Information Governance, Electronic Patient Records and Patient Online Access

Dr Masood Nazir

General Medical Practitioner

National Clinical Lead – Patient Online

Chief Clinical Information Officer – Your Care Connected programme

Clinical Information Lead & SIRO Birmingham CrossCity CCG

Friday 29th January 2016

How to Safely Share Data

What are the benefits of paperless

to the NHS?

Clinical diagnosis

Patient & staff experience

Safety

Reduce burden & improve efficiency

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We owe patients a seamless, paperless NHS, but if they want a letter - fine

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www.england.nhs.uk

The challenges

Over last 10 years:

• the demand on the NHS has increased significantly

• increased ageing population

• increase in GP consultations from 260,000,000 to

360,000,000 per year

• consultations becoming more complex due to factors

such as multiple LTCs and shift of work from secondary care

General practice only receives about 7.7% of the NHS

budget.

www.england.nhs.uk

www.england.nhs.uk

Shared information is a

relationship of trust

Cartoon with thanks to the British Medical Journal

Patients and information are the two most under-used resources in the NHS

Dr. Richard Fitton

www.england.nhs.uk

• Local information sharing with an implied consent model (for the enabling of sharing) with later explicit consent/permission to view at the point of care.

• An implied consent model is needed for maximum patient participation.

• High patient participation is necessary to secure buy-in from healthcare professionals.

• Evidence shows that patients are more comfortable with their information being shared locally

• Data Controllers need to have in place a data sharing agreement with partner organisations.

Some examples of principles for sharing

www.england.nhs.uk

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Your Care Connected programme

A simple, yet quite ambitious aim:

To provide a more joined-up NHS service in Birmingham,

Sandwell and Solihull

• To support direct patient care

• To give those treating patients the information

they need when they need it

The record will be:

• Viewed via “lookup” method – no data

warehouse or extraction involved

• Accessed only with the permission of the

patient at the point of care, unless they’ve

opted out

• Completely auditable

www.england.nhs.uk

It’s been a long road

The benefits of Your Care Connected

The benefits of the system are:

• Faster and easier access to up-to-date medical information,

which could save lives

• More secure than paper-based access

• Supports the improvement of the safety and quality of patient

care

• Enables safer delivery of emergency care

• Less time spent on the phone and fax providing or requesting

patient records

Why have we supported the work so far?

Most people know their own history but...at times of

illness, they can forget information e.g. medication.

• Vulnerable groups require more support:

• Complex frail elderly

• Children who need safeguarding

• English is not first language

Better access to information means timely

decisions can be made – better for patient care.

A complex second city

Provider organisations: Clinicians

318 practices in 4 CCGs +……………

• University Hospital Birmingham FT

• Heart of England FT

• Sandwell & West Birmingham NHS Trust

• Birmingham and Solihull Mental Health FT

• Birmingham Children’s Hospital

• Birmingham Women’s Hospital

• Royal Orthopaedic Hospital

• Birmingham Community Healthcare NHS Trust

• WMAS (West Midlands Ambulance Service)

• Out of Hours GP service providers ( Badger/Primecare)

What is Your Care Connected?

GP

EMIS practice

GP

GP

Vision practice

GP

GP

SystmOne practice

EMIS Server

SystmOne server

Vision server

Partners

BTMIG

System suppliersGP Practice

BT FilterMIG interface

GP

GP

GP

Mental Health Trust

Acute Hospitals

Emergency Care

Out of Hours

• 1.6 million of population will benefit from this approach

• 318 practices across Birmingham, Solihull & Sandwell

• 14 partners organisations have been confirmed

Public information programme

1 Preparation development - engagement with

patients and stakeholders in creating

information and campaign so we know its

clear

2 GP Practices awareness raising, engagement

events and toolkit to help support practices

3 For patients - awareness raising advertising

and PR campaign so patients know they

should receive information by post – buses,

radio, events

4 Opt out - Letter and leaflet to patients

informing them of what is happening and how

to opt out

5 Ongoing support through helpline for practices

and patients through process

GP Record node – Only available if data is present on the

MIG – access controlled by Active Directory group

Consent Continued …

• Once T&C’s are confirmed:

• NB – in development awaiting wording from the CCG

Audit trails

Access Audit to Your Care Connected Record

Details of Access to this patients Your Care Connected Record

Information shared via Your Care

Connected

Information NOT shared via Your Care

Connected

Allergies

Medication

Hospital admissions and referrals

Vaccinations and immunisations

Test results

Diagnoses

Treatment

Medical procedures

End of life wishes

Demographics (age, gender etc.)

Concerns related to abuse of

vulnerable children or adults (if

applicable)

IVF Treatment

HIV and AIDS

Sexually Transmitted Diseases

Gender realignment

Termination of Pregnancy

Marital status

Criminal Convictions

Complaints

Free text from GP record

What does Your Care Connected show?

Exclusion data set

Your Care Connected and other data sharing initiatives

Over 9 in 10 patients would be happy for doctors and

nurses in hospitals and paramedics to view their GP

medical record

Suppliers

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Implementation

MDU & ICO update

LMCs, CCG, practice manager engagement

CSU support Webinars

www.england.nhs.uk

Patient Online programme

www.england.nhs.uk

Online appointment booking

98.7% of practices offering the service

8.5 million patients signed up

12% of all appointments are made

available online

Online repeat prescriptions

97.4% of practices offering the service

8.3 million patients signed up

4% of all repeat prescriptions

requested online

Online access to records

97% of practices offering access to a

summary of the record

2.9 million patients signed up

5% of practices offering access to

the detailed record

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What is Patient Online?

www.england.nhs.uk

GMS/PMS regulations 2015/16

From April 2015, practices are required to offer

online access to detailed information held in

coded form within the patients’ GP record.

www.england.nhs.uk

This is an example of categories of information that patients may see.

Some of the information in list above will depend on what your clinical system is able to routinely display.

Demographics

Allergies/Adverse

Reactions

Medication (dose, quantity and last

issued date)

Immunisations

Results (numerical values and

normal range)

Values (BP, PEFR)

Problems/Diagnoses

Procedure Codes

(medical or surgical) and

codes in consultation (signs, symptoms)

Codes showing referral made

or letters received (no attachments)

Other Codes (ethnicity, QOF)

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Detailed coded data example

Overriding principle

The coded record must be

MEANINGFUL to the

patient

www.england.nhs.uk

Improve safety

Look up medical

jargon

Improve health

control

Improve

knowledge and

health literacy

Improve access and

convenience

Reduce errors and

duplications

Less pressure on

staff

Increase use of

SMS

Save phone calls

Increase patient

satisfaction

Improve

communication with

patients

Administrative time

saving

Source: http://goo.gl/49oD49

Saving time and resources

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Benefits of using online services

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DNA Appointments

Aug Sep

2015/16

% DNA traditional 4.1% 3.6%

% DNA online 2.3% 2.3%

0%

1%

1%

2%

2%

3%

3%

4%

4%

5%

% DNAtraditional

% DNAonline

Number of Appointments DNA

2015/16

Aug Sep STRAWMAN REF

TOTAL no. of appointments booked34,355,70

1

41,487,45

1108 - appointment_scheduled_trans_count

TOTAL No. booked online 695,869 759,928 610 - appointment_scheduled_ online_trans_count

TOTAL Number booked/cancelled online 893,268 977,331 POMI TOTAL Number booked/cancelled online

TOTAL APPOINTMENTS DNA 1,401,574 1,485,267 212 - appointment_dna_appt_count

TOTAL APPOINTMENTS DNA ONLINE 16,177 17,580 213 - appointment_dna_online_appt_count

% DNA traditional 4.1% 3.6%

% DNA online 2.3% 2.3%

www.england.nhs.ukwww.england.nhs.uk

New practice baselines

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What NHS England are doing to support

practices

Detailed interviews

with patients

Promotion to the public

Building benefits

evidence

Case studies and videos

preparation

Working with EMIS

Focus on enabling record

access

Answering practice

and patients queries

Developing

guidance & policies

Engagement (CCG

and LMC engagement,

workshops for practice

managers, training for

CSUs/HISs)

www.england.nhs.uk

Ensuring a

patient’s

notes are

ready to be

shared

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www.england.nhs.uk

• Third Party Information

• Must be excluded as required by data protection act and common law duty of practice (same as with Subject Access Requests)

• Sensitive Codes

• Examples include sexual & reproductive health, child and adult safeguarding, domestic violence and criminal activity

• These codes may need to be excluded or discussed with the patient prior to access to avoid upset or harm

• This is relevant particularly to coercion and proxy access

• Guidance from the RCGP is due out soon

• Free Text

• Whilst not required it can add meaning, especially to blood results. See later slide on free text.

From EMIS 5.8 it will be possible to choose which elements of the record have free text e.g. only shown for results.

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Issues to Consider

www.england.nhs.uk

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www.england.nhs.uk/patient-online elearning.rcgp.org.uk/patientonline

Our resources

www.england.nhs.uk

Main Websites

NHS England - https://www.england.nhs.uk/ourwork/pe/patient-online/

RCGP – http://elearning.rcgp.org.uk/patientonline

Specific Guidance

ID Verification - http://elearning.rcgp.org.uk/course/view.php?id=181&section=2

Coercion - http://elearning.rcgp.org.uk/course/view.php?id=181&section=1

Proxy Access - http://elearning.rcgp.org.uk/course/view.php?id=181&section=3

Children and Young People - http://elearning.rcgp.org.uk/course/view.php?id=181&section=4

This guidance is being updated and new guidance is coming soon

Documents and Forms (downloads)

http://elearning.rcgp.org.uk/mod/page/view.php?id=4775

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Links to Resources

“An individual without information can’t take responsibility.

An individual with information can’t help

but take responsibility”

Jan Carlzon, business leader (QuoteDaddy)

www.england.nhs.uk40

Thank you!

#patientonline