Information-sharing to support joined-up care

pharmacy

Information-sharing to support joined-up care

Introduction

The changes planned in health and social care over the next decade – from reducing premature births to helping people live healthier, longer and more independent lives – are all underpinned by better use of information and technology to improve care.

In order to realise these benefits, we need to agree what information should be shared and deploy systems that will talk to one another across health and social care, with the right safeguards in place.   The PRSB are working with citizens and health and care professionals to define this in a ‘core information standard’.

How much information should be shared?

In the future, digital advances mean that most, if not all, information related to a person’s health and care can be shared with care professionals and citizens themselves. This is subject to being able to demonstrate that there is a legal, justifiable need to share for the benefit of the person.

We are a long way from this goal today so we need to start with a modest set of core information that is a realistic and achievable goal for most health and care systems over the next few years. The draft core information standard described here will include important information from a range of sources including primary, secondary and specialist care as well as social care and information contributed by individuals themselves.

In consultation with professionals and citizens on what a standardised set of core information should include, it is clear that achieving widescale adoption over time of even a modest set of information that can be shared between information systems would deliver profound improvements in the quality, safety and efficiency of care.

The core information standard

The core information standard will define a set of information that can potentially be shared between systems in different sites and settings, among professionals and people using services.  Which components of core information are accessed and used will be different depending on:

  • Who you are e.g an A&E consultant, a GP, a physiotherapist, a person accessing their own records
  • The situation e.g a crisis or emergency situation, being discharged from hospital to a care home, managing a long-term condition
  • The wishes of the person the information concerns regarding who should have access to their information e.g all my information can be shared, only my GP should have access to my sexual health history

How these different views of information are physically presented in systems will be dependent on system vendors and local implementers. It should ensure that the required information is presented in a way that is useful and usable and supports professionals to do their work efficiently and safely and citizens to access the information they need to manage their own care.

This is a journey.  The core information standard will provide a framework which local health and care systems can reference and move towards over time, according to their local priorities and capability to innovate and change at a speed that makes sense for them.  The core information is a baseline, and it is expected to evolve and grow as we learn from its practical application and use.

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”