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Healthcare providers not sharing information puts patients at a disadvantage, says Birmingham and Solihull Mental Health NHS Foundation Trust’s chief clinical information officer (CCIO), James Reed.
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Speaking at Intersystems’ joined-up health and care conference this week, Reed, who as well as being the trust’s CCIO is also a forensic psychiatrist, highlighted the importance of sharing data, particularly in a mental health setting.
Traditionally, mental health data is talked about as something “kind of special or secret”, said Reed. “As a psychiatrist, I have always felt that is a complete misrepresentation because mental health data is no different from other health data,” he said. “But if we make out that somehow our data needs to be kept secret, that disadvantages the patient first of all, because it means that all the other professionals involved don’t have access to it, but also, more broadly, it disadvantages the whole system of care.”
Patients who suffer from mental health issues, particularly those in crisis, will often end up visiting several different emergency departments and hospitals, said Reed.
However, as it currently stands in most of the country, one hospital will have no idea that the patient has also visited another hospital, what treatment was given or what plan was in place for that patient, he said.
Mental health trusts have traditionally been fairly good at digitising within their own hospital walls, said Reed, but he added: “What we are not very good at is connection between organisations. In Birmingham, we have got quite a large number of trusts very close together, but as things currently stand, there is very little, if any, formalised automatic data sharing between them.”
To help to remedy that, Birmingham and Solihull is working with three other trusts in the West Midlands on a project to share patient data across hospitals.
Birmingham and Solihull, together with Black Country Partnership NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust and Coventry and Warwickshire Partnership NHS Trust form one of NHS England’s Vanguard programmes. Their project is called Merit – short for the Mental Health Alliance for Excellence, Resilience, Innovation and Training – and it aims to do a lot more than just share data.
Reed said the main areas of work include culture, with the aim of reducing readmissions and focusing on crisis care and bed management.
All mental health providers are struggling for beds, said Reed. The hospitals may have available beds, but there is no visibility of this at the moment, he said. “We are not managing them as a unit, and the idea is that we should.”
The project also includes developing a consistent approach to working, so that a mental health professional could go to work in any of the trusts and the essence of the job will be the same, governed by the same set of principles. Of course, part of this involves data sharing, he said.
“The first thing is understanding the benefits of seeing data and managing beds across the region,” said Reed. “Secondly, it’s beginning to bring clinical data together.”
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The trusts have signed a contract with Intersystems for its HealthShare platform, which enables trusts to share data across systems in an integrated way.
“The vision is that all the mental health trusts contribute data and all are able to view it,” said Reed. “So at the point of contact with the patient, if they appear in any of the trusts, we will have access to the system and be able to see the patient information.”
In the first instance, this may simply be information telling the trust that the patient is already known to mental health services, demographics and whether there is a crisis plan in place, but eventually, Reed hopes the records will become richer and include the wider health economy.
“We are in the early stages of implementation, so we are really very much at the point of it being about vision rather than about something we have already done, but nonetheless we are getting the infrastructure together,” he said. “We have done a lot of the background work around data and are optimistic about delivering something very soon.”
But it has not been straightforward, and the experiences of all the trusts involved will vary, particularly as they are all at different stages of digital maturity and all use slightly different electronic patient record systems.
“The other big challenge from a user’s point of view is integration,” said Reed. “The harder it is for users to use it, the less likely they are to do it. Even having to log out of one system to log into another is enough to put people off, despite it having proven clinical benefits. Unless it’s easy, it’s very hard to get staff to do it.”
That particular point has already been proved by the trust’s use of the Summary Care Record, which has experienced low uptake among clinicians.
With HealthShare, the plan is for Birmingham and Solihull’s RiO EPR to have a link to click, which will take users directly to the patient data they need. There are also legal challenges, such as the upcoming EU General Data Protection Regulation (GDPR), which comes into force next May.
“We are still getting to grips with what GDPR is going to mean and still thinking about the consent model. It’s not straightforward,” said Reed, adding that generally, patients see the benefits of having their data shared, and many believe it is already being done.
For now, the data sharing programme involves only mental health trusts, but Reed hopes that, in the future, “we could go wider”.
“I don’t think it’s out of the way to consider it could become the single platform for sharing data across the region,” he said.
Reed said he is also keen to see a common standard for mental health records in the NHS. “That would make the exchange of information an awful lot easier than what it is at the moment.”