Collaboration and team work are the key to successful programmes like the Yorkshire & Humber Care Record (YHCR). There are 74 organisations across Yorkshire & Humber, who have a vested interest in our integrated care record and the underlying technology we have developed over the last 18 months. Ensuring successful ‘buy in’ from all these organisations has been important. Without this our stakeholders would have been marginalised and their requirements misaligned. There were a number of key deliverables YHCR had agreed but two were critical:
- to develop and implement an integrated care record across the region and be accessible, appropriately, for the clinical and social care workforce and
- to create a ‘data ark’ which would access key patient information (de-identified) to provide risk stratification and pro-active planning.
The majority of the 74 organisations will feed both and the two are interdependent. Cross organisational working can be difficult, many organisational agendas do not necessarily align so it can be difficult to gain agreement between so many stakeholders. Our strong governance model helped.
Before the programme kicked off key representatives were involved in the bid for funding. They wrote the document detailing the programme and were part of the interview process with NHSx before funding was awarded. A set of objectives agreed by the delivery board made clear the aims of the programme; what we intended to deliver and how we planned to do it. Prioritisation of which organisations should be included in the initial pilot waves was agreed. Our joint organisational working relied on each party meeting specific criteria. A pilot site must already have electronic patient records (EPR) in place and not be about to undertake any large projects that would impact on their EPR. They must have enthusiastic engagement from their medical director and CIO and they needed to have technical resources available with an experienced project manager to ensure local development was undertaken in a timely manner. Peers from across the region made decisions at the delivery board as we progressed and continued the governance cascading decisions to each ICS using their voting rights to agree consensus and ratify board decisions.
Use of any integrated care record depends on mutual requirements. There must clear useful outputs for each stakeholder. A number of pilot sites were agreed by our delivery board with each organisation agreeing to make data visible from their EPR systems in a provider capacity and in turn each member was then able to consume that data on an equal footing. This has been done with appropriate information governance and signed off by the delivery board.
It was clear once planning began that the majority of organisations wanted to be able to view similar types of information from each other as patients moved between multiple care settings. The ability to see Yorkshire Ambulance Service (YAS) transfer of care for patients moving into a hospital emergency care setting has proven consistent across multiple receiving Accident and Emergency departments. The ability to view episodic patient records between primary and secondary is critical to improving quality of care across the region. So to ensure we were consistent YHCR developed a number of pilot use cases.
By working with clinical and social care across multiple organisations, we began to understand where the gaps in patient information lay. We found common themes and developed models that can be reused in repeated care settings. For example: clinicians treating patients in Leeds Teaching Hospitals NHS Trust who began diagnosis and treatment in Rotherham NHS Foundation Trust need to see patient activity prior to their arrival in Leeds. Rotherham and Leeds are pilot sites but this applies to any setting where a patient has a changes their care provider. YAS paramedics need to know if a patient has a mental health crisis plan in place to ensure the patient receives the best and most appropriate care rather than automatically taking a patient to the nearest A&E department.
All this required cross organisation working to the mutual benefit of patients. By breaking the work down into use cases with key staff from each pilot organisation we were able to develop solutions to the gaps in data. The use cases were ratified by the delivery board with representatives from all the STP/ICS organisations. Our governance model has allowed cross organisational working and we are now moving into Stage 2 of the programme. Rolling out our development and lessons learned from Stage 1 and continuing our successful joint working partnership across the Yorkshire and Humber.