This document discusses principles of sharing patient care records between healthcare providers. It outlines different methods of record sharing, from basic summaries to full integrated records. Key principles are that patient safety and privacy must be paramount. Effective record sharing requires reliable identification of patients, attribution of entries, and application of data standards. The document also examines what information primary care providers need from hospitals to effectively care for shared patients after discharge.

1. Sharing of Care Records
Dr Maureen Baker CBE DM FRCGP
Chair of Council
RCGP

2. Declaration of interests
• Strategic Safety Adviser to HSCIC
• Previously Clinical Director of Patient Safety
HSCIC (NHS CFH)
• Led development of NHS ISB safety standards
(ISB 029 and 060)

3. Record sharing methodologies
• View of Information (Summary Care Record)
• Access to electronic record (where view is
governed by sharing model and patient
consent)
• Inter-operable records
• Full access to full shared record

4. Principles on record sharing
• Patient safety is paramount
• Personal information should be subject to
highest standards of privacy and
confidentiality
• Tension between above two must be properly
governed (eg Caldicott Guardian)
• Views and entries must be reliably timed and
traceable to individual caregiver

5. Factors to consider
• Could be creating long-term record (many years
and multiple episodes of care in multiple
settings)
• Major differences from record focusing on one
episode of care (eg hospital in-patient)
• Safety dimension in accurately identifying critical
information quickly (eg drugs, allergies, results)
• IG dimension in protecting info that patient does
not want widely shared

6. Designing for safety
• NHS needs systems as safe as design and forethought will
allow
• System designers need to think how technology can
support clinicians in safe practice
• Systems need to be tested in 'real' environments
• Safe view (right patient, right information)
• Safe transfer (retention of semantic meaning; right field
to right field)
• NHS safety standards must be applied (NHS number; ISB
029)

7. The Holy Grail
• Timely
• Reliable
• Accessible
• Concise
• Coded
• Attributable
• Retrievable

8. Data to inform
commissioning decisions
• Any data from anywhere in NHS system has
potential for commissioning
• Demographics; Drugs; Interventions;
Outcomes
• GPs currently have most comprehensive
coded datasets over longer periods of time

9. Rubbish in rubbish out
• Data quality is a patient
safety issue
• Data quality is a
commissioning quality
issue
• Need a system-wide
understanding of
importance - but also
limitations - of data
quality

10. Clinical information for commissioning
• Need routine capture as 'by-product' of care process
• Must minimise (preferably eliminate) burden of data
capture for clinicians
• Appropriate patient consent models MUST be in
place
• GPs and practices need mechanisms to allow
patients to enable patients to exercise their choice

11. What GPs want
• Timely discharge information
• Results
• Key events during admission (not always clear,
or on discharge summary)
• Drugs at discharge and reasons why any
changes made to previous regime
• Follow-up information/requests

12. What GPs
DON’T want
• Blank or minimal information
• Vast amounts of detail specific to
admission (eg nursing notes)
• Lists of instructions (eg GP to.... –
Grrr!)

13. Safety handover guidance
• Based on extensive work
by national and
international organisations
• Endorsed by the DHIDs
National Clinical Content
and Requirements Board
in partnership with the
Royal College of Physicians
(RCP)
• Contains a check list for
Clinical Safety Officers to
use when reviewing
handover IT systems for
use in the NHS

14. Guiding principles
• The data items constitute a core set of issues which must
be used in any and every electronic clinical handover
• The core set of issues is necessary but not sufficient for
any and every electronic clinical handover – each health
care setting will have its own, additional set of essential
data items to be transferred in a clinical handover
• The guiding principles and related data items for ensuring
safer clinical handovers are additional to, and not instead
of, all usual clinical safety assurance measures as set out in
Data Set Change Notices (DSCNs) 14/2009 and 18/2009

15. Data items
• Name (‘last name’ and ‘first name’ as endorsed by the ISB standard
04/2009)
• Date of Birth (DOB)
• NHS Number
• What is wrong with this patient? e.g. Active clinical problems
• What has been done? e.g. Relevant investigations & treatments to
date
• What needs to be done? e.g. Action plan – including when and by
whom
• Medications – current
• Anything else I should know? (eg. Alerts such as risks, allergies,
statuses, disability; resuscitation status; advance directives; next of
kin)
• Responsible consultant/team/clinician e.g. GP or nurse making the
handover

16. Conclusions
• Very few/if any truly integrated records in NHS
• Integrated OR interoperable?
• Local health economies and emerging
Integrated Care Organisations should consider
options for integrated records
• Basic standards already in place – NHS no.,
safety standards, electronic handover guidance

17. Thank you!
@Maureenrcgp