An ambitious programme to move every GP practice in Milton Keynes onto a single integrated patient records system is not just delivering better quality data, but is facilitating truly integrated working for the benefit of patients, says David Churchill, Head of Clinical Systems at NHS Arden & GEM Commissioning Support Unit.
Over a quarter of a million patients across Milton Keynes are now benefiting from more accurate, consistent and effective healthcare thanks to an ambitious and multifaceted programme, which has seen every GP practice and 12 Primary Care Outpatient Clinics (PCOCs) in the area move to a single integrated patient record system.
From the outset, the focus of this project has been on delivering clinical change – adopting new ways of working that put patients at the heart of service delivery and support GPs in their efforts to provide the highest quality care. Beyond improving data quality, this project has encouraged and enabled integrated working, not only across GP practices but also among community health and social care teams.
Opportunity knocks
Milton Keynes is home to 27 GP practices, covering a population of over 250,000 patients. With many patients being treated by a range of NHS healthcare professionals in a variety of locations all using different systems, information – and effort – was being duplicated.
With the advent of the PCT Clustering Arrangements in April 2012 the Primary Care Trust in Milton Keynes identified an opportunity to review the clinical information systems and consider introducing a single supplier. Arden & GEM Commissioning Support Unit (CSU) took the project forward in April 2013, in partnership with Milton Keynes Clinical Commissioning Group (CCG).
Getting our ducks in a row
Using our bespoke project management system, we invested time in assessing all the potential benefits and barriers which could impact this project. Our aim was to deliver benefits that not only made life easier for clinicians, but directly improved patient experience. Among our extensive list of requirements, we wanted a system which would enable clinicians within a practice to share information, with the patient’s consent, with the capability to allow specialist clinicians, Out of Hours doctors, nurses and pharmacists access to some elements of a patient’s record.
Working closely with Milton Keynes CCG, we established a clinical group to determine pathways for specific illnesses and conditions. By agreeing a standard pathway, clinical templates could then be set up in the system to support business process standardisation across the patch.
A full audit of the hardware and software in use by the 27 practices followed, in order to identify and budget for the necessary upgrades and replacements to enable every practice to benefit.
Implementing the solution
Between January and December 2013, the system was successfully rolled out to the 27 practices, including the migration of 260,000 patient records alongside installation of new hardware to enable patients and clinicians to realise the full benefits of the integrated clinical record system.
With 600 staff impacted by the project, a dedicated programme of training and support was established which covered both standard and bespoke information. The training ensured clinicians sought patient consent before recording information which could ultimately be shared with other professionals involved in their care. The patient remains in control of what information is or isn’t shared.
Secure yet flexible
Security was a key element of this project from the outset. While there has traditionally been some nervousness around access to personal information of this kind, there is an overwhelming benefit in improving safety. With multiple clinicians accessing one single record, there is a much-reduced risk of duplication or error down to missing information or incomplete notes.
All patients in Milton Keynes can now access online services. Currently they can book appointments, manage their medications and view a summary of their care record. By April 2016, they will also have access to coded portions of their records including community entries (such as those made by district nurses and mental health services).
Realising the benefits
Health professionals are now more able to structure their thoughts and make appropriate decisions, with all the necessary facts to hand, including lab results, specialist letters and prescribing information.
In addition to improving data quality and patient safety, the programme has delivered a number of additional benefits for both GP practices and patients, including savings in practice costs and administrative overheads of over £400k per annum, reduction in duplication of activity, lower third party costs thanks to integrated SMS messaging and scanning software, and Improvements in reliability and consistency of information and care.
Widening the impact
We are now managing a pilot with Milton Keynes Council which brings together health and social care systems. Using the same software, multidisciplinary teams can now also access a patient record where appropriate. Continuing the integration of primary, social and community care, the project’s next phase will see a rollout to Central and North West London NHS Foundation Trust (CNWL) who provide community health and mental health services within the region.
In enabling more efficient, secure and accurate ways of working together, we believe the Milton Keynes integrated patient records programme has set a useful blueprint for other regions looking to deliver joined-up care.
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