Our mission at Healthcare Gateway is to improve health and care for all by being the number one managed service; supporting integration across health and care systems in the UK. We build solutions to solve interoperability challenges regardless of technology or standards, bridging gaps by integrating data to provide a holistic view in real-time.

The latest government statistics show the prison population is close to maximum capacity. It is our view that the large population in prison today require efficient care, aligned to the criminal justice journey. Without safer, more joined up care wider issues can prevail. A patient journey that is disjointed, especially in this space, creates wider issues for prisoners whilst in prison and upon release.

Holistic views inside

In our experience, patient information held across disparate systems generates silos of data which are unhelpful for the healthcare professional providing care. Presenting all the information in one single view and in real-time builds a full picture of the patient’s medical history. A holistic view of patient data needs to be aligned to prisoners moving into prison, while inside prison and on release. For example, the first few days upon release is deemed to be most vulnerable for prisoners and critical to health and welfare. If clinicians have access to discharge summaries and transfer of care documentation transition can be coordinated to ensure the best patient outcomes.

In our research, we believe that clinicians currently have inadequate access to real-time patient data across geographical and organisational boundaries in the sector. Resulting in the loss of patient data, and restricting the ability for supporting organisations to recognise those in need quickly enough to avoid damage to welfare, or the potential for re-offending.

Effective care planning for prisoners

The creation and continuation of care plans for patients during their sentence and following release is critical in improving care pathways. Interoperability is required to ensure care plans are informed, joined-up and readily accessible to all professionals involved in a patients care.

Medication

Accessing health records which provide detailed views of prisoner’s medications, allergies and addictions minimise errors in prescription such as duplication or risk of overdose, and supporting successful rehabilitation on release. Particularly as the associated anxiety of prison release can result in self-medication if not appropriately managed. However, views of prescribed drugs used within the prison can be lost during the transfer of care as typically interoperability isn’t in place to facilitate the consumption of prison data in out of prison healthcare systems or settings.

Mental Health Crisis

The Institute of psychiatry recognises that there is an existing crisis of unmet mental health needs in the prison system. Findings show that over half of prisoners have mental health problems, yet the Prisons and Probation Ombudsman (PPO) report that one in five prisoners diagnosed with poor mental health receive no care from a mental health professional in prison.

Addressing mental health by co-ordinating and improving the process of care planning relieves pressures created by this crisis. When entering the prison system, knowledge of inmate’s mental health history prior to admission enables better provision of care while incarcerated.  Using the Medical Interoperability Gateway (MIG) a patient search presents all available information about a patient, including mental health data. So if mental health care plans are in place, the continuation of care is extended upon release. The provision of integrated care is of particular importance in mental health instances to avoid triggers, and prevent escalation by ensuring patients only tell their story once.

Safeguarding prisoners

The Care Act 2014 states a requirement for the local council of the prison region to assess prisoner’s social care needs, informing a care and support plan where required. In the instance of prison transfer or release, local councils need to communicate and transfer the details of the prisoner’s social care needs to the new local council and social services to assess their needs in the new prison or living in the community.

Looking ahead

For a truly integrated care system, levels of care must be comparable across all settings where medical intervention exists.  However, there are significant interoperability gaps in the sector which need addressing to ensure the care received a prison environment is the same quality of care as received by the wider population. Adopting solutions that are widely used across the UK, such as the MIG, can support the criminal justice sector in its capability to rapidly achieve smarter, connected care.

It is our passion to provide interoperability between systems and settings. Healthcare Gateway are exploring how they can support interoperability between data silos within a criminal justice setting and also connectivity inside and outside of a prison, as a patient’s care is managed between Criminal Justice and the NHS Health and Care, we are open to explore these further.

Why is the Shared Care Record initiative in place?

In August, Simon Stevens, NHS CEO, outlined the third phase of the NHS response to COVID-19, setting out priorities for the NHS developing and implementing a full Shared Care Record. Since, NHSX CEO Matthew Gould has called for all 42 STP’s and ICS’s to have the Minimum Viable Solution of a Shared Care Record in place by September 2021. These steps are in place to address inequalities in digital maturity across the NHS, and satisfy the need for digital transformation across health and care.

What is the Minimum Viable Solution?

The details of the Minimum Viable Solution are set out in the Core Information Standard by the Professional Record Standards Body (PRSB). This identifies 1500+ data fields which are necessary to achieve the basic level of a Shared Care Record.

However, the use of these data fields and achievement of the Minimum Viable Solution is open for interpretation by STPs and ICSs based upon your own data access needs. You should consider the scale and needs of your trust when adding datasets to the Shared Care Record and establishing connections between systems. Required patient data will be held across many clinical systems, therefore, interoperability and bi-directional feeds of information between these systems is essential to the achievement of the Minimum Viable Solution.

We have recently become a partner of the PRSB’s Standards Partnership Scheme. Supporting Healthcare Gateway’s commitment to adopt professionally endorsed record standards that will improve and integrate care and support delivery of interoperability. 

What is the goal of the Shared Care Record?

The Minimum Viable Solution acts as a ‘basic’ level of record sharing, fulfilling NHSX’s goal to get all NHS trusts over the minimum threshold of interoperability. This will ensure all NHS trusts deliver a core set of capabilities, closing gaps in digital maturity.

According to Matthew Gould, this is the first chapter in the digital transformation of the NHS. Paving the way to increasing flows of data between health care settings, and optimised patient outcomes. Initiatives such as NHSX’s reinforce this goal. So far, allocating funding and support to 55 NHS trusts to develop their digital strategy.

How can a successful Shared Care Record be achieved?

Deployment at scale and pace

The September deadline for Shared Care Record deployment leaves a narrow time frame for successful delivery. Our Prince2 qualified projects team have a track record connecting over 4500 health and care settings, with rapid deployment. We deploy our projects at pace, meaning clinicians can quickly access patient data to support informed decisions and clinical safety.

Shared Care Records need to link to multiple clinical systems to ensure data flows between care settings. Today, Healthcare Gateway have 80+ clinical systems, supporting programmes of work at both local and regional level. Facilitating an average of 18 million safe and secure transactions each month.

Availability of patient records

The complex landscape of clinical systems in place across the NHS uncovers gaps in patient care where patient data is not connected. A true Shared Care Record is one that is connected and reliant upon data locked in disparate systems. The MIG using national standards makes this simple by joining up any patient data from any clinical system in real-time. This ensures every healthcare professional can access accurate patient data in their native system, improving patient care pathways.

The MIG connects patient data from ALL primary care systems plus health and social care data. Working with our trusted partners the MIG enables bi-directional feeds of HTML or structured data, making a complete economy of data available to clinicians when and where it is needed. Including, primary care, acute, mental health, social care and community datasets.

Interoperability specialists

Interoperability is at the heart of every Shared Care Record. It’s the component that breaks down data silos, enabling data to flow. We’re not only a technology provider. We’re experts currently supporting 60% of STPs across England, spanning projects of all shapes and sizes. Beyond implementing MIG solutions, our specialist knowledge and partner alliances ensure our customers receive that crucial end to end fully managed service.  

Our MIG Managed Service provides specialist support at every step of your interoperability journey, from project scoping and delivery to tailored account management beyond implementation. Providing expertise in all aspects including data governance guidance, technical support and service-led engagement.  We’re ISO27001 certified, with our people keeping the gears moving across digital transformation projects.

In Summary

Healthcare Gateway can support the roll out of Shared Care Records by:

• Implementing interoperability projects at pace
• Provide access to patient data from ALL primary care systems, plus health and social care data
• Support integration and beyond with our end to end fully managed service.

We’re interoperability specialists. We have already supported the roll out of many Shared Care Records, yours could be next.

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