“The support which SCW provides has been critical to the development of our Integrated Care System. An example is SCW’s support to the development and delivery of the Connected Care shared care record programme. The development of a shared care record is a central building block to the overall development of our ICS – and to the realisation of our transformation plans for the system - and SCW’s support to us on this programme has been excellent.” Nigel Foster, Director of Finance and IM&T, Frimley Health NHS Foundation Trust
Podiatry Lead Diabetes "I work in a MDT clinic at the RBH, our team find it very useful for seeing what medications have been prescribed by the GP, particularly antibiotics (often patients unsure of the name) and for any interactions or contra-indications to therapy. When seeing NEW patients it’s useful to see medical history if referral letters are lacking information."
Specialist Children’s Nurse "I am the team Leader for Community Children’s Nursing. I have needed to use Connected Care whilst working a shift at the children’s respite centre to clarify a medication dose that had been prescribed by the GP. Without this service it may have meant me making several phone calls and possibly the child not being able to attend respite. When I have approached parents for their consent they have always been willing and think that this is a really good idea."
SCW has worked with a range of technology suppliers on a number of major local care records programmes to integrate data from multiple health and care providers and deliver benefits for patients, care professionals and commissioners.
SCW has been at the forefront of developing digital solutions with Berkshire East and Berkshire West to implement their vision to support the delivery of safe, effective and collaborative care using a digital shared care record as an enabler for service transformation. Berkshire East and Berkshire West comprise of seven Clinical Commissioning Groups (CCG’s) serving a population of circa 850,000. The provider organisations involved in the shared care record programme include two acute hospital trusts, over 100 GP practices, a community & mental health provider, an ambulance trust and six local authorities.
Berkshire East and Berkshire West reside within different STP areas, both of which are experiencing increasing pressure in the delivery of care. Financial models have identified a ‘do nothing’ funding gap of several hundred millions of pounds by 2020/21.
Although there was a broad alignment between providers and commissioners on the size of the challenge, Berkshire East and Berkshire West had been developing and implementing separate interoperability strategies. Using a number of facilitated workshops and a stakeholder engagement and communications strategy SCW was able to demonstrate that a single solution could be adopted to meet the needs of both geographic areas.
Critical to success was building the relationships between the provider organisations, ensuring a common language, identification and agreement of cross organisational requirements and a governance structure that maintained focus and enabled quick decision making.
Connected Care in Berkshire / Frimley was built using Graphnet's CareCentric solution, and is now providing integrated data for 18 health and social care partners across Berkshire. The programme oversaw the design of an interoperability solution that provides unique opportunities for health and social care providers to access whole-system data analytics.
- SCW managed all
pre-procurement activities including: requirements gathering, stakeholder
engagement, IG engagement, budget management, options appraisal, procurement
vehicle, early vendor assessment, ITT management and planning.
- This preparatory work
allowed Berkshire to conduct and complete their procurement within a three
month timeframe. Following vendor selection, SCW then conducted the contract
negotiation and partnering agreements required for such a complex
- Graphnet was selected to
supply their solution using the CareCentric software product which enables
health and social care professionals to view information from multiple care
providers in one place.
- The Connected Care solution went
live in February 2017 and is currently a read only shared care record. It is actively
being used by over 700 users each month, accessing between 3,000 to 5,000
records each month. This increases each month as
new data feeds become available.
- The Connected Care programme
in Berkshire reflects the ‘central repository’ architecture pattern, with data
from source systems shared via the extract management and integration engine
capability into the clinical data repository – currently on a nightly basis
from primary care and local authority source systems but in near real-time
information updates from Royal Berkshire Foundation Trust.
The clinical data repository provides access to:
- An integrated care record for professional use, with health and social care professionals accessing under role-based access
control. This includes work-flow support for clinical forms, alerts and
- A patient & carer portal / Personal Health
- Data for clinical analytics and risk-modelling
to support direct patient care, with plans to apply machine learning methods.
When fully implemented the platform will provide:
- A care professional portal with unlimited end
- A patient portal with unlimited patient portal
- Single patient view, alerting, notifications,
care plans, full auditing
- Integration for 20 organisational systems and
130 GP practices
- SCW managed all pre-procurement activities including: requirements gathering, stakeholder engagement, IG engagement, budget management, options appraisal, procurement vehicle, early vendor assessment, ITT management and planning.
Connected Care enables relevant information to be available at the point of care delivering the following (clinical, financial and personal) anticipated benefits:
- Safer care across care settings & more appropriate and
timely coordinated care.
- Improved health outcomes- leading to reduced attendance
across primary/secondary and tertiary care.
- Improved discharge experience.
- Ensures citizens needs/preferences regarding End of Life and Care Plans are observed;
For clinicians and carers
collaborative assessment, care planning and safeguarding.
access to a greater range of real time, accurate, complete patient data and
information at point of care to facilitate improved decision making and
in time spent looking for information/data, in turn freeing up additional time.
- Avoiding unnecessary or duplication of laboratory tests.
- Reduced ambulance conveyance costs- currently high due to
Long Term Conditions, Mental Health and frail elderly avoidable admissions.
- Reduced costs associated with more efficient prescribing
- Improved system wide workforce planning.
- Improved discharge planning, as a result of the availability of complete information about each patient resulting in a reduction in elective and non-elective excess beds days.
The shared care record allows for innovative developments, such as the creation of individualised care plans, creating co-ordinated multi-agency care for individual patients and enabling new ways of delivering services. Patients only need to tell their story once and healthcare professionals will be able to work together, with access to all the key information about a person, to give timely and seamlessly coordinated care.
The Connected Care programme in Berkshire was shortlisted for the Enhancing Care by Sharing Data and Information category at the 2017 Health Service Journal Awards.
- Safer care across care settings & more appropriate and timely coordinated care.