Transcript Slide set on using additional information in SCR for

The NHS Summary Care Record
Supporting person centred coordinated care
June 2016
v1.11
Current status
• SCRs are an electronic
record of key
information from the
patient’s GP practice
• As a minimum contain
medication, allergies
and adverse reactions
SCR creation
96%
of patients
have had an
SCR created (55 million)
SCR utilisation
3.2m
SCRs
accessed last
year to support urgent and
emergency episodes of care
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SCR benefits
Effectiveness
Safety
40%
49%
of patients
have a
medication error identified
when SCR is used
of patients
guided to a
more appropriate care
pathway when SCR is used
(feedback from A&E clinical users)
(feedback from ambulance clinical hub users)
Efficiency
29
minutes time
saved per patient
undertaking a medicines
reconciliation
(Journal of Medicines Optimisation-Dec 2015)
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“While I use SCR relatively
infrequently, on EVERY occasion
it has directly informed, changed
and better aided patient care …
when we use it, it counts
enormously and directly saves
lives.” ED consultant
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@NHSSCR
SCR benefits
Supporting unscheduled care
“The SCR is a secure and easy to use source of clinically
important information that is readily available at times
when you would otherwise be unable to obtain it. It is
particularly helpful in an unscheduled care environment
when this information is not otherwise available.
Patients expect information about them to flow through the
NHS and the SCR supports this. Every day of my working
life the SCR is making my job easier and is improving the
quality of care I can deliver to patients.”
Dr Keith Grimes, Locality Medical Director and GP
IC24, Ashford, Kent
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SCR benefits
Supporting older patients
“Patients presenting as an emergency may have been
unable to bring medication information with them, older
patients in particular may be unable to recall all the
medications they are taking.
The SCR means we can gain information within minutes
and ensures we can use the information to aid diagnosis
and treatment, often facilitating a safe discharge from the
Emergency Department. Without access to information in
the SCR to aid management, patients can have an
unnecessary admission to hospital”
Dr Alison Cracknell
Consultant Interface Geriatrician, St James’s
University Hospital, Leeds
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SCR benefits
Supporting community and intermediate care
"Sometimes when we get a new patient referred there is
no information we can access. Previously this would mean
that when we visited the patient they would often have
struggled to recall all of the details that we need. This
would be particularly frustrating for patients with
communication difficulties. Now, at the time of arranging
the visit, we can ask if we can look at their SCR. Having
this information when we first see a patient speeds up the
assessment and improves their experience of care as they
are relieved to not have to answer countless questions
about the same thing.”
Louise Philips, Community Matron
Maldon Integrated Care Team
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@NHSSCR
SCRs with additional information
Supporting person centred co-ordinated care
• GP practices now have
capability to enrich SCRs
with a set of additional
information - with patient
consent
• Includes individual
coded items and
associated free text as
recorded in the GP record
SCRs with additional
information include:
• Reason for medication
• Significant medical history
(past and present)
• Anticipatory care information
(such as information about the
management of long term conditions)
• Communication preferences
(as per the ISB-1605 national dataset)
• End of life care information
(as per the ISB-1580 national dataset)
• Immunisations
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SCRs with additional information
Supporting end of life care
These are key extracts from an example SCR with additional information
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SCRs with additional information
Scenario 1: supporting end of life care
Tom has lung cancer and the disease has progressed to a terminal
phase. He has a life expectancy of a few months. Together with his
wife Joan, Tom has made a competent decision to receive best
supportive care and to die at home.
• Palliative Care Team
offer Tom the choice
to have an enriched
SCR at his review.
• Tom agrees and his
consent status is
changed.
• Important additional
information from his
GP record is now
automatically included
in his SCR.
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• One night Tom’s
condition worsens, his
breathing deteriorates
and he coughs up
blood.
• Joan wants to support
Tom’s wishes to
receive care at home
so calls NHS 111 for
advice.
• The call is transferred
to the GP OOHs team.
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• A GP calls back and
accesses Tom’s SCR.
• Tom’s preferences can
be seen and
information about
anticipatory
medication.
• A district nursing team
is contacted and
administers the
medication relieving
Tom’s symptoms.
@NHSSCR
SCRs with additional information
Supporting end of life care
“The Summary Care Record provides a great opportunity
for everyone to have their views and preferences digitally
recorded by their GP practice*, and viewed when
necessary, during the final stages of their life. This can
bring enormous peace of mind to these individuals and
those close to them, and help professionals who are
trying to deliver care in accordance with the individual’s
needs and wishes.”
Professor Bee Wee
NHS England Director for End of Life Care
* The SCR provides the end of life preferences entered in the GP practice system
- complementing local Electronic Palliative Care Co-ordination systems (EPaCCS)
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SCRs with additional information
Supporting those with long term conditions
These are key extracts from an example SCR with additional information
www.hscic.gov.uk/scr
[email protected]
@NHSSCR
SCRs with additional information
Scenario 2: supporting those with long term conditions
Kate is a busy working mother of three children. She has type 1
diabetes, complicated by neuropathy, eye disease and early stages of
kidney disease. The last thing she wants is to be admitted to hospital.
• As a patient with multimorbidity Kate was
identified by her GP
practice as someone
who could benefit from
an enriched SCR.
• Kate is out shopping
with a friend when she
feels shaky and weak.
• Kate’s friend drives
her to the nearest
A&E department.
• Kate’s SCR is
accessed and
contains information
about her diabetes
and contact details for
her liaison nurse.
• A note was added to
Kate’s record to offer
her the choice next
time she presented.
• By the time she
arrives her speech is
slurred. Staff identify
that she is suffering a
hypoglycaemia
episode.
• Kate’s insulin dose is
adjusted and her
liaison nurse confirms
that this is not unusual
and Kate does not
need to be admitted.
• When asked Kate
provided her consent.
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SCRs with additional information
Supporting those with long term conditions
“Continuity of information is a vital contributor to
continuity of care and better outcomes. The ability to
enrich Summary Care Records beyond medications,
allergies and bad reactions mean that more and more
relevant information from the GP practice will
be potentially available wherever a patient is receiving
treatment in the NHS. This will improve safe, effective
care and contribute to a positive experience for patients.”
Dr Martin McShane
NHS England Director for Long Term Conditions
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@NHSSCR
SCRs with additional information
Supporting those with learning disabilities
These are key extracts from an example SCR with additional information
www.hscic.gov.uk/scr
[email protected]
@NHSSCR
SCRs with additional information
Scenario 3: supporting those with learning disabilities
Lawrence is a middle aged man with a moderate learning disability.
He has difficulty hearing, his speech can be difficult to understand
and he gets anxious with people that he does not know. His sister is
his next of kin and is very involved in his care.
Lawrence attends an
annual health check at
his GP practice.
Key information from his
healthcare passport,
including his phobia of
needles and his interest
in football, is recorded
in his GP record.
In discussion with
Lawrence and his sister,
his GP makes a ‘best
interests’ decision to
create an enriched SCR.
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Six months later, he is
brought to A&E with a
carer. He has been
refusing to eat for the last
few days and clutching at
his chest. Lawrence’s
SCR is accessed which
shows contact details for
his sister. It also shows
anti-inflammatory
medication that he has
received recently and that
he has previously been
treated for gastritis.
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Lawrence initially
refuses blood tests but
he is persuaded to have
them by using local
anaesthetic cream and
a chat about football. He
is found to be anaemic.
An endoscopy is
arranged which is
supported by his sister.
He is found to have a
gastric ulcer. He is
started on treatment
and discharged home.
@NHSSCR
SCRs with additional information
Supporting those with learning disabilities
“People with learning disabilities often have their
behaviours misinterpreted as being part of their disability
rather than their illness – something we call ‘diagnostic
overshadowing’. The Summary Care Record helps
enable reasonably-adjusted care and more accurate and
timely diagnosis, which will make a very important
contribution to the efforts to reduce premature and
avoidable mortality.”
Dr Dominic Slowie
National Clinical Director for Learning Disability
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SCRs with additional information
Supporting older patients
‘When treating older patients, the Summary Care Record,
enriched with additional information gathered during the
process of Comprehensive Geriatric Assessment, or as part of
the proactive care processes within the primary and community
care setting, can be used to support decisions from the
beginning of any new episode of care. This will increase the
likelihood that complex conditions are accurately recognised
and more appropriate treatment plans put in place. This will
contribute to safer, more effective and efficient care for older
people across the urgent care system, potentially avoiding the
need for hospital admission or helping facilitate earlier and
safer discharge’
The British Geriatrics Society
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SCRs with additional information
Supporting urgent and emergency care
“Sharing data appropriately is central to the
implementation of the "Keogh" review of urgent and
emergency care. We know that when relevant information
is available to healthcare professionals outcomes, safety
and patient experience are all improved. The ability to
create richer Summary Care Records provides an
excellent opportunity to share additional information such
as care plans, and we strongly encourage primary care
teams to consider processes to seek the required consent
from those patients that would benefit most.”
Professor Jonathan Benger
NHS England Director for Urgent Care
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SCRs with additional information
Supporting urgent and emergency care
"The enhanced functionality to create enriched SCRs is
simple. I can record information once and share it easily,
which is fantastic! As an Out-of-Hours GP, I know the
importance of making sure essential patient information
can be accessed.
Creating enriched SCRs empowers other people looking
after my patients to be able to access accurate and
detailed information – it reassures me that my patients will
receive the best possible care whenever they need it.”
Dr Mark Spring, GP Sandford Surgery, Dorset and
Clinical Lead for Urgent Care Services
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@NHSSCR
SCR and local information sharing
The SCR, now and in the future, will:
• Provide a nationwide data sharing solution – a foundation
for access to a key set of common information that all care
settings need to access
• Complement local record sharing - complex care coordination will still occur at a local level using local systems
• Provide a cost effective solution for settings that have lower
digital maturity and where local solutions are not in place
• Provide a cost effective opportunity for health communities to
accelerate local record sharing by enriching SCRs with
additional information
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[email protected]
@NHSSCR
SCR and local information sharing
"At the Hampshire Health Record, we are always looking
to find ways of improving the efficiency, effectiveness,
safety and completeness of the information we provide
locally to clinical staff. We are very pleased to be working
with the Summary Care Record to integrate patient
information held nationally with the detailed information we
hold from hospitals, community, mental health and social
care providers locally. We believe this will give a more
rounded, accurate and timely picture of the patient journey
and improve patient care."
Peter Cambouropoulos
Programme Manager, Hampshire Health Record
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[email protected]
@NHSSCR
Where next for the SCR?
• Optimise the use of SCR, based on demand from care
professionals to improve integration and extend the
benefits to other settings
• SCR Expert Advisory Committee ensures proposals to
extend SCR use are subjected to consultation and analysis
• SCR is a core part of the Paperless 2020 agenda within
Domain D
National Information Board - Domain D - Integrated Care
We will better inform clinical decision making across all health
and care settings by enabling and enhancing the flow of patient
information
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@NHSSCR
Web:
www.hscic.gov.uk/scr
Email:
[email protected]
Twitter:
@NHSSCR
Sign up to the SCR bulletin:
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