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What can England learn from the rest of the world as it sets a shared care record target?

Richard Strong, vice president and managing director, EMEA, welcomes a new target for the NHS in England: to have shared care records in place by September 2021. However, he argues that healthcare communities need to pick the right technology, and to choose a platform like the dbMotionSolution, which has proved its worth during the coronavirus emergency.

As the UK emerged from the first wave of the coronavirus emergency this summer, the NHS started to look forward to the end of the pandemic.

NHS England wrote to health and care leaders in July 2020, urging them to prepare to return to “near normal” levels of non-COVID activity, to get ready for winter and to be ready for “system working” next spring.

In plain terms, “system working” means finishing the job of creating integrated care systems to plan care at a population level and to make sure that health and care organisations are delivering “joined-up” services for patients.

It’s an approach that requires good data and shared care records that enable health and care professionals to work together. And NHS England’s “Dear Colleague” letter recognised this.

It said healthcare communities should, “plan for developing and implementing a full, shared care record, allowing the safe flow of patient data between healthcare settings, and the aggregation of data for population health.”

dbMotion: Twenty years of experience

It was great to see the NHS’s most senior leaders recognise the importance of shared care records for the future of healthcare in this way. Allscripts is recognised as a leader in this technology, thanks to our dbMotion platform, which originated in Israel in the late 1990s.

At the time, the health management organisation, Clalit (General) Health Services, wanted to share information between clinicians working at its network of hospitals and clinics.

Clalit is not just a major HMO in Israel, it is the second largest HMO worldwide and provides comprehensive healthcare services to more than 4.5 million patients, or 53% of Israel’s population.

It developed a shared care record, and with it the platform that became dbMotion. From the outset, the platform was built for growth, and it went on to become the foundation of the national Ofek (Horizon) country wide programme.

This connects more than 30 different health organisations, 50 different hospitals and thousands of primary care clinics, providing clinicians with a “view-only” record of more than 9 million people—within 10 seconds.

Ofek especially proved its worth in the first phase of the pandemic, when it was used to give all of the country’s healthcare providers immediate access to a patient’s COVID status, to support diagnosis and treatment, and for research.

dbMotion became an independent company in 2004, formed a relationship with Allscripts in 2009 and was acquired by the company in March 2013, enabling Allscripts to take the benefits of its platform worldwide.

In 2019, South Western Sydney’s health information exchange, the integrated real-time activity data interoperability project, or iRAD, became the first HIE to deploy a cloud-based version of dbMotion.

Again, this proved its worth during the first wave of the pandemic, when COVID-19 risk notifications and dashboards were developed to enhance patient and staff safety.

Meanwhile, in the UK, The Dudley Group NHS Foundation Trust accelerated a planned deployment of dbMotion to give its clinicians easy access to the information they needed to triage and treat COVID-19 patients from within the Sunrise™ electronic patient record.

This has not only made a significant contribution to the trust’s COVID response, it has also put it in a much better position to move forward with its vision working within an integrated care system this spring.

Picking technology that works now and will form a foundation for the future

Matthew Gould, the chief executive of the NHS’s digital agency, NHSX, gave the Public Accounts Committee more information about the roll out of shared care records when it met in October 2020.

He said he wanted to see all 42 of the areas of England that are due to become integrated care systems (ICSs) to have a shared care record in place by September 2021. He acknowledged that this is a “stretching target” which is certainly true.

However, he also indicated that these records should “minimally cover” acute trusts and GPs and enable them to share the data items in the core information standard developed by the Professional Records Standards Body, which focuses on data for direct patient care.

That would put social care and data for research, analysis and planning out of scope for the moment. But I think healthcare systems should be more ambitious.

Areas that are just embarking on their shared care record journeys need a platform that their clinicians can use immediately. Unlike some of the other products on the market, one of the features of dbMotion is that it sits on the systems that clinicians use every day.

It uses a context-link overlay that presents itself as a “blue button” to clinicians. It tells them when additional information is available and presents it to them in a normalised, aggregated format. One of the clinicians at The Dudley Group commented that if people could use a mobile phone app, they could use dbMotion.

Even better, clinicians can take elements of the GP or other data in dbMotion and add it to their own patient record, using a feature called SendToMyEHR.

At the same time, it is important to choose a platform that can support future developments. dbMotion can be used to support care coordination, or packages of care that “wrap around” the patient and enable them to be cared for at home or in the community.

As healthcare systems around the world engage with the second wave of COVID-19, this kind of care planning is becoming increasingly important. Organisations are looking to build on the rapid roll out of virtual clinics and consultations to create digital-first care packages that enable both clinicians and patients to be treated safely at home whenever possible.

But, as NHS England recognised in July 2020, it is also important for the future that we create health and care systems that can efficiently and effectively support our increasingly elderly populations, living with a growing burden of chronic disease.

Needless to say, the data in dbMotion can also be used for sophisticated population health analytics that the commissioning board described.

Start small, think big

All shared care records projects start small. dbMotion grew out of a need for one health system in Israel to share information between its hospitals and clinics. But shared care records grow as organisations and clinicians see how the data they contain can help them improve care and respond to new challenges.

dbMotion now supports hundreds of institutions, thousands of clinicians and millions of patients around the world and proved invaluable when they faced the challenge of COVID-19.

So, England’s new target of rolling out shared care records is a good start; organisations looking to meet it need to pick a technology platform that will work for clinicians out of the box and create the foundations they need to expand in the future.

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