the benefit that would be gained by patients. It is never easy to be the first to implement new technology, but Bolton has a track record for innovative thinking and being digital pioneers.

Using the GDPR principle of sharing data for Direct Clinical Care and role based access, stakeholders have been assured that we have produced a robust process which gives the treating clinician access to information which may influence treatment options. This was achieved via feedback from the PRG, Caldicott guardians, the joint Information Governance Board and from our suppliers, Graphnet and Advanced, to create the Data Protection Impact Assessment. This close partnership working has enabled Bolton Care Partnership to be the first locality to go-live.

What are the key learning points?

This project demonstrates what can be achieved when traditional barriers to data sharing are broken down. One of the biggest challenges to overcome was anxiety over data breaches and ownership of data. There were lengthy discussions around the fact that all users having access to records must have up to date Information Governance training and are bound by their own professional standards. Engagement with stakeholders has been key to success and this has involved face to face meetings with some, as well as online meetings during the pandemic. It is interesting to note that many members of public assume that this level of data sharing already exists and generally there is an expectation that this should be shared. This expectation also helps to create the narrative for data sharing. Recent high profile news stories also illustrate the dis-benefit and risks of siloed working in health and social care – barriers which this project intends to continue to overcome.

As a result of the extensive work done during the programme to ensure that it is fully compliant with all information governance regulation, the DPIA (data protection impact assessment), training material, FAQs and guidance and exclusion list has been shared with all other Greater Manchester localities for adoption. The next steps for the Bolton locality are to support partners in Greater Manchester to rollout this technology further across the area. They will be looking to Bolton to emulate its approach to ensure consistency, and because of the successes the project has realised to date. The project also intends to make clinical letters available to social care, to help understand and support care needs. The GMCR is one of the UK’s largest digital integrated records, used by health and social care professionals to improve care for Greater Manchester’s 3.2 million residents across 10 localities. Having worked with Advanced to develop the solution, it is now available as part of their solution portfolio for use not only across Greater Manchester but other Advanced customers who use the Graphnet care product. As such, this project is highly scale-able and available to others today.

Additional Comments

We continue to gather data on the positive impact that this project is having on patient care. Emergency medicine colleagues report that access to clinical letters has enabled them to discharge certain patients directly from A&E, avoiding hospital admission. Given the current pressures on Emergency Departments, any solution which helps admission avoidance is of significant benefit