{"id":7282,"date":"2022-10-06T14:26:12","date_gmt":"2022-10-06T14:26:12","guid":{"rendered":"http:\/\/orionhealth-blog.local\/?p=7282"},"modified":"2022-10-06T14:26:12","modified_gmt":"2022-10-06T14:26:12","slug":"growing-and-evolving-the-shared-care-record","status":"publish","type":"post","link":"https:\/\/orionhealth.com\/uk\/blog\/growing-and-evolving-the-shared-care-record\/","title":{"rendered":"OrionCC22: Growing and evolving the shared care record"},"content":{"rendered":"

The UK has made a significant investment in shared care records. In England, local health and care record exemplar projects were established in 2018, to build on the success of early movers like Connecting Care in Bristol.<\/p>\n\n\n\n

Two years later, integrated care systems were given a target to have a \u2018basic\u2019 shared care record in place by September last year. In Scotland, a digital health and social care strategy that also came out in 2018, prompted health boards to roll-out portals and integrated digital care records.<\/p>\n\n\n\n

While Northern Ireland developed the Northern Ireland Electronic Care Record to underpin information sharing across the country. However, most of these projects now face a challenge. How do you grow a shared care record while also maturing it to support the new world of population health management?<\/p>\n\n\n\n

The global shift to population health management<\/strong><\/p>\n\n\n\n

That was the challenge addressed by Orion Health\u2019s UK and Ireland Customer Conference 2022, which was held in Bristol in September after a three-year hiatus due to the Covid-19 pandemic. Brad Porter, who took over as chief executive from founder Ian McCrae this summer, told the event it is not a challenge that the UK is facing alone.<\/p>\n\n\n\n

\u201cAround the world, countries are releasing data strategies that focus on the need to make healthcare more integrated and more accessible to those who need it most,\u201d he said. \u201cThese strategies also recognise the need for digital to address the waiting lists caused by Covid, and to meet the demands of Gen Y and Gen Z, who have grown up with digital.\u201d<\/p>\n\n\n\n

In these strategies, he said, population health means: putting the patient at the centre of their care, empowering clinicians by streamlining pathways, and \u201ccapturing and analysing data for the entire population, so we can identify the care needed by the individual, before they need it.\u201d<\/p>\n\n\n\n

Three pillars to build on<\/strong><\/p>\n\n\n\n

While this sounds \u2013 and is – complex, OrionCC22 heard that NHS England has set down three, basic pillars for population health management: infrastructure, intelligence and intervention; and that Orion Health has mapped its products to them.<\/p>\n\n\n\n

On the infrastructure point, the company\u2019s approach is underpinned by the Amadeus platform, which integrates data from multiple IT systems, and makes it available to products that include the shared care record, the Coordinate suite of collaboration tools and care pathways, and the Engage patient portal.<\/p>\n\n\n\n

From the outset, the company has been committed to using open standards like HL7 FHIR to support that initial integration into Amadeus. And Nicole Allan, global solutions director, told the conference that it has extended this approach to make it easier for customers to \u201cplug and play\u201d their own integrations.<\/p>\n\n\n\n

Orion Health has created a suite of APIs, an API framework, and a list of \u2018adaptors\u2019 or data providers to make this possible. So, Allan explained, while early movers like Connecting Care spent a lot of time building point to point integrations, \u201cnewer shared care records will have much more of what they need out of the box.\u201d<\/p>\n\n\n\n

Pillar one: infrastructure<\/strong><\/p>\n\n\n\n

At the same time, a lot of work has been done to define the content of a shared care record. Oliver Lake, deputy chief executive of the Professional Records Standards Body, explained it has been working on a Core Information Standard to define the information that could potentially be shared between sites, systems and professionals.<\/p>\n\n\n\n

In a significant piece of news, he announced that Orion Health has just become the first supplier to achieve conformance with the CIS. \u201cThis is a landmark for us,\u201d Lake told OrionCC22. \u201cThere are more than 1,600 items in the standard and it has taken more than a year of meetings between Orion Health and ourselves to achieve this.<\/p>\n\n\n\n

\u201cNow, we want it to be the start of a movement that gets everybody thinking about how to implement standards correctly.\u201d Tracey O\u2019Brien, digital consultant at NHS South, Central and West, said<\/a> the CIS would make a big difference to Connecting Care.<\/p>\n\n\n\n

It has started to receive information from social care and to extend access to care homes, and to do this she said: \u201cWe had to map our terminology to social care and agree a local information standard.\u201d Now the CIS is in place: \u201cIt will make that process a lot easier.\u201d<\/p>\n\n\n\n

Pillar two: intelligence<\/strong><\/p>\n\n\n\n

On the intelligence piece, Orion Health has an analytics solution, Discover, that sits alongside the shared care record and holds data that can be used to crunch administrative and clinical data.<\/p>\n\n\n\n

Katharine Guthrie, stakeholder engagement and benefits manager at the Care and Health Information Exchange, told the conference that it has been using Discover to explore who is using the shared care record and why so its BAU team can better support users and work out how to get more people on board.<\/p>\n\n\n\n

However, to support population health management, customers will need to use Discover to segment their populations into cohorts and design effective interventions for them.<\/p>\n\n\n\n

Kevin Ross, research director, said it has been Orion Health\u2019s mission from the outset to \u201ccapture data and to make sure it can be put to the right use at the right time.\u201d The company has 250 data scientists working with customers to \u201cunderstand their data and how it can be used to improve health and care.\u201d<\/p>\n\n\n\n

But, again, it has also been developing tools that customers can use themselves. These include a de-identification product and an algorithm hub that can be used to develop, store, and manage the algorithms that underpin segmentation and decision support tools.<\/p>\n\n\n\n

Pillar three: intervention<\/strong><\/p>\n\n\n\n

Kira Levy, UK public sector head of healthcare at Amazon Web Services, said integrated care systems, like other accountable care systems around the world, needed to develop a solid data architecture to do this. One that is secure, scalable, and \u201cisn\u2019t limited to particular use cases.\u201d<\/p>\n\n\n\n

But, she stressed, the best data architecture, analysis and research is no use unless there is an intervention for clinicians to refer patients into. Levy also stressed that population health management interventions will only work if clinicians find the tools that support them easy to use.<\/p>\n\n\n\n

Ben Wilson, product solution director, told the conference<\/a> that Orion Health has been doing a lot of work in this area. For example, he said, the adoption of progressive web app technology means the shared care record can be scaled for use on a laptop, mobile or even smaller devices.<\/p>\n\n\n\n

A standard framework design has been developed to bring a consistent look and feel to different use cases and to align with PRSB standards. While a lot of work has gone into helping clinicians to understand the data they are using, and to personalise their data choices.<\/p>\n\n\n\n

Continuing the support for intervention theme, product solution director Bruce Horne showed delegates<\/a> a new version of Orion Health\u2019s Forms product. This makes it much easier to construct forms and to attach them to Collaborative Worklists, so they can drive new interventions and workflows.<\/p>\n\n\n\n

Horne explained how this approach had enabled Orion Health to work with Connecting Care to support a Community Integrated Care Bureau in the third wave of the Covid-19 pandemic. In \u201cjust seven weeks\u201d, a team was able to create a form for patients ready for discharge that could be shared into collaborative worklists used by three hubs organising onward care and by overall co-ordinator Sirona Care.<\/p>\n\n\n\n

Tips for the journey<\/strong><\/p>\n\n\n\n

More developments are on the way. Chris Lucas, vice president clinical portals, said he was \u201creally excited\u201d about Smart Search, which uses natural language processing to help clinicians find information in the document tree, without having to \u201copen and skim, open and skim.\u201d<\/p>\n\n\n\n

A pilot of Smart Search is underway at Southern Cross Healthcare in New Zealand. Southern Cross is the country\u2019s largest, private provider of healthcare, and nursing director Carey Campbell came to Bristol to tell the conference about its ten-year journey<\/a> to implement Clinical Workstation.<\/p>\n\n\n\n

While this acute product is not used in the UK, her account of the challenges of running a successful implementation and go-live, and then expanding and evolving the use of an electronic patient record, struck a chord.<\/p>\n\n\n\n

Campbell also had some great advice for ICSs that are still at the start of their shared care record journeys: embrace disruption, be bold and brave, \u201cpick a good team\u2026 and then get out of its way\u201d; remember \u201che tangata, he tangata, he tangata \u2013 or, the people the people the people\u201d; become fluent in clinical and tech and act as an interpreter; and then \u201chave fun\u2026 and more fun\u2026\u201d<\/p>\n\n\n\n

The irony of population health management<\/strong><\/p>\n\n\n\n

At the end of the day, Anne O\u2019Hanlon, product director, reminded the event that population health management is about more than products, or their implementation, or their use by clinicians. Critically, it has to be about patients and citizens.<\/p>\n\n\n\n

Yet, she told OrionCC22, the evolution of accountable care and integrated care systems, the development of digital strategies and digital first approaches, and the introduction of new, patient facing technologies has led to a paradox. Across the world, there is \u201cmore fragmentation than ever.\u201d<\/p>\n\n\n\n

Indeed, O\u2019Hanlon argued that healthcare and health tech globally needs to confront the \u201cirony\u201d that \u201cjust as systems are trying to put the patient at the centre, and using technology to do it, none of that joins up.\u201d<\/p>\n\n\n\n

To do that, she said, systems need to \u201crethink the process from end to end, from the patient perspective\u201d \u2013 while recognising that patients will want different ways to interact with them, so their processes must work from those different starting points.<\/p>\n\n\n\n

O\u2019Hanlon also updated the conference on two products that Orion Health has developed to help. One is the Engage patient portal and the other is the Digital Front Door, which has been developed with a Canadian province\u2019s healthcare system to give citizens access to news, advice, symptom checkers, and other consumer-facing health tools.<\/p>\n\n\n\n

Seeing the way, delivering the vision<\/strong><\/p>\n\n\n\n

Expanding a shared care record while evolving it for population health management is challenging. One speaker described the road facing UK shared care records as \u201cfull of mud and potholes\u201d while O\u2019Hanlon\u2019s presentation reminded everyone that if things get out of step the result is \u201cone hot mess\u201d for patients.<\/p>\n\n\n\n

But Gary Birks, executive vice-president Europe, closed out the conference by stressing that Orion Health has the tools to smooth the road; and journeys are invigorating. \u201cI think we are fortunate to be working in two of the most exciting industries on the planet: technology and healthcare,\u201d he said. \u201cBecause we are making progress, and we do have an end point \u2013 which is a better system for clinicians, patients and citizens.\u201d<\/p>","protected":false},"excerpt":{"rendered":"

The UK has made a significant investment in shared care records. In England, local health and care record exemplar projects were established in 2018, to build on the success of early movers like Connecting Care in Bristol. 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