NEW CARE MODEL
Integrated Primary and Acute Care System
Salford Together is a partnership between Salford City Council, NHS Salford Clinical Commissioning Group, Salford Royal NHS Foundation Trust, Salford Primary Care Together and Greater Manchester Mental Health NHS Foundation Trust.
Salford Together vanguard aims to help those who are well and healthy to stay active and busy, so they stay healthier for longer, and support those who have care needs to improve their quality of life and independence. The programme is also anticipated to deliver around £27m of recurrent savings by 2021 through reducing hospital admissions and eliminating duplications across the health and social care system.
HOW ARE THEY HARNESSING TECHNOLOGY?
Salford Together vanguard are pursuing plans to become an Integrated Care Organisation (ICO), an ambition which grew from much smaller integrated care programme for older people in Swinton and Eccles. The ICO brings together the contributions of GPs, district nurses, social workers, mental health professionals, care homes, voluntary organisations and local hospitals into a more aligned system.
The ICO, which is delivered by Salford Royal in the role of prime provider for all adult health and social care services, also commissions mental health services and has responsibility for domiciliary and nursing home care.
A key factor in bringing many organisations and disciplines together is ensuring that there is a workable IT system and the right technology in place. So too is the development of a shared care record system across many diverse systems – from GP, hospital and social care records. This has required a significant programme to plan the interoperability and integration solutions.
Some of this work has been considerably challenging, for example, when 450 adult social care staff transferred across from the Salford City Council to the health team under Salford Royal to create a new team of health and adult social care workers working together.
Social care staff still needed to access the council’s CareFirst record system, plus a number of other sub- systems, and the document management system that feeds into that. They also had their own internal communication system allowing them to track who was in the office, or out on visits, and real-time messaging to get quick answers from colleagues to help speed up ways of working.
“All of these systems were business critical to the way social care staff did their jobs. The difficulty of integrating council colleagues onto the trust’s IT system while still retaining access to their core systems, mustn’t be underestimated” says Phil Bell, Salford Royal’s information management and technology deputy chief information officer.
In March 2016, Salford Royal selected Allscripts CareInMotion population health management platform to supersede their existing shared integrated record system to help make the transition to Salford Together’s new model of integrated care. The platform helps healthcare organisations share data across disparate systems within clinicians’ workflows. It also offers a framework that enables healthcare organisations to address their specific population health priorities through, for example, predictive analytics, care coordination and patient engagement.
Salford Royal also uses the Allscripts Sunrise Clinical Manager, an electronic health record solution.
This includes areas such as A&E and critical care, departments which previously relied on paper. This has enabled staff to electronically record and track decisions about patient care, which has been integral to the trust’s strategy to be the safest organisation in the NHS.
Initially, the electronic health record solution will connect Salford’s acute doctors and GPs (INPS and EMIS Health GP systems), providing them with a comprehensive view of patient information to enable fully informed care decisions. Eventually, the trust’s existing integrated Electronic Health Record (EHR) will be connected to the broader community.
WHAT HAVE THEY LEARNED?
Bringing such large organisations together meant tackling some big barriers. For instance, the council and trust had very different approaches to IT and worked within different environments. A lot of work was undertaken to coordinate and get networks together. Seemingly simple things took longer than expected, such as enabling trust wifi in the council buildings and vice versa.
There was also the challenge of social care staff being given new email addresses whilte retaining log ins to the council system. Staff were using council hardware on council networks and logging on to the Acute Electronic Patient Record remotely. The project team had to tie in council networks, making sure that software versions weren’t conflicting, while ironing out some of the initial wrinkles of remote sessions dropping out.
It was important for the information management and technology (IM&T) team to understand how the newly formed ICO would work and what people required to do their job. To help staff understand the ‘art of the possible’ and build the vision in partnership with IM&T, the team held an open day where staff could find out about what the shared integrated record could do and deliver. IM&T also held workshops so that they understood systems and processes used by staff, and how staff wanted to work in the future.
The team is keeping an eye on the broader landscape, particularly the other technologies and innovations such as GM Connect, which is looking at wider data sharing across Greater Manchester, to ensure they are not doing anything that overlaps with or contradicts the Greater Manchester strategy.
Phase two of the project will look to create single logins from anywhere staff are working to ease frustrations with logging into remote systems. To enable this, Salford Royal is looking to take over the management of the hardware because the core systems, such as the electronic patient record, are managed by the trust.
Salford Royal has also signed a contract with a US data platform supplier to help plug into data from wearables used by patients, such as fitness and sleep data. As part of its pilot testing, patients’ sleep, heart rate and exercise data is integrated into their EHR so that clinicians can assess their metabolism and modify medication accordingly. If successful, the system could be expanded to include a wide range of clinical, biometric, lab and lifestyle data. It could also be aggregated into databases to be used by researchers at a population level.
For further information, please visit www.salfordtogether.com
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