Implementing an interoperable health record with Primary and Secondary Care

Gourav Manipatruni, ICT Head of Applications Development at Central and North West London NHS Foundation Trust (CNWL) and Digital Pioneer Fellow, shares the organisation’s journey to interoperability and explains why it is required.

CNWL provides a diverse range of services in Mental and Community health for an extensive population across wide geographical areas ranging from North Central, North West London, Surrey and Milton Keynes. Interoperability between various care systems provides more informed and joined-up patient records, improves patient care and safety by providing rapid and real-time access to data for those staff working in multi-disciplinary teams and provides the full picture of a patient’s health. It also helps patients by eliminating the need to repeat their care story at every stage of their care journey and stops clinicians having to send emails back and forth with attachments, requesting repeats of the same tests already done in a different care setting and better ensures consistent and complete care records. The NHS Long term plan also embeds interoperability as one of the essential conditions to achieve the Digitally Enabled and Interoperable Patient record nationally for all Trusts.

The CNWL interoperability journey

The CNWL Interoperability journey started in 2019 when the Trust successfully finished implementing a new Electronic Patient Record (EPR) System for its mental and community health services. When I started in the Trust in 2019, I quickly realised that in order to treat patients effectively, linking the Primary and Secondary Care records with the CNWL EPR across a range of different services and service providers would be vital. To achieve interoperability with Primary and Secondary Care providers I formed various stakeholder groups by working with local Clinical Commissioning Groups (CCGs) to explore the requirements, possible solutions and the required processes. There were many challenges identified by stakeholder groups including the different system requirements within the current suppliers, the existing sharing process, creating and agreeing new data sharing agreements, Information Governance (IG) rules, Clinical Safety rules, identifying the necessary technology providers and, most importantly, winning over the hearts and minds of all clinicians involved. After understanding the complexities in each care setting, I quickly decided to form focussed task and finish groups for various care settings to achieve interoperability with CNWL EPR.

Interoperability with Primary Care providers

TPP and EMIS are the leading suppliers of clinical systems and enablers of clinical information within the NHS and they implemented a two-way data sharing process called ‘SLIP’ (Supplier Led Interoperability), between their systems. SLIP allows the community or mental health provider to share the full patient record with GPs, and vice versa. This is also approved nationally by NHS Digital.

I led the focus groups for Primary Care providers and quickly identified various suppliers operating in the geography and determined that SLIP (Supplier Led Interoperability) was the best away to achieve CNWL EPR Interoperability with Primary care. I therefore initiated the formation of separate implementation teams for each borough in liaison with CCGs and CNWL development teams to implement the SLIP Project.  The biggest challenges we encountered were establishing data sharing agreements, as they were not consistently in place across the region, so we needed to prepare one for each Borough. With the help of CCGs and CNWL IG Teams we used the newly developed DSA Portals to complete this process. CNWL now has full interoperable records with Primary Care (GPs) in all the regions it operates in.  This has been communicated within CNWL and all the GP Forums so to reap the benefits.

Interoperability with Secondary Care providers

Interoperability with Secondary Care is a complicated affair as different hospitals, community and mental health services use different EPR systems. After the initial discovery phase with various stakeholders, I found that the Health Information Exchange (HIE) solution supplied by Cerner is best suited for CNWL EPR to achieve Interoperability with Secondary Care settings. HIE provides a joined up electronic health record by connecting all the acute, specialist, mental and community health hospitals and services in the boroughs covered by CNWL. Focus groups have implemented HIE for CNWL in North Central London, and Milton Keynes and we are currently working to implement HIE in the North West London region. We are already seeing the benefits to clinical services, where access to a patient’s Secondary Care records is helping CNWL clinicians improve clinical decisions and save time.

Our future interoperability journey

The next steps of CNWL’s Interoperability journey is to link with Social Care and council systems. This will better help services treat people with physical healthcare problems in their own homes, or close to home, where they will be more comfortable and can continue to live independently. Interoperability of primary and secondary clinical data with social care will avoid hospital admissions and enable a quicker recovery period for the patients with better outcomes. CNWL is also looking to implement further patient facing portals to share information with patients so patients can see all their relevant information in one area and send messages to the clinicians involved in their care. 

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