How the Care and Health Information Exchange is helping health and care professionals
CHIE is one of the longest standing shared care records in the country. As it continues to reach more and more users across Hampshire and the Isle of Wight, it is proving that shared care records really do improve care efficiency and quality. In this blog, professionals tell their own stories.
“A shared care record is about bringing together the different parts of an individual’s health and social care history in a single place, so that when health and care professionals are offering care and support to that individual, they can see who they are and what is going on,” says Astrid Fairclough, programme director, Wessex and Dorset Care Records.
The Care and Health Information Exchange is the shared care record for Hampshire and the Isle of Wight. It has grown over time to include information from GP surgeries, hospitals, community and mental health trusts, social services, and other providers.
It has also extended the range of professionals who can access this data, saving them some of the time they would otherwise spend hunting through paper notes or calling surgeries and clinics for information. Teresa Orme, a podiatrist who works at Fareham Community Hospital, says: “It’s really brilliant.
“I can see medicines information, and x-ray reports, and blood tests, and medical history, all in one place.” As an example of how this is useful, she says: “One of the complications of diabetes is a condition called Charcot, which causes changes to the foot.
“We need regular x-rays to see what is happening, and thanks to CHIE, we can see the x-ray report soon after an x-ray has been carried out. We don’t need to contact the hospital to chase up the result or refer the patient for another test. It’s a lot more streamlined. It also makes us feel we’re really part of the multi-disciplinary team.”
Stefan Stefan, a musculoskeletal physiotherapist working at the same hospital, feels the same way. “I assess patients referred by their GP or a hospital and help them with rehabilitation,” he says. “Usually, those referrals come with very succinct information – they might just be one sentence.
“So, it helps me to open the clinic letter and see more information about an operation or the plan drawn up by the consultant. CHIE saves a lot of time and means I can do my job better, because I can spend more time with the patient, focusing on their rehabilitation.”
That access to a shared care record like CHIE also improves care is a point made strongly by Dr Ian Ward, the lead GP for Southampton and Portsmouth urgent treatment centres. “We see whatever walks through the front door, which might be anything from a minor blister to broken bones or pneumonia – or anything and everything in between,” he says.
“We don’t have access to GP records, so CHIE makes our practice much safer. For example, I recently saw an older gentleman who was on multiple medications, but didn’t know what they were, and if he had a kidney problem. I was able to look up what drugs he was on, and his recent blood tests, to see what it would be appropriate to prescribe.”
James Burbridge, a project support officer for the Hampshire Care Association, which provides advocacy and support for social care providers, says care homes see similar benefits. “What I often see, when I go out on a visit, is a member of staff on the phone, waiting to speak to a GP or a hospital about a blood test or what is happening to a resident,” he says.
“Access to CHIE helps to cut that down. Staff can log-in to the system, find the patient’s record, see more or less real-time data about them, and use it to inform their choices about how to proceed with their care.”
It’s not just frontline care staff who benefit from CHIE, though. Michelle Baker, a senior project manager in NHS Continuing Healthcare, says it helps her colleagues, who draw up packages of social care for people with complex needs.
“CHIE helps the clinicians to get a fuller picture of the clients they are assessing, which means they can make a more informed decision about whether they are suitable for continuing care, or end of life care,” she says. Hannah Little, a fast-track specialist practitioner, says access to CHIE is particularly useful in her job.
The fast-track service is for people at the end of their lives, and aims to get packages of care in place within 48 hours. However, it only operates Monday to Friday. So, Hannah says: “If an application comes in late on Friday afternoon, I can access CHIE on a Monday morning, to see if the client is still with us or they have passed away over the weekend.
“I can also see whether the community nurses have been in, and whether they’ve got a syringe driver up. It gives me access to lots of little details that help me to help the carers as I’m getting a package of care together. It also helps me to fulfil the patient’s wishes. Although I never meet these lovely clients, I am a huge part of their journey.”
Alison Lawrence, a clinical quality manager for the Hampshire and Isle of Wight integrated care board, and a nurse by background, says CHIE also helps her in her role as a local area coordinator for the Learning Disabilities Mortality Review – or LeDeR – programme, which looks into the deaths of people with learning disabilities.
“When I’m doing a review, I look at CHIE to get an oversight of their care, and what happened to the individual towards the end of their life,” she says. “We speak to clinicians and access other records, but recently it has been very difficult to get information about people who have died in hospital, because hospital is such a busy place.
“If I can use CHIE to get some information, like a discharge summary, from that last admission, it might let us close the report down. Or it might tell me something I didn’t know, that takes the investigation in a new direction.”
Developing on the Orion Health platform
CHIE changed supplier two years’ ago, moving to a cloud-based platform provided by Orion Health. Users can now access the system via single sign-on from their electronic patient or client record system or via a web-based portal.
CHIE has been able to introduce multi-factor authentication for portal users, which has made it much easier to extend access to health and care professionals. Orion Health also conforms to the Professional Record Standards Body’s Core Information Standard, which is designed to make sure that the right information flows through the system, in the right way, to benefit patient and client outcomes.
Ynez Symonds, the chief nursing information officer for Solent Mental Health NHS Trust, says this really matters: “As a CNIO, you are very interested in making sure that information is structured well; that it is in the right order, and people can find it quickly.
“At the same time, patient safety is a massive thing. So, we want to make sure the data we have about patients is as accurate as possible, and that we’ve thought through any risks and mitigated against them.”
Emma Davis, a GP at the Living Well Practice and the clinical lead for CHIE and the Wessex Care Record, also feels the move has delivered benefits. “CHIE has been developed over quite a long time,” she points out. “Initially, the data was quite random, but it has become more and more user friendly.
“Moving onto the Orion Health platform was a big change, but I like the new design. It is laid out in a way that clinicians are trained to find information. A shared care record is becoming a standard part of medical practice across the country. We have led the way in Hampshire and Isle of Wight, and now we need to evolve into this new world.”
Making life easier
Astrid Fairclough agrees. “I think we are at a really interesting point in CHIE’s development path,” she says. “It was a shared care record before shared care records were really a thing, so we have this real depth of history of being used by so many partners for so many years.
“We have got fantastic capability in our new technology platform. We just need to make sure we are using that to best effect.” Meanwhile, professionals in Hampshire and the Isle of Wight are in no doubt that their colleagues can benefit from CHIE, today.
“Often, one of my colleagues gets a referral, and they say to me: ‘Look at this referral, there is nothing on it’,” says Stefan Stefan. “And I say: ‘Go and look on CHIE, it will give you the answers. It will make your life so much easier.”