Every integrated care system in England has a shared care record in place, but there is a lot of work to be done to make sure they deliver on their potential, Orion Health’s UK and Ireland Customer Conference 2023 agreed.

A lot has happened in the shared care records space over the past couple of years. NHS England made the deployment of SCRs a focus of its plans to recover health services after the COVID-19 pandemic, building on the success of the local health and care record exemplar programme.

It set, and met, a target for every integrated care system to have an SCR by September 2021, and then drew up a roadmap for their development. So, as Mark Hindle, vice president, UK and Ireland, told the Orion Health UK and Ireland Customer Conference 2023, if you just went by coverage on health tech websites, you could think it was job done: “The SCR is live, and people are building services around it.”

On the ground, though, things feel a little different. “I have been struck by the disparity in usage,” he told the event in London, noting that while one of Orion Health’s SCR customers has almost a quarter of a million views a month, another has just a couple of hundred.

At the same time, the SCRs out there are still “using different data models” despite efforts to encourage them to use the Professional Record Standards Body’s core information standard. Care plans – a priority for NHS England – “are also being shared in different ways.” And “patients can access their records in some parts of the country, but not in others.” It’s not, Hindle argued, that “we haven’t made progress” – but there’s a lot more to do.

ConCRs and national plans

Sarah Pearl, NHS England supplier relationship lead, said one thing will be to adjust to a new name for shared care records – which NHS England is now calling connecting care records – or ConCRs. That done, her colleague Vikash Tailor, ran through some of the key programmes that NHS England is looking to progress.

The first is “how shared care records can join up and share information across the country” – which Tailor argued is important for ambulance services, which are often called to patients who live outside their area.

NHS England wants to use the National Record Locator Service to achieve this, by building an IHE adaptor that will enable one SCR to send information to the NRL and the NRL to send it on to a second SCR. “The first goal is that within 12-18 months, every clinician should be able to see the patient record,” Tailor said.

“That can be a passive view of non-structured data, so we are accepting that full interoperability won’t happen in the timeframe. However, going back to my ambulance point, some data is going to be better than none.”

In the longer term, though, there will need to be a renewed focus on interoperability, and making sure that SCRs are using standardised data models. So that’s a second focus for NHS England, alongside work to “level up” SCRs, to help them work more collaboratively, and to make sure they can be financially sustainable when the current comprehensive spending review period ends in 2025.

Moving from MVS1 to MVS2

When it set its September 2021 target, NHS England outlined a minimum viable solution, or MVS1, to aim at. In a national maturity assessment that asked SCRs to rate themselves from 5 (high maturity) to 1 (low maturity), none put themselves at 5, but 20% put themselves at 4, and only 2% put themselves at 1.

NHS England is now developing a new baseline, MVS2, that will start at level 4, and the conference heard that it will issue guidance and make funding available to help SCRs meet it. Pearl said SCRs should expect to expand their user base from “core NHS organisations” to social care, ambulance services, and community pharmacy, to improve usability, and to add care plans and NRL connections.

NHS England is also looking at adopting the International Patient Summary, a standardised set of basic clinical data for use in unscheduled or emergency situations, that would enable a degree of information sharing beyond the UK. Ben Wilson, product solution director, said Orion Health is well-placed to help its customers deliver MVS2: and some are already doing some of it.

In an overview of the 12 months that have passed since the last customer conference in Bristol, he said that the Dorset Care Record has now trained 7,000 users, is recording 100,000 views a month, and has taken an upgrade to permit integration with the Mosaic system used in social care and the Halo system used by drug and alcohol services.

The DCR is also using FHIR standards to exchange documents with the Care and Health Information Exchange in Hampshire. Off to the south and west, a new customer the Devon and Cornwall Care Record is already talking to domiciliary care providers about access.

It is also trialling the national GP Connect interface for medicines and allergies information, digesting “a huge volume” of discharge summaries and other documents from one of its acute providers, and working on a “first of type” upload to the NRL.

A further new customer, Joined Up Care Derbyshire, has helped Orion Health to develop an interface to another social care system, LiquidLogic, and is passionate about adding end-of-life care plans. While long-standing customer Connecting Care has built a solution using Orion Health’s forms and collaborative worklists to help a Community Integrated Care Bureau discharge hospital patients faster.

Coming next from Orion Health – and its partners

In the immediate future, Wilson said Orion Health will be doing more work on standards, including the adoption of the second iteration of the Core Information Standard, more work on interfaces, and more work to develop its “ecosystem” of partners.

The presence of partners was one of the features of the conference, with Black Pear invited to talk about its care plan technology and Synanetics invited to talk about its work on a national booking and referral standard that could be used to open up booking systems to clinicians and patients.

However, Wilson said Orion Health will also be developing its Amadeus Digital Care Record product, which now sits alongside the Orchestral Health Intelligence Platform and Virtuoso Digital Front Door on the Orion Health Unified Health Platform.

“With all this data coming in, we want to make sure that clinicians don’t get data fatigue – or to experience what I’ve heard described as data waterboarding,” he said. To combat this, Orion Health is trying to keep to a standard layout across its products, while enabling “personalisation” that lets clinicians turn off views they don’t want, expand out views they do, and search more intuitively.

Moving forward, together

With so much policy, technical, and product development work going on, a panel discussion on where shared care records are going over the next 12 months argued it will be important to look up occasionally and keep an eye on the big picture.

After all, the reason the NHS has made such a significant investment in SCRs is because of their potential to help them deliver on their remit of joining up health and care services and using data to create more predictive, preventative, and personalised care for populations and patients.

Yet the conference heard that at a national and a local level, different teams can be working on SCRs, the development of data platforms and analytics, and the roll-out of one-off digital patient solutions, such as portals. Ian Binks, Orion Health’s business development director for digital care records, argued there needs to be more cohesion and more focus on the potential of the SCR.

“I think that if we are going to make meaningful progress on keeping people well and treating sick people better, we need to stop seeing the shared care record as a shared care record and start seeing it as a unified health platform,” he said. “We would be mad not to use the data made available by SCR integrations to identify individuals at risk of moving from left to right [ie: into ill health, or from community to hospital treatment] and to act on that.”

To do this, Rob Nimmo, head of digital transformation at Cambridgeshire and Peterborough NHS Foundation Trust, argued there will need to be more consistent investment over the next three to five years. While panellists backed the more collegiate approach.

Jane Owens from Joined Up Care Derbyshire said: “We need everybody to come together: managers, clinicians, suppliers, everybody.” Phil Koczan, a GP, national and London SCR leader, said: “We need true partnership.” And Nimmo concluded: “There is no way anybody on their own can solve this: which is why it is pleasing that there are so many people in the room – and we are looking forward to working on this together.”