Future Care Capital reports on the Dorset Care Record following an interview with our SRO Dr Phil Richardson as part of its report on the progress of national care records
The Dorset Care Record
Interviews with: Director of Design and Transformation at NHS Clinical Commissioning Group and Dorset Care Record Senior Responsible Officer – Dr Phil Richardson
The Dorset Sustainability and Transformation Plan identifies three key challenges to overcome in the five years to 2023: the health and well-being gap – whereby health inequalities impact upon different groups of Dorset residents; the care and quality gap – whereby some services do not meet national quality standards and result in a variation of quality; and the finance and efficiency gap in health services – projected to be £229 million per annum by 2023. The Dorset Care Record (DCR) is considered critical in overcoming these challenges and working towards achieving a ‘digitally-enabled Dorset’ (Dorset Sustainability and Transformation Plan, 2017).
Development of the Dorset Care Record
In 2014, clinicians in Dorset expressed a desire to share information with partners and it
became clear that an integrated approach to data sharing across organisational boundaries
was key to enabling new models of care. Coupled with thinking nationally around the rollout
of Summary Care Records, of which Dorset was an early adopter, and the promotion of patient access to records, the DCR was identified as the preferred solution by key stakeholders.
Development of the DCR began in 2014 and partners anticipate it being rolled out to participant organisations in Autumn 2017.
Overview of the Dorset Care Record
The DCR will draw selected information from clinical record information together to provide
a single electronic record which may be viewed by approved professionals working across
the health and care sector. Part-funded by NHS England’s Integrated Digital Care Fund, and
supplemented by funding from partner organisations, the DCR has been developed with
technology partner Orion Health.
Design of the Record
1. Access
- The organisations with permission to access the DCR are: Dorset GPs, NHS Dorset
Clinical Commissioning Group, hospitals (Poole Hospital and Royal Bournemouth and
Christchurch Hospitals), Dorset HealthCare University Foundation Trust (community and
mental health trust) and councils (Borough of Poole Council, Bournemouth Borough
Council and Dorset County Council). A longer-term aspiration is to extend the range of
organisations able to access the record to include additional health and care organisations
such as hospices and nearby NHS facilities – providing the record’s information sharing
security criteria are met. - Geographical reach of the DCR: only participating organisations within Dorset will be
able to access the DCR, but the project is working with Salisbury, Yeovil and Southampton
hospitals to explore the scope for them to add information to the record in future, by
virtue of their proximity and role within the Dorset health ecosystem. - Secondary data access: there are no plans or provisions in place to share the DCR with
anyone other than professionals directly involved in an individual’s care.
2. Data Sharing
- How data is shared: selected data is drawn from an individual’s records and brought
together in a single electronic record – this record is then shared across a range of medical
settings and the three local authorities involved in the project. - Data included in the record: contact information and clinical records are shared,
including:
▪ patient contact details and care needs
▪ diagnosed conditions
▪ medications
▪ allergies
▪ test results
▪ referrals, clinic letters and discharge information - Information Sharing Standards: the Dorset Information Sharing Charter (2015) governs
data sharing by professionals involved in the DCR. The DCR generates an access log
recording who viewed it, when they viewed it and what information was accessed.
3. The Role of Citizens
- Consent: everyone registered with a participating organisation will automatically have a
DCR but sharing of the record works on an opt-in consent basis (i.e. people will be asked for
consent to share their record when they first visit their GP or another medical professional).
Individuals will be offered multiple consent options to choose from – they can provide
blanket consent enabling any professional involved in their direct care to access their record,
grant consent a to specific professionals, and choose to allow access either indefinitely or
for a specified time period. If an individual doesn’t provide consent for their information to
be shared, the contents of the DCR pertaining to them will remain hidden, with the option of
sharing the record in future. In keeping with the law, a patient’s carer or relative can provide
consent on their behalf should a patient lack the capacity to provide consent. - Public engagement: as the development of the DCR was linked to Dorset’s Clinical
Services Review, the views of thousands of patients were heard and fed into its
development. Leaflets, including an easy read version, have been produced to explain
the key features of the Record. The DCR also benefits from a comprehensive
public-facing website. - Public access to the record: individuals will not be able to access the DCR in electronic
format – although their record can be provided in hard copy format in keeping with the
DPA – but the DCR has plans to launch public access to the record in 2019.
Future Plans
- Extending the scope of information entered into the DRC: a number of additional
information sources are being considered for inclusion in the DCR which could contribute to a planned extension of the record from a patient record to one which more broadly covers the whole population. - Social care information: initially social care professionals will only have read-access to the
DCR – the next step is inclusion of social care information, including contact information and
care plans. - Additional detail from healthcare organisations: for example, looking to include access by,
and data from, hospices and neighbouring hospitals. - Wearables/patient contributed data: once an integrated digital care record is in place,there is the potential to incorporate information from additional data sources, including from wearable devices or remote monitoring systems. This could include connecting remote
cardiac monitors, for example, to better support people with Atrial Fibrillation who are at
very high risk of stroke if the condition is not well-managed – through the DCR they can be
connected to a person’s integrated record to provide clinician access to real-time data. - Extending access to the DCR: there are plans to make information available to all partner
organisations signed up to the record, including social care organisations, in future. This will
enable the production of a joint care record or care plan, whereas each organisation creates
its own care plan, using its own system, at the moment. Public access is expected by 2019,
and is widely regarded as an opportunity which could lead to clinicians entering into digital
conversations with service users – empowering individuals