The Northern\nIreland Electronic Care Record has really proved its worth during the\ncoronavirus outbreak. Almost every aspect of the clinical response, from\ncreating \u2018hot\u2019 and \u2018cold\u2019 treatment centres, to enabling remote and paperless\nworking, to sharing information with families, has been supported by\nfunctionality in the record, which uses Orion Health technology. <\/p>\n\n\n\n
\u201cWhat struck me\nduring the outbreak was how adaptable this system was and how quickly our teams\nwere able to scale-up and reconfigure for different activities,\u201d says Stephen\nBeattie, ITS eHealth programme manager at the Northern Ireland Business\nServices Organisation. <\/p>\n\n\n\n
\u201cOur clinical community was coming to us with ideas and we were working with Orion Health to implement them. It was almost like the early days, when we were setting up and working in an agile, innovative way to implement the vision of our users. As we prepared to deal with the outbreak everybody re-engaged and re-committed to doing what needed to be done.\u201d <\/p>\n\n\n\n
The Northern\nIreland Electronic Care Record is one of the most extensive shared care records\nin the UK. It launched seven-years ago as a clinical portal, bringing together\ninformation from Northern Ireland\u2019s five health and social care trusts and its\nambulance service to create a single patient record. <\/p>\n\n\n\n
Since then,\nadditional features have been added. Two important elements are the Emergency\nCare Summary Record, or ECS, which holds demographic and basic medical\ninformation about a patient, and the Key Information Summary Record, or KIS,\nwhich includes additional details to support end-of-life care. <\/p>\n\n\n\n
More recently, the\nNIECR team has been using Orion Health Coordinate to build a patient pathway\nthat is being used for diabetes patients, but which will be used with other\npatient groups, and Orion Health Engage to create a patient or citizen portal\nthat is being trialled with people living with dementia. <\/p>\n\n\n\n
As planning to\ndeal with the coronavirus got underway, the record had around 25,000 users; but\nthis soon increased significantly, as access was extended to new groups of\nfrontline workers and the independent sector. \u201cOne of the main hospitals in\nBelfast was repurposed as a Nightingale hospital, and that meant the urgent\nsurgery that could no longer be done there had to move into the independent\nsector,\u201d Stephen Beattie explains. <\/p>\n\n\n\n
\u201cSo, there was\nan urgent need for the independent sector to get access to the NIECR, so\nclinicians working there had information about the patients coming in. There\nwas a question about whether we could really countenance sending patients into\nthe independent sector without access to the NIECR, which shows just how\ncentral it has become to patient care.\u201d <\/p>\n\n\n\n
At the same\ntime, changes were made in the record to support the care of Covid-19 patients.\nEnabling paperless working was a priority, because porters couldn\u2019t enter\nCovid-19 wards and, even if they could, hospitals wanted to reduce the risk of\ntransmitting the disease on physical records. <\/p>\n\n\n\n
So, new forms\nwere created in the portal for Covid-19 admissions and ward rounds. Meanwhile,\nSouthern Health and Social Care Trust undertook another practical piece of work\nthat was subsequently shared with the other four health and social care trusts\nin the country. <\/p>\n\n\n\n
Because\nfamilies cannot visit Covid-19 patients, the trust set up a Covid-19 communications\nteam, consisting of two senior medical staff, to call their next of kin and let\nthem know how they are doing. The \u2018next of kin\u2019 details are recorded in the\nshared care summary that is part of Coordinate, and Orion Health created a new\n\u2018progress note\u2019 in pathway software to capture information from ward rounds. <\/p>\n\n\n\n
This means the\nteam always has the most up to date information to pass on. Project manager\nMary McCluskey says this is a good example of where functionality that was\nalready available in one part of the record has been put to good use in another\nduring the crisis. <\/p>\n\n\n\n
\u201cInnovation is\nnot always about inventing something new, it is about making better use of what\nyou have got,\u201d she says. What\u2019s nice about this initiative is that it has been\nreally well received by patients and their families.\u201d <\/p>\n\n\n\n
There are\nfurther examples of how functionality that was available in one part of the\nNIECR has been used in another during the outbreak. For instance, GPs were\nalready using e-triage functionality to seek advice about patients and to make\nreferrals to hospital consultants. <\/p>\n\n\n\n
As more and\nmore clinicians started to work from home, e-triage was extended to the acute\nsector, so consultants could continue to assess patients and consult each other\nremotely. When audiology consultants said they needed a particular report to\nsupport their work, it was added to the portal. <\/p>\n\n\n\n
Similarly,\nbecause many patient clinics and consultations are now being conducted over the\ntelephone, a \u2018progress note\u2019 was created to capture key elements of the call\nand to incorporate them into the patient record. And more clinicians are now\nbeing made aware of the KIS and its important end-of-life information. <\/p>\n\n\n\n
As the\ncoronavirus crisis has played out, and the NHS as a whole has moved rapidly to\nadopt digital technology, there has been a growing sense that there is \u201cno\ngoing back\u201d. Stephen Beattie is convinced that many of the changes made to the\nNIECR will be retained and, indeed, that there will be a continued interest in using\nit to drive innovation in areas such as remote patient monitoring. <\/p>\n\n\n\n
Mary McCluskey\nagrees: \u201cI think the biggest changes are remote working and virtual\nconsultation,\u201d she says. \u201cWe need to work on how to capture the information\nfrom a remote consultation and on how we put it into a management plan to\nsupport patient monitoring in the community. <\/p>\n\n\n\n
\u201cHowever, we\ncan progress things like that, and we should be able to do it quickly because\npeople are now thinking \u2018can we make it paperless\u2019 and \u2018can we do it\nremotely\u2019.\u201d Also, within the NIECR, Northern Ireland already has a lot of the\ntools it needs. <\/p>\n\n\n\n
\u201cThe system is\nso mature that being able to continue to innovate sustainably is not that much\nof a challenge,\u201d says Stephen Beattie. \u201cThat is what we have proved during\nCovid-19. Our BSO ITS staff, Trust IT and service staff and Orion Health\u2019s staff\nworked over Easter to get the first changes in place, but the building blocks\nwe needed were already there; and because of that we are also well prepared for\nthe future, whatever that turns out to look like.\u201d <\/p>\n\n\n\n
This case study\nis one of a series of agile changes to existing regional IT systems managed at\nportfolio level by Karen Bailey, director of the BSO ITS service and David\nBryce, head of BSO ITS which has supported the work of the NI CDIO Dan West in\ndelivering digital support to health & social care across NI during this pandemic.<\/p>\n","protected":false},"excerpt":{"rendered":"
The Northern Ireland Electronic Care Record has really proved its worth during the coronavirus outbreak. Almost every aspect of the clinical response, from creating \u2018hot\u2019 and \u2018cold\u2019 treatment centres, to enabling remote and paperless working, to sharing information with families, has been supported by functionality in the record, which uses Orion Health technology. \u201cWhat struck […]<\/p>\n","protected":false},"author":6,"featured_media":3494,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[1],"tags":[44],"region":[23,27],"class_list":["post-3493","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-population-health-management","region-global","region-uk"],"yoast_head":"\n