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‘Need to know’ crucial to care integration



Joint teams and 'push out' technology could support efforts to align health and social care

As the integration of health and social care remains high on the public service agenda, organisations have to grapple with the governance issues around allowing staff from different agencies to share each other's data. One factor that could help to provide solutions is the creation of integrated teams with co-located staff and controlled access to each other's databases.

This was one of the themes to emerge from a discussion today on mobile technology in healthcare, staged by TotalMobile and involving representatives from health organisations and local government.

The emphasis on integrated teams came from Julia Clarke, chief executive of Bristol Community Health CIC, in response to a question on how teams from the different sectors can deal with data governance issues.

She said the group has a formal partnership with Bristol City Council around intermediate care, dealing with issues such as avoiding admissions to hospital and supported discharge, and can avoid the need for access protocols as staff from both sides work alongside each other. They do not have to log into each other's systems, but can share information on a 'need to know' basis.

Consent catch-up

"If you create access to the whole system it's not on a 'need to know', and I don't think our consent mechanisms have quite caught up with the capability we've got," she said.

"It's not holding us back yet, but we need to solve it. I don't think it's a technical problem, because you can restrict access to certain fields, but it's getting your head around what fits with proper information governance and protection of patients."

Clarke said the "direction of travel" is towards integrated teams, but there are questions about the limits of access to data. She cited the example of hospital teams possibly gaining from seeing some community records, but said it would not be right to allow wholesale access.

Sarah Royles, service development manager for ICT for Nottinghamshire County Council, also spoke of the difficulties in the issue.

"The technology is there, and we can get the information we need from whatever systems providing the APIs are available, but the difficulty is the agreement at a high level on what it is acceptable for other people to access," she said. "We already have in local government people sitting in health facilities, logging on to two separate systems to access information from local government and healthcare.

"We will have got permissions but not in the same place. So some of it we should be able to get around in a straightforward way, because it's getting the right information to the right people, or it's being persistent to bring that together. On the wider level it's still to be addressed."

Royles told UKAuthority that Nottinghamshire has made some progress through the creation of a multi-agency sharing hub for child safeguarding, with representatives from the council, healthcare organisations and local police working from a shared office and having desktop access to any relevant information. It is looking at extending this into mobile access as part of a programme to equip up to 2,000 employees, predominantly in social care, with tablets by the end of the year.

Growth in sources

Data issues are likely to become more complex as efforts to support public health take in data from numerous sources. Dr Simon Wallace, a former GP who now specialises in informatics, noted that local authorities are more active in promoting public health and the relevant teams will increasingly want data from service areas such as transport and housing.

Advances in technology are providing an extension of the 'need to know' principle. There was talk at the event of solutions that make it possible to 'push' information to an accredited official who makes a request, without giving them access to back end systems. This is especially important with the growing use of mobile devices that are used in communities rather than the controlled environment of an office.

There was also a consensus that the health service has reached a tipping point in taking up mobile technology. It was attributed to public familiarity with the devices - five years after the appearance of the iPad - and the fact that encryption standards are now providing more confidence in data security.

"It has already happened," said Graham Softely, associate director of IT strategy and delivery at Buckinghamshire Healthcare NHS Trust.

"We have a duty of care to ensure the security and encryption on devices was up to scratch, and three years ago that really wasn't very robust, whereas now it's built into every device. I think that over the past couple of years it has been gathering momentum."

Pictured: The panel at the event (left to right): Roy Lilley (chair), Julia Clarke, Simon Wallace, Sarah Royles, Graham Softely and Gareth Tolerton of TotalMobile.

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