Project provides single platform for patient data – with potential to make available for wider use
Camden Clinical Commissioning Group (CCG) has taken steps to ensure hospital doctors in the borough can access information on patients from their GPs and other sources with the creation of the Camden Integrated Digital Record (CIDR).
Hasib Aftab, head of IT and systems at Camden CCG, told Capita’s Channel Shift Conference last week that the project comes on the back of a care pilot, involving acute hospitals and health and social care data providers, that the CCG completed in 2013.
It revealed it would be hard for the providers to look at a patient’s data on a single platform, as each of them had large IT contracts with different suppliers.
“It was clear that in order to share that data we needed to come up with some sort of infrastructure model,” said Aftab. “We wanted to do something standardised to enable providers to share data and to scale this up.”
It has led to the development of a portal that takes in health, social care, community and mental health data from GP surgeries within Camden, as well as data from Royal Free Hospital and University College London Hospital.
The central hub is provided by Orion Health, which aggregates data from other healthcare IT systems such as those from UMIS, SystmOne and Cerner. The data is then matched anonymously where necessary and pushed back out to clinicians.
“Clinicians came together and said they didn’t want every bit of data in GP systems, or care plans; they wanted very clinically focused datasets,” Aftab explained.
It took about a year and a half with clinical input to get the solution to where it is. There were challenges in the development, such as enabling the different systems to feed in specific datasets, agreeing the opt-in and opt-out mechanisms for patients, and accommodating the opt-outs in the technology.
“We wanted to know if we had an appointment for mental health or sexual health and the patient doesn’t want to share the data with the GP, how we could build provisions to not share that data, and we had to get that across to all of our providers,” Aftab explained.
This required working with suppliers, providers and lawyers to iron out the issue, and then spending significant resources in communicating the project with patients through media, leaflets, letters, roadshows and other public engagement events.
By engaging with patients the CCG found a three-tier consent model, which Aftab believes is working, based on gaining consent separately by patients for emergencies, care settings and for the long term.
Currently, the solution is read-only, so that data from one source cannot be amended by a clinician from another. Aftab explained that this was because Camden CCG did not want clinicians to be liable for any misdiagnosis by others based on data that that had been changed.
The solution and the data all sit within the NHS’s N3 network, and Aftab emphasised that Camden CCG ensures the data is for clinical use only and not used by third parties.
There were teething problems: some GPs told the CCG their systems could not display the data.
“We then questioned whether we could use a single sign-on to display the data, in which data could be selected and aggregated in one place,” Aftab explained. This took a lot of effort and escalation to achieve – but eventually it got there, becoming the first in the UK to get single sign-on for a GP system.
The CCG is now negotiating with Cerner to get a single sign-on for hospitals.
He added: “We had to go through NHS England to escalate it and our usage has come from 200-300 GPs logging into the system to about 800. GP practices in Camden now instantly have access to records, and we’ve dealt with the details from third parties, so if they get consent then the system allows you to access the data and because of this we have a lot of traction of people wanting to deploy the system.”
The plan is to get these datasets to other entities that exist within the health system such as NHS 111, ambulances and hospices, and Camden CCG is engaging with patients on the possibility of an online patient portal.
“We are doing surveys through our council, around who this would benefit most and whether it is worth doing it universally. There is a clear business case for clinical portals which allow clinicians to share data, but would our quarter of a million population want an app?”.
Camden CCG has now commissioned a study on the benefits, with a particular focus on the clinicians’ ability to make decisions on point of care, and hopes to release the results within six months. But Aftab said the early feedback is that it the portal is making decisions a lot easier.
“You don’t need to phone or fax people, and it’s improving the clinical safety of decisions, while decreasing clinicians’ workload,” he said.
“Patient experience has also improved as they don’t have to repeat the same things to clinicians over and over again.”
There is also a business case for the solution to be used across North Central London and the potential for it to be available to other CCGs in the longer term.