Integrating care: what’s needed?

By Stephen McMillan, Director, PwC

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Integrated care can reap dividends, if only the right practices are in place to support integrated information management.  The solutions are out there, but all too often not properly applied.

Last week’s Department of Health study evaluating integrated care pilots in England found that the programme has delivered few benefits.  Difficulties with sharing data and communicating across health and social care teams were identified as “a barrier to success”.  Reasons included lack of interoperability between the IT systems used by partner organisations and reluctance among partners to share patient data with one other “due to privacy concerns”.

A number of IT systems have already been proposed and piloted to share information across health and social care.  To share information more effectively, and to realise the benefits of sharing, four key principles should be established:

1. Establish stakeholder requirements and priorities. The priority in most cases is for clinical safety and patient care, and stakeholders must include not only clinicians, social care workers, and operational staff, but also carers and patients.
2. Make better use of existing IT infrastructure and investment.  Rather, before expending time and effort on new systems, utilise the excellent, established and trusted IT and IT services already provided by the NHS.  This has the added effect of minimising change, and greatly reduces the risk of failure.
3. Ensure systems work across the patient pathway.  Existing IT systems most commonly address requirements for particular organisations or departments; in the design of information for integrated care, the ‘horizontal’ patient journey needs to be taken into account.
4. Use real time information.  Too often, information presented is out of date.  Information needs to be updated and shared in real time to allow for instant decision making and scope for prediction of patient requirements. To facilitate this, users must be able to update information wherever they are, necessitating mobile access.

Some suppliers have successfully established protocols for data sharing across organisations; in time this should help integration.  And software such as portals are already helping organisations to integrate, by bringing together information and patient records to be accessed in one place, and shared in real time - negating the expense and inconvenience of investing in an all new system.  As one senior clinician said to me “I had given up hope that the NHS and its partners could share information, but it can be done and to the betterment of my patient’s care”.

More of this good practice can be achieved in integrated care if the organisations involved pay attention to these key information principles – which are already accepted and promoted by the health and social care sector.

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Contact Stephen McMillan

Comments

[Deborah Harris]

As a non-executive in the NHS I feel it is so important for board level discussions that recognise the need to constantly ensure the 'culture at the coalface' reflects the level of patient care and dignity we feel driven to provide in the services.

The integration of care is often lauded but not really moved forward, information sharing being one of the most common barriers. However, in some areas (eg child protection/ vulnerable adults) the sharing of information has made some great strides forward as clinicians and social workers focus on the raison d'etre - maybe the time is right to adopt a similar approach for developing integrated care for other sections of the patient community?