1. Get Involved Group Records Sharing to Support High Quality Care Becky Gayler Clinical Informatics Project Manager 17 th September 2014

2. The CCG is working to Ensure that high quality information is available where and when needed to support you, and the health professionals treating you, to make good decisions about your health and care, to…. improve patient safety, health and experience reduce inequalities improve efficiency

3. Where are we now? “Patients, carers and the information to support them are the most under-utilised resources the NHS has available.” NHS needs to make better use of information: to provide high quality care when increasing pressure on resources to avoid fragmentation, to integrate care and make it personalised

4. Where do we want to be? “The Power of Information ” 2012 ambitions: Information used to drive integrated care within and between organisations; Information recorded once on computer, and shared securely to support care; A culture of transparency: access to high-quality, evidence-based information about services Innovative and integrated solutions, Using national standards which allow information to move freely, safely, and securely.

5. Our Vision has the Patient at the Centre

6. Types of Records Sharing 1.Sharing for planning and research 2.Sharing to support your urgent and emergency care 3.Sharing to support your local planned care 4.Having access to your own medical (GP) record

7. Benefits of Sharing Better decisions about your care –Improved safety –More appropriate care –Continuity of care maintained Better patient experience –Appropriate care delivered quicker –Better patient experience – wishes respected –Less need to repeat procedures e.g. tests –Care delivered closer to home

8. What’s happening locally?

9. 1. Providing you with online access to : a. see information in your GP record b. order repeat medications and book appointments c. contact health professionals d. obtain information about lifestyle and treatment choices. 2. Sharing relevant information (including GP records) with health professionals treating you. This will include care plans agreed with your health professional, to help you and those supporting you, manage your day-to- day health and setting out what should happen if you do become more unwell or need urgent care. Key Areas of Work

10. Right Information, Right Place, Right Time Already happening….. Summary Care Records: summary of medications and allergies available to clinicians treating you in Urgent Care, additional information (e.g. significant history is coming soon) GP2GP: ensures the patient detailed record moves with the patient and is immediately available to a patient’s new GP Electronic Clinical Correspondence: Letters sent directly to GP information system: more secure, quicker, less paper. Electronic Prescription Service: Prescriptions sent electronically to patient nominated pharmacy. Prescriptions can be cancelled electronically.

11. Right Information, Right Place, Right Time Its early days…. Shared detailed records: with patients consent, the GP record, or part of, can be made available to professionals treating the patient elsewhere to support integrated care. Electronic care plans: available to support continuity of care in line with patient wishes. Patient access: already using booking and medications ordering. From April 2015 GP Practices must offer the facility for patients to view summary information online. Patient Held Records and Self Management Tools: pilots being considered as part of Better Care programme…….

13. What's my role in sharing information?

14. Sharing requires consent Consent can be Implied (opt-out) or Express (opt-in) Consent must be informed: “Do you know how your information is shared and with whom?” Patients should decide what to share and what not to share, and when to share, with whom. Access to records for you, and your carer so you can see what’s recorded. Its your CHOICE

15. Your Choice Currently… Consent for sharing Detailed Records is different to Summary Care Record and Care.Data. Opt-out to stop sharing your Summary Care Record Opt-out to stop information going to Care.Data Opt-in to share detailed information from your GP Record If a health care professional needs to view your GP Record, you will be asked for permission to view. You can change your mind at any time by talking to your GP surgery. You can restrict access to sensitive parts of your record.

16. Your Choice You also have choices about: Using the Electronic Prescription Service. Paper prescriptions will continue to be available for patients who don’t nominate a pharmacy. Using Online Services. These are an option and not a replacement for face to face services.

17. Sharing must be secure NHS Care Records Guarantee imposes a duty to: –Maintain accurate records –Keep records secure and confidential –Provide information in an accessible format Caldicott Guardians ensure patient information is protected and is only shared on a need to know basis Only staff treating you can view your information You can find out who has viewed your information Encryption and technical safeguards such as smartcards Mandatory training for all staff Professional ethics

18. Our Commitment

19. We need to ensure…  Patients understand and choose how their information is shared  Information is secure and shared with those who need it  Information is high quality  Information is available to professionals who need it  Information will be developed around the patient, enabling more personalised care  Patients will be empowered and supported to use information and tools.  Information will be recorded once and shared

20. Records Sharing: how can it support High Quality Care?

21. Records Sharing How can it support High Quality Care? Scenario 1 Urgent / Unplanned Care Summary Care Record used by Out of Hours GP “An elderly man who had repeatedly denied any drug allergies was found, using the SCR, to have had such a severe anaphylactic reaction to penicillin previously, that he had been prescribed an Epipen – our healthcare staff were about to give him amoxicillin (a penicillin-based antibiotic).” Dr Simon Collins, Clinical Lead, Medway On Call Care

22. Records Sharing how can it support High Quality Care? Scenario 2 Shared Care Shared record Patient with rheumatoid arthritis taking methotrexate, prescribed by the consultant. The following week the patient attends their GP surgery, diagnosed with urinary tract infection. Using the shared records helped the GP choose which antibiotics to use avoiding a potentially dangerous interaction. The GP went on to take over shared care prescribing and monitoring of the methotrexate. Consultant Rheumatology Nurse Clinical Lead

23. Records Sharing How does it support High Quality Care? Scenario 3 Shared Care Plans Co-ordinating Palliative Care An elderly gentleman with lung cancer was admitted to hospital when he developed a chest infection. When he was discharged home, he decided he didn’t want to go into hospital again and wanted to die at home. His preferences were added to a shared care plan by his GP and a “Just in Case box” organised. During a crisis at the end, Out of Hours services were contacted. All the services involved were able to see his preferences, and contact his District Nursing team who enabled him to die peacefully at home.

24. Records Sharing How does it support High Quality Care? Scenario 4 Shared Care Plans Preventing avoidable admissions South East Coast Ambulance use a system to enable their crews to have up to date information about a patient's health, their care plans and needs. This supports crews to make the best clinical decisions when they are with a patient because they know what's normal for the patient, who to contact and what the patient’s preferences usually are. Your district nurse can share information about your care with the ambulance service to help in an emergency. You will be asked for your consent and be aware of the information shared.

25. Records Sharing How does it support High Quality Care ? Scenario 5 Patient / Carer as Care Partners Patient Online Access to GP Records Patients / Carers with online access say that it: reduces trips to the practice, allows them to view tests results and other important information when needed e.g. travelling, when consulting other professionals supports shared decisions “I have a chronic disease and feel a real partner in the management of my health. Whether I am at home or abroad, I can monitor information and share it with any other health professional involved in my care. I would be lost without it now !”

26. What do you think….. What do you think are the benefits of sharing information about your health? What do you want to know about how your information is used? How can we ensure people in your community know about the choices they have to control the way their information is used? What are the implications and considerations for your community of more information and health services going online? What support will people from your community need to make good use of online technology and information about their health? What concerns do people have about their health information being shared?