Make shared care records work for urgent and emergency care

Expecting paramedics to wade through shared care records is unsafe and inefficient. In an emergency, access to essential information has to be easy and fast, writes Claire Jones from NHS England South West

With winter biting hard, demand for urgent and emergency care is at a peak. We already know that access to the right information is key to supporting clinicians’ informed decision-making and health and care outcomes. However, this is even more critical in urgent and emergency care services when time is everything and professionals need to make urgent decisions about the person’s situation.

I want to be confident that my care needs and preferences are readily available to those providing care in an emergency – whenever and wherever I need it. This should also be possible across borders, so that people can be assured that their information will ‘travel’ with them and will be accessible, particularly by ambulance teams in an emergency.

There are 42 integrated care systems in England with 32 shared care records, which is excellent news for planned and elective care. However, the expectation that paramedics will access the multitude of current shared care records is unreasonable, unsafe, and inefficient. It is like asking them to flick through tonnes of paper notes. It isn’t feasible for any clinician, and it certainly should not be expected in urgent and emergency settings.

Whilst ambulance services may need access to the entire longitudinal record, it is imperative that in those first vital minutes of an emergency they have the most pertinent and relevant data at their fingertips. In such cases, information sharing can be a matter of life or death. We should make it as easy as possible for emergency care providers to access and view relevant information about the person in their care.

Support critical decision-making

Ambulance teams need a defined set of information that can be shared to support timely, critical decision-making in urgent and emergency services – and the Professional Record Standards Body’s Core Information Standard can help make it a reality. The standard enables information to be shared between systems in different sites and settings, among professionals and people using services. Different components of that information can be shared and accessed depending on the setting in which it is required.

Ensuring that emergency care providers have the right information to deliver critical care will help avoid unnecessary transfers and help people receive further care at the right setting, improving their experience and overall outcomes. It will also help enhance confidence in decision-making and empower providers in delivering high quality care. Emergency staff shouldn’t have to worry about needing to create workarounds or wasting time logging in to multiple systems.

There is a shared national agreement that urgent and emergency care data is a flagship use case. The next step is to define a view of the information in a shared care record that is relevant for urgent and emergency care. This would be a landing page or a filter of time sensitive information so that ambulance staff, at the press of a button, have the essential information they need to make the right clinical decisions based on the care protocols they follow. They wouldn’t have to scroll through data that is not relevant in urgent or emergency circumstances. National technologies to make this data routinely available to all 10 ambulance trusts still need to happen.

A CCIO in every ambulance trust

This is where having a chief clinical information officer in every ambulance trust is so important because they have the clinical knowledge of what is needed operationally and the leadership skills to make it happen. Anyone in a green uniform is clinically active and does not typically have time available for the transformation activities required to enable the sharing of time critical patient data.

Unlike in other parts of the health system however, CCIOs are only just being recruited by ambulance trusts. London is ahead of the curve in this regard, but this is not yet the norm.

We need to innovate collaboratively and that means across ICSs and shared care records, not just amongst ambulance trusts. South Western Ambulance Service NHS Foundation Trust covers seven ICSs and six separate shared care records. How can we create a single view for all ambulance staff in the South West, let alone across the country? ‘Once and well’ is a mantra that we have adopted in the South West and I would urge others to adopt it.

It would make sense for an organisation such as PRSB to develop a standard ‘view’ of the subset of the the Core Information Standard that is needed to provide urgent and emergency care so that can be implemented by  ambulance services, shared care records and ICSs. This would effectively guarantee that whenever and wherever a person requires urgent and emergency care their essential clinical information would be available immediately.

National efforts are needed for this to happen, and progress towards better interoperability between systems and health and care providers needs to speed up. ICSs (of which ambulance trusts are a part), should be empowered to take the key steps to make real, permanent improvement in the system. A lack of timely information sharing and access in urgent and emergency care inevitably results in delays and mistakes. People’s lives depend on us.

Claire Jones is the clinical lead for digital transformation in NHS England South West.