Joined-up working can be notoriously difficult to achieve when it relates to data connectivity. Great leaps have been made for health services to share patient data with other health services, but what about health sharing with social care providers when a person’s needs commonly bridge both care settings?

In this edition of the blog, Treesa Carter and James Hitter share their experiences of working on the transformation of health and social care integration at Suffolk County Council. They tell us about the power of a joined-up data set, spanning traditional boundaries.

The shared care records service for our local geography – Health Information Exchange (HIE) – started with a pilot project to share acute hospital and GP records back in 2018 and was run by West Suffolk NHS Foundation Trust. This was a successful project in its own right and when more central funding became available in 2019/20, we were able to realise our ambitions of increasing the number of partners involved in the programme, as well as expanding the geographical reach across the Suffolk and North East Essex Integrated Care System (ICS).

Background to the project

The connectivity levels have since expanded to include multiple acute hospitals and community settings – with mental health provision planned. This collaborative work effort influences the roadmap of connections across the ICS and wider eastern region, with a view towards a future connection to the One London programme. Adoption and usage across the geography has gone from strength to strength as new connections come online and the value of the data becomes evident to those providing care and services to local residents.

At the end of 2020, Suffolk County Council Adult Social Care joined the HIE shared care record that covers the Suffolk and North East Essex ICS and beyond. This means that practitioners identified as having a direct care role within the service can now access an array of GP, hospital and community data available for a person, which will soon expand to include mental health data too.

Patient, customer or client?

Georgia Horobin, HIE project manager, West Suffolk NHS Foundation Trust

As the teams from West Suffolk and Suffolk County Council began to work together on the HIE project, it became clear that the language used in social care differed considerably to that used in the acute healthcare setting.

This prompted discussion and review, both within the Council and between the project teams. As a result, the terminology in the clinical safety case was agreed and modified, with healthcare organisation becoming health and social care organisation, and clinician becoming HIE user.

As our regional HIE begins to include a wider scope of health data, it is important that the language is inclusive and informed, allowing the HIE platform to be equally useful to all of our partners.

Key takeaway: There are differences in language and terminology between the health and care sectors. This has been a real point of learning and cross-team collaboration to ensure mutual understanding.

This programme of work was not without its challenges, but at the heart of making this a success was the collaboration of teams from acute, community, GP federations, social care, mental health and a range of other local providers. This has been about more than just ensuring the technology worked and getting the necessary approvals for the data to be shared – it was (and still is) a project about understanding how care delivery teams work and what information they need to know when interacting with system users.

Working as effective partners

Thinking about what we needed to have in place for this to work, the emphasis would be on the importance of having a strong social care voice within the ICS digital governance to influence and remind the group that this is a joint health and care programme. Particularly due to the timing – launching during a global pandemic – it was critical to remind people of the bigger picture and what we were trying to achieve.

We were fortunate to have West Suffolk NHS Foundation Trust, who hosted HIE and also managed supplier relationships. Without this partnership and communication transparency, we would have really struggled to get the digital technology off the ground.

From the outset, we were very clear over what we wanted to achieve from the project, so we set ourselves up to be able to measure our success rapidly and be in a position to share our stories and celebrate the great work the team has done – in continuing to serve our communities, but also deliver fantastic, informed care, which can only ever be a positive experience for the system user!

“I have found access to HIE invaluable. I can honestly say it really does support my practice and provides up-to-date and accurate information to bring to the multidisciplinary team meetings. My nursing colleagues in health request GP records prior to our meeting and they are often a week or two out of date by the time we get them, so to have real-time access – including hospital discharge summaries – really supports our analysis and reasoning when making recommendations as we have accurate clinical records.”

Caroline Saxby
Independence and wellbeing practitioner, flexible care and support team
Suffolk County Council

People and places

In terms of the challenges we faced, there wasn’t really anything unexpected, but it’s worth highlighting the complexity of geographical boundaries as being one challenge to consider when embarking on a records sharing project at ICS level. The geographical boundary of Suffolk County Council does not match up neatly with one single ICS, so we focused the first stage of the project on Suffolk and North East Essex ICS, which covers the majority of the area – we needed to be able to define the scope. Unsurprisingly, adequate resourcing and sufficient investment in dedicated project resource is another area that shouldn’t be overlooked – particularly to support organisation and cultural change on the frontline.

Perhaps the biggest challenge of all was around the workforce development needed to understand the types of clinical information available and the acceptable use of that information. Practitioners and managers were anxious initially, but they needn’t have been – they process sensitive information appropriately every day in their roles and direct access to this using HIE is just an extension of that.

We contacted our most frequent HIE users in March 2021 to find out – from a qualitative perspective – the impact using HIE has made in their day-to-day work. It was clear that HIE is creating multiple benefits in terms of time saving but also accuracy of information and improved outcomes for customers.

As part of our work to demonstrate the value of having access to this new information source, we focused on three particular workflow areas to measure the impact of HIE:

• Checking progress on a patient prior to discharge: We found that the new process with access to HIE took between 5-15 minutes whereas before, this would have taken anywhere from 20 to 45 minutes. Overall, this equates to 1.5 hours of time saved per home first team leader per week – scaled across our whole service, this could equate to 1.4 FTE.

• Checking medication in the community: This saved a team leader up to one hour per week, which is 35 hours per week across our service or the equivalent of one FTE.

• Finding swab results and vaccine records: Particularly relevant during the pandemic, the immediate access to information through the HIE has been estimated to save a team leader up to three hours per week and across our whole service; the equivalent to three FTEs.

That study alone demonstrates that the wealth of information at our practitioners’ fingertips has been shown to save a single team leader 5.5 hours per week – a significant amount. Across our whole service, the impact across the space of a year could equate to 5.4 FTE.

The next chapter

The next important milestone for us in this work will be ensuring that social care information can be shared back with health partners, rather than just in one direction. For us, this will be a real gamechanger for the health and care system. We are also working on integrating children’s social care data – and we are working through data sharing and data protection principles with professionals in children’s services.

This will build on the careful work conducted as part of the My Care Record approach to ensure people's data is handled sensitively and safely. We work closely with the data protection teams across the integrated care system to ensure that as we share data across organisations, we ensure we have the right checks and balances in place to be confident it is only accessed by those providing direct care.

The future potential for this work is fantastic and we’re so excited to see what we can deliver and how we can really continue making a difference in Suffolk, Essex and beyond.

To learn more about My Care Record, please visit here.

^{Suffolk County Council calculated their own findings.
Cerner has not validated the accuracy of these claims.
Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.}