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National ambitions to achieve integration across health and care are stronger than ever. New models of care are being trialled and tested at pace as vanguard sites and devolved health economies strive to find innovative ways to connect services together across primary, secondary and social care, mental health, community settings and beyond.
Put simply, integration has been spoken about for decades. Now it has a chance in reality, which is good news, as achieving this is not just nice to have – it is absolutely essential for the sustainability and even the very survival of the NHS.
NHS number mandate is not a complete answer
A legal requirement that came into force in November 2015 should be greeted as a welcome development in this journey. Accurately identifying patients across all health and care organisations is critical to making integration a reality, so that clinicians can make decisions based on a complete picture of an individual patient.
From October 1st, NHS and adult social care organisations across the country have an obligation to use the NHS number. Under recent additional rules, health and adult social care bodies are expected to share information with each other when they are working together to provide direct care and treatment to a patient.
Laudable as this is, simply mandating the use of the NHS number may not be enough to quickly achieve an immediate and pressing need to link episodes of care. Yet integration must happen with speed if health and care services are to cope with growing pressures. We cannot afford to wait years for this to happen, it must happen now.
The need to go further to connect different care settings
The NHS and other organisations have, of course, been working together in attempts to draw on technology to link together information for some time. Clinical portals, for example, have been an effective way of collating NHS records and medical histories into a single view for the clinician. We now need to go much further than that.
True realisation of an integrated digital care record, an underpinning element of making integrated care a reality, means the ability to draw together and accurately identify care episodes that are recorded by social workers, local government, mental health organisations, community providers and many others – for all patients, whatever their age or location and whatever services they receive. We need to be able to match records, however they have been recorded.
While the new mandate from the centre is a positive move towards this, we still need to account for areas where the NHS number may not yet cover. National identifiers, such as the NHS number or Scotland’s community health index (CHI) system, are certainly helpful in the mission to accurately match records across different organisations, but they don’t offer a complete solution.
It is true that more organisations have been gradually progressing towards universal adoption of the NHS number as part of the vision set out in the National Information Board’s Personalised Health and Care 2020 framework. However, we need a more comprehensive and immediate answer to connecting data and we must be able to do it across every care setting.
We need to account for issues and anomalies associated with the use of national identifiers, such as duplicate records, or potential instances where a number is being used by more than one patient. We must be able to cope with errors that can occur in assigning an incorrect NHS number due to false assumptions over similarity in names, addresses and other demographic data.
We also need to bridge the gap where current technologies, such as patient administration systems, might not be presently able to communicate using the NHS number.
Patient identification in practice
The Connecting Care programme in Bristol, which was selected as an integrated digital care record exemplar by NHS England, has found an answer, having been working since 2011 to address integration. In its early days it connected 13 organisations, including GPs, community providers, local authorities and three acute trusts – and this has been growing.
It has not relied on waiting for universal use of the NHS number across the different care settings to achieve this. Rather, the partnership of organisations has used an innovative piece of technology, the NextGate Enterprise Master Patient Index (EMPI) system, to confidently identify and match records on patients across the different organisations.
Use of national identifiers is an important part of this, but through the EMPI tool, Connecting Care has been able to positively match individuals regardless of the number identifier used in partner organisations.
This has allowed systems across our different health and care partners to interoperate without any modifications, by automatically comparing a wide range of common identifiers such as names, phone numbers, dates of birth and other data. We can then determine if records held in different organisations refer to the same patient, even if the NHS number is missing or inaccurate.
The result is that partners across health and social care are now working with accurate, up-to-date information so care can be better co-ordinated.
Effective and comprehensive records on individuals are being built with secure user-based access, which allows hundreds of care professionals to make and execute more informed care decisions.
Wider adoption throughout the country of such an approach could have a significant impact on the ability to create accurate integrated care records – an important development both for clinicians and for empowering patients.
If integration is to be accelerated now, clinical facing technologies must be able to recognise a patient by using different pieces of information to ensure all episodes of care are captured. Unnecessary delay on this important step to integration must be avoided.
Andy Kinnear is the programme director of Connecting Care, Bristol’s shared record scheme which shares real-time patient data between GPs, community providers, local authorities and acute trusts.