Views from our Partners: Cerner

A citizen’s journey across the health and social care system is made up of a multitude of intricate steps and interactions, with a wealth of data to understand and interpret.

The focus of a citizen’s health has often been about illness versus wellness. Considering this duality is important and becomes all-the-more apparent when there is an integrated multi-disciplinary care team working across a system. Both of us can recall experiences whereby we have seen our peers struggling in the middle of a clinical shift trying to piece together a patient’s story. Documented care about patients is often siloed and focuses on the problem recorded on that day and misses holistic assessments across the health and care system.

Through our roles at Cerner and working with our clients and colleagues across the NHS, we can appreciate the power of an integrated care record; sharing data with the right person at the right time, and supporting clinicians and the healthcare team to deliver better outcomes.

Innovation in health and care is flourishing but there are still silos of clinical data that exist in a multitude of applications, systems, products and platforms that the healthcare team, citizens and patients must interact with. We live in an interconnected, information-rich age with the ability to share a wealth of clinical data that is not just beneficial, but often essential for all stakeholders. For this interoperability journey to progress positively, standards are a must and should be at the core. We firmly believe that aligning to and supporting PRSB standards are essential steps to aiding the national interoperability journey and this is why Cerner chose this partnership.

We started working with PRSB on small deliverables, such as workshops and supplier events. We were impressed with the truly multi-disciplinary and inclusive approach that placed the patient at the centre. As we continue to develop and enhance our UK workflows and patient journeys, the importance of aligning to PRSB guidance and recommendations was clear. PRSB represents the Royal Colleges, which provides our end users with a forum to provide valuable input into the design of those standards.

Cerner has worked with the NHS for over 25 years and we are hoping this will enable us to contribute positively to the PRSB partnership through sharing implementation experience, end-user feedback and adoption challenges, as well as potential areas of improvements to consider for future industry standards. Cerner is committed to improving patient experience and health outcomes, enhancing the clinician experience and enabling access to care information for all members of the care team.

As with all our products, content and workflow development, we aim to ensure that data is captured as part of the natural clinical workflow, making our products more intuitive and user friendly. We would like to bring the same ethos to the PRSB partnership, working with PRSB and other partners to ensure standards are not seen as obstacles but as enablers in delivering an integrated and connected citizen, patient and end-user experience.

 
Cerner overview

At Cerner, we believe in building positive, long-term partnerships that drive value across the health and care landscape. Our intelligent platforms and services connect people, information and care at 27,500+ facilities of all sizes in 35+ countries, and help manage the health of 223 million citizens across the globe.

In the UK, our powerful, open and interoperable Cerner Millennium® EHR platform is utilised by 144,000+ health and care professionals across 24 NHS Trusts to manage 1.5 million patients every month, our Health Information Exchange (HIE) is sharing over 19 million health records, while our population health intelligence platform, HealtheIntent®, is contracted to help clients proactively manage and improve the health of over 9.5 million individuals.

Author information

Andrea Dantas
Director, European Consulting Practice, Cerner

With training as a surgeon and a Master’s degree in International Health Management, Andrea joined Cerner in as a physician executive. She co-created the UK clinical transformation practice in 2008 and has been one of the two clinical leads for the UK Model Experience team since 2017. As one of the directors in the European Consulting Practice, she leads UK healthcare executives as part of the clinical transformation practice, focusing on clinical adoption and executive engagement.

During her time at Cerner, Andrea has driven our clients to the pursuit of value and outcomes through technology. She is considered by her clients as a trusted advisor, helping them shape clinically-driven and outcomes-focused strategic roadmaps for their organisations. As part of the UK Model Experience team, Andrea supported the transformation of our consulting approach to focus on patient journeys, helping further drive the patient to the core of what we do.

Tim James
Senior healthcare executive, Cerner

Tim joined Cerner in 2015 and has been involved in several EHR deployments, as well as working in partnership with multiple CCIO/CNIOs. Having previously worked in the NHS in a clinical informatics role, he is passionate about the development of nurse leaders in digital health and is an active mentor. Tim is also clinical lead and clinical safety officer for Cerner’s Model EHR content and workflows in the UK. He has insight in translating clinical practice into solutions and advising on digital health governance.

In January 2021 he began serving on the Royal College of Nursing e-Health Forum committee and is also a member of the Faculty of Clinical Informatics. Tim continues to work in clinical practice as a paediatric nurse in the NHS.

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.