Connected Nottingham offers safer, more efficient care with MIG record sharing

Connected Nottingham

Connected Nottingham offers safer, more efficient care with MIG record sharing

Sharing patient data via the Medical Interoperability Gateway (MIG) is boosting efficiency and helping to save lives among 1.1m people in the Nottinghamshire area.

Ninety-two per cent of staff say the MIG from Healthcare Gateway has helped them to improve overall patient care*. The MIG lies at the heart of the ever-evolving Connected Nottinghamshire (CN) data sharing network, making vital, real-time information from 143 GP practices across six CCGs available to a wide range of NHS users including hospital doctors and nurses, social care workers and ambulance staff.

“We wanted to improve health and social care data sharing. After extensive research, we chose the MIG in 2014 as a low cost, high value tactical solution that we could deploy easily. We can summarise complex data from any source and share it widely to other systems via the MIG very quickly. We are now making information from over 90% of GP patient records available, compared to 15% in 2015.”

CN’s first target was to make patient records, including a supportive care dataset, available for acute emergency care and out-of-hours clinicians.

Shared medication data via the MIG was directly responsible for saving one overdose patient’s life and has also helped GPs and A&E doctors to spot attempts to obtain multiple medications – preventing unsafe duplicate prescribing. CN’s evaluation estimates record sharing has taken two minutes off every consultation (adding up to over half an hour in each clinician’s day) and reduced hospital admissions by one per clinician per month.

The major benefit has been to make accessing medical histories quick and easy for clinicians, letting them make better informed decisions about assessing, prescribing, referring and planning care for patients. The additional dataset supports decisions around end of life care and treatment while recognising a patient’s wishes and preferences.

“Access to live primary care records via the MIG gives our doctors and other out-of-hours clinical staff the vital information they need to make safe, effective and appropriate decisions. We now look at the patient’s GP record in almost every case we manage and, if it’s not available for some reason, it’s like having one arm tied behind your back. Immediate access to GP records can also prevent unnecessary hospital admissions, which is particularly important with frail elderly people.”

The MIG worked so well that within two years of its launch in Nottinghamshire, it was enabling record sharing across many healthcare organisations including out-of-hours services, multiple hospitals, 111 staff, GPs, community carers, mental health workers and many others. Via the Midlands Accord, CN has crossed regional borders to share data with organisations including DHU 111 and the East Midland Ambulance Service.

Giving every GP the background data they needed to handle an unexpected death was another priority. If they didn’t know the patient or hadn’t seen them within the last 14 days, GPs previously had to opt for a post-mortem. Evans said the MIG had been “transformational” in changing local policy in this area.

“The MIG saves time otherwise spent contacting GPs and other trusts to obtain information. We can more easily check which other medications patients are taking for any potential drug interactions and it also stops patients getting annoyed that GPs and hospitals don’t talk to each other.”

The MIG is also making information from Nottinghamshire’s GP Repository for Clinical Care (GPRCC) more widely available to organisations like 111. The GPRCC analyses data from GP, community, mental health, acute provider and social care systems to produce information such as risk scores for COPD and an Electronic Frailty Index.  Sharing valuable GPRCC intelligence through the MIG will allow clinicians to better prioritise response to acute workflows and guide patient care.

Offering sophisticated and flexible “integration technology”, the MIG currently connects 4000 health and social care providers within the UK, sharing a total of 30 million patient records. More are being added all the time.

“We are delighted that the MIG employed originally as a tactical solution is now integral to the care provided to residents of Nottinghamshire. There are many real quantifiable benefits in time-saving, efficiencies and a more positive experience for patients and clinicians.”

Find out more

If you would like to find out more about the MIG and get in touch with a member of our team please get in touch here.

* [Independent benefit analysis conducted by NHIS direct with clinical staff using MIG]

IKR

Palliative patient data that improves care across the Fylde coast

Community nurse speaking to elderly patients

Palliative patient data that improves care across the Fylde coast

Blackpool Teaching Hospitals NHS Foundation Trust are using the Medical Interoperability Gateway (MIG) to share patient Electronic Palliative Care Coordination System Records (EPaCCs) across a variety of different health and care organisations.

Background

Blackpool Teaching Hospitals NHS Foundation Trust provides a range of acute services to the 330,000 population on the Fylde coast as well as a range of community health services to the 445,000 residents of Blackpool, Fylde, Wyre and North Lancashire.

Previously, healthcare staff had no consistent way of recording and sharing an individuals end of life preferences electronically and relied on a paper-based system. With limited information about care planning, there was an increased risk of unnecessary admission and delays in discharge.

To provide continuity of care to patients, the Trust looked to make it easier for health care professionals to access a patient EPaCCs record electronically. With access to an EPaCCs record, a patient’s preferences and key details about their end of life care could be shared across organisations to improve coordination of care, planning care and anticipation of crisis.

What did they do?

In 2016 the Trust implemented the MIG’s Detailed Care Record (DCR) and EPaCCs Dataset.  They began by accrediting their in-house system ‘Nexus’ to allow integration with the MIG. This was followed by integrating Adastra used by the Out of Hours services (OOH). With the MIG successfully integrated, the EPaCCs dataset was then available to healthcare professionals as an embedded view in the system they used day to day, by clinicians in accident and emergency (A&E), acute medical unit (AMU), frailty wards and community nurses.

Today, using the MIG the OOH service views vital EPaCCs information as an embedded view in Adastra. On accessing patient records, clinicians are notified by an alert if an EPaCCs record exists and are prompted to view at the point of care.

Reducing unnecessary admissions

This information is also being used to inform The North West Ambulance Service (NWAS) in particular, paramedics.

When a patient or relative calls the 111 service, call handlers can respond efficiently by accessing EPaCCs information. An alert notifies the call handler the patient is under the care of the care coordination service and that an EPaCCs is in place. The patient is then directed to the care coordination team in OOH to receive direct access to a GP.

The benefits of accessing an EPaCCs record

The Trust has found the MIG invaluable. Instant access to real-time patient information supports medical decisions in line with patient wishes.

“EPaCCs has provided a platform for end of life decisions and conversations to be documented and shared in such a way that clinicians in both the community and acute settings can access it. This has meant that patients who might otherwise have faced either a lengthy hospital stay or death in a hospital bed are now much more likely to be cared for and die in their preferred place.”

A holistic view of a patient’s medical record and end of life desires is presented in one view, including background information about medications, end of life care status and any prior discussions about the preferences and treatment decisions of the patient, which is crucial to the coordination and delivery of palliative care. This ensures everyone involved in a patients care plan can see their wishes and any care they receive is in line with what they have decided.

In Blackpool the MIG has allowed a patient’s care plan to be followed:

“A patient presented at the Emergency Department (ED) who was in the last days of his life, all the appropriate arrangements were in place to care for him at home and he had an EPaCCS record. Upon arrival in ED the patient was not able to communicate and his wife was too upset to communicate effectively. We were able to access his EPaCCS record and establish that his GP had spoken to him about his preferred place of death and that he wanted to be at home. As a result of this the patient was taken home where he died peacefully in-line with his wishes. Without having access to the MIG, the patient would undoubtedly have been admitted.”

The creation and accessing the EPaCCs record allowed the patient’s wishes to be fulfilled and enabled the best outcome for both the patient and family.

From a clinician’s point of view, being able to access the EPaCCs record enables clinical staff to make more informed decisions around care and treatment, whilst recognising the patient’s wishes and preferences.

Find out more

To find out how your organisation can access the MIG EPaCCs dataset or to arrange an online demonstration, get in touch here.

IKR

University Hospitals of Morecambe Bay and NHS Lancashire North CCG – Using palliative care data

University Hospitals of Morecambe Bay and NHS Lancashire North CCG – Using palliative care data

University Hospitals of Morecambe Bay and NHS Lancashire North CCG are using our End of Life Care Dataset to share patient information between hospitals in the North West.

Background

There’s been a strong history of good palliative care in the North West. The ambition is to provide gold standard end of life care to patients wherever they present but there was a fundamental problem. Necessary information was stuck in the GP record which meant the hospitals weren’t getting the information they needed.

What did we do?

We worked in partnership with the hospital and the CCG to implement the Detailed Care Record (DCR) and Specialist Datasets. They needed to implement the DCR before they could share the Electronic Palliative Care Co-ordination Systems (EPaCCS) record with the hospital.

The MIG shows relevant end of life information from the GP practices as a view inside Lorenzo, the hospital’s clinical system. The interoperability the MIG offers means the hospital didn’t have to replace their current software to have access to this information as it was integrated with their current system from the GP records.

How have they benefited?

Tim Reynard, GP clinical lead for Health Informatics at Lancashire North CCG, believes there are three main benefits;

1.    Automatic alerts

The patient’s supportive care record is automatically shown as an alert; if there is one present. As only about 1% of patients coming into hospital have a palliative care record, doctors might not have checked whether one is present as a matter of course.

2.    Delicate handling of sensitive information

Having access to a patient’s preferences enhances the patient experience by making healthcare professionals aware of what end of life care has been decided upon. It can be distressing for patients to repeat what their preferences are.

Also if the patient has deteriorated and is not able to state their preference, there is break glass functionally in the MIG, which means that consent couldn’t be given but a reason for accessing the record can be provided for an audit.

3.    Spend more time with patients

Healthcare professionals having access to the same information for palliative care means that there is less duplication in data entry and will free up staff time to spend more time with patients.

“The nurses and team absolutely love it, it's extremely useful. Having this information available to colleagues undoubtedly empowers the patient.”

What’s next?

The roll out of the project is being led by the palliative care team who will train the other teams in the hospital.

A&E and acute care are using the information at the moment and they want to share the data with other healthcare teams, such as out of hours (OOH).

IKR