Integrated Care Records (ICR) are being developed at pace across the country – and with good reason. Improving integration between health and social care is a long-held ambition, and the ability to share data between organisations involved in the support and treatment of individuals is a significant step in enabling that vision.
It was against this backdrop that Coventry and Warwickshire Integrated Care System (ICS) began work on an ICR. But what started as a project involving ten partners covering a population of over 900,000 people, grew in both size and complexity, with the addition of Birmingham and Solihull ICS and Herefordshire and Worcestershire ICS, taking the number of partner organisations to 40.
The three ICRs are now up and running, with health and local authority partners already sharing and viewing data within their own ICS. It’s a great step forward - but getting to this stage didn’t come without challenges. To help other ICSs currently embarking on their ICR programme, we’ve outlined the principal experiences and learning points to help future programmes get off to a good start.
1. Shared vision and clinical leadership
The Coventry and Warwickshire ICR was a ‘must do’ to accelerate work already progressing as part of the Coventry and Warwickshire strategic vision, with the additional requirement of supporting the Nightingale Hospital at the National Exhibition Centre (NEC) should it be needed.
While the programme’s focus was on product delivery, the vision was to create the foundation for transformational change which would see better information sharing and consistency of approach across a large part of the West Midlands.
Maintaining that vision required a shared understanding of the benefits and return on investment. These included improving safety, clinical decision-making and clinical efficiency, as well as freeing up administrative resources and reducing time wasted on unproductive appointments due to lack of information. For patients, additional benefits include reduced risk of medication errors, fewer repeat appointments and only having to tell their story once. Benefits realisation is still a work in progress but an area that warrants focus from the start to help keep everyone pulling in the same direction.
2. Programme governance
Each ICS – indeed each organisation – had different priorities and challenges to navigate. We needed a way to ensure the programme kept moving ahead while giving each ICS the flexibility to make decisions pertinent to their own patch. The governance structure involved three programme boards, one for each ICS, plus an overarching ICR programme-wide board with membership reflecting each of the ICS’s stakeholders. Getting the set up right took a lot of navigating, particularly in ensuring board membership was balanced across health and local government.
To facilitate clear decision-making, each organisation was expected to put forward people who were empowered to make decisions on behalf of their organisations, or send a suitably qualified deputy if required – absence would not delay decisions.
3. Information governance (IG)
IG barriers can be successfully overcome but you must start early. Finding solutions that enable us to share the information clinicians and social care staff need to see involved a lengthy process, with each partner often seeking their own specialist legal input before agreeing a common approach. Building confidence with colleagues in primary care – the richest source of population data – was key, with both GPs and Local Medical Committees essential stakeholders in making this happen.
It took over 18 months to achieve but IG arrangements now provide the bedrock that supports the ICR programme. This was achieved by adopting an open and collaborative approach throughout, while also agreeing fixed points where decisions had to be taken to enable the programme to progress.
4. Stakeholder engagement
From immediate partners to the public, engaging effectively with stakeholders underpinned every aspect of this programme. This included accommodating the timescales and governance processes of the different organisations and ensuring consistent messages were being escalated to the right audiences in those partner organisations, particularly when it came to decisions about spend.
Don’t underestimate the amount of reassurance that will be required to give partners confidence in sharing information and decision-making, and keep in mind that you may not be talking the same language. Terminology varies, particularly between health and social care, so ensuring everyone has the same understanding is key.
Public engagement played a significant and supportive role in this programme, providing additional impetus for delivering the ICR. But there are pitfalls to navigate – enlisting specialist stakeholder engagement expertise enabled us to manage this aspect well, resulting in almost 100 people registering to take part in a forum and provide ongoing input about future digital developments across the region.
5. Supplier relationship management
All three ICSs had selected the same system supplier which made collaboration more straightforward. But avoiding the risk of multiple demands required a workable supplier contract with one lead negotiator. The complexity of agreeing this, and the time required to allow the inherent hurdles to be overcome, was something we had not fully anticipated – particularly when extending that contract to work across three ICSs. There were many challenges, and it was essential to ensure all partners had an opportunity to input into conversations with the supplier.
Even with the contract in place, we needed to address how could we ensure timely escalation of technical issues for all partners? The three ICSs worked together to fund and set up a technical helpdesk, with subject matter experts to handle the most common issues or escalate to the supplier where required.
Having an independent programme manager to guide the ICS partners through all the challenges identified above, proved invaluable. This enabled us to build confidence and trust among all partners and provide a clear structure to maintain momentum at a time when the pandemic added to the pressures being faced on all sides. That independence meant the programme manager was able to challenge robustly where needed and keep all partners on track to complete the programme.
In summary, ICR programmes are achievable – and can be delivered beyond system boundaries. But don’t expect success overnight. Even with clear decision-making, strong governance and independent direction, patience, determination and compromise will be needed to get your programme over the line.
This article was originally written for National Health Executive by Jayne Rooke, Programme Manager at Arden & GEM, and Alec Price-Forbes, Chief Clinical Information Officer at Coventry and Warwickshire Integrated Care System. You can view the article here.
