Main Report of the National Review of Primary Care Out of Hours Services

9 Data and Technology

Aim

The prime objective of the Data and Technology Task Group was to develop recommendations for improved functionality for:

• Communications and data flows to support new ways of working in OOH services.
• Requirements for clinical records, decision support and integrated records
• Complete, accurate and timely information fundamentally underpins safe and effective health and social care
• Clinicians and social care providers require information to be routinely shared if they are to provide optimal care to patients and citizens

The full report of the Workforce on Data and Technology is available on the Review website.

Recommendation 21 relates to data, technology, mobile and communications infrastructure

Methodology

In addition to the evidence base, the Data and Technology Task Group took account of the Scottish eHealth Strategy, the Caldicott Principles and the Newcastle Declaration as follows:

The seven Caldicott principles must be observed for justified use of patient data, ensuring security and patient confidentiality and the obligations of users. This includes the duty of sharing information, which is as important as the duty of protecting patient confidentiality.

The principles of the Newcastle Declaration (2015) should also be taken into account and in particular:

• Complete, accurate and timely information fundamentally underpins safe and effective health and social care
• Clinicians and social care providers require information to be routinely shared if they are to provide optimal care to patients and citizens

A preliminary review of the OOH Information Technology (IT) system (Adastra) was instigated and its findings contributed to recommendations made.

The data and technology challenges for OOH services are the same as those for daytime working. The recommendations offered may have potential to improve all health and social care systems in Scotland on a 24/7 basis. Levels of health literacy, ease of access to data and the information needs of both patients contacting OOH services and staff also emerged as areas for improvement.

The nature of how people access out of hours services, was explored through extensive consultation with individuals with special access requirements. Questionnaires and workshops were arranged with the support of the Health and Social Care Alliance Scotland. Discussions focused on the need for integrated patient records and improvements at the interfaces of care, widening patient and multi-sectoral professional access to securely held electronic records at the right time, irrespective of place or circumstance.

Detailed recommendations by the Data and Technology Task Group are presented in its full report available on the Review website. Some short term priorities, listed as 'quick wins', are already underway or considered to be urgent. The recommendations offered address the following issues:

• Lack of integrated IT systems lead to poor quality of communication, particularly at handovers of care with safety risks
• Patient care plans should be available electronically 24 hours a day to front line services
• Primary Care OOH is not a priority component of the national IT strategy and this is reflected at local levels in terms of resource allocation Lack of national standards and infrastructure for recording and using information. Variation in implementation causes confusion and frustration for clinicians, and an inconsistent service for patients
• People with particular communication requirements are disadvantaged. Standards for accessing support and information are inconsistent and those in place are not adequately implemented

Summary

• A consistent view is required of all relevant health and social care information necessary to provide optimal OOH and urgent care. Subject to agreed consent, this information should be available securely to the right people at the right time, irrespective of care setting and location
• Consistency of data sharing must be improved and should underpin better person-centred care
• All health and social care stakeholders should agree a common summary of defined data items and updating protocols
• Current referral records and mechanisms are fragmentary and are often still paper based. Referrals from OOH services to all care sectors should be electronic and fully auditable, in order to ensure effective and timely continuity of care
• The NHS NSS National Unscheduled Care Framework presently advises on the procurement of NHS IT systems. In partnership, this framework should now be reviewed in the light of future health and social care integration requirements

• A collective service-led review of OOH IT systems currently in use and related governance arrangements is urgently required in order to deliver national consistency in use and optimisation of individual patient care and information

The Review Group recommended that better use should be made of video and mobile communications and technological innovation:

• High quality and reliable video links should be in place between Urgent Care Resource Hubs and local Urgent Care Centres (Recommendations 3 and 4). This technology should also be deployed to support practitioners in remote and rural locations, in intermediate care settings - residential care homes and community hospitals, in the Scottish Prison Service and for mobile healthcare delivered by SAS. The technology may also be appropriate for location in the homes of some patients with complex care needs.
• The Scottish Centre for Telehealth and Telecare, in collaboration with the Digital Health & Care Institute, should look to support the development and roll-out of proven technologies at scale, including accredited mobile applications for self-care and access to the most appropriate care services, subject to appropriate evaluation.

All of these recommendations are assimilated as Recommendation 21.

Multidisciplinary Social Services Community Alarm Scheme, Dundee