Bodily and psychological healthcare work together in complicated and vital methods, and but historically the NHS has handled the 2 as separate points. Can digital shared data assist tackle this unhelpful separation and enhance affected person care? Jennifer Trueland investigates.
As a psychiatrist, Ayesha Rahim has educated for years to develop an experience in psychological sickness – and one of many key classes is that it doesn’t exist in isolation.
An individual’s bodily and psychological well being are inextricably linked however this isn’t all the time mirrored in how providers are designed or, crucially, in the best way that info flows between totally different elements of the well being and care financial system.
“People don’t exist in silos but care often exists in silos,” says Rahim, from the Royal School of Psychiatrists. “Having access to information means that you can make better clinical decisions.”
When speaking about psychological well being providers, it has virtually grow to be axiomatic to explain them as “Cinderella”. Chronically underfunded and nonetheless beset by stigma, even the price range announcement of a minimal £2 billion money increase is unlikely to show the psychological well being pumpkin right into a carriage and ship it to the ball.
Forward… after which behind
Hardly surprisingly then that, on the subject of digital, psychological well being providers have lately been felt to be lagging behind different elements of the system. This hasn’t all the time been the case, nevertheless. Digital pioneer Sarah Amani – who’s now senior programme supervisor at Oxford Educational Health Sciences Community however was beforehand a psychological well being nurse and chief medical info officer – says psychological well being was initially forward of the sport.
“It’s a bit of a paradox. The mental health world was using electronic health records ahead of other areas and most [trusts] went digital by 2009. But then not much changed in the next 10 years.”
This example might be about to be reworked – and never due to fairy godmother Philip Hammond both. A rising recognition amongst key gamers together with clinicians, distributors and senior managers that each one elements of the system ought to work extra intently collectively is galvanising motion, with some areas already a way down the monitor to a shared document which integrates bodily and psychological well being.
Health secretary Matt Hancock’s drive in the direction of interoperability is just more likely to improve the momentum, which is music to the ears of lovers resembling Rahim and Amani.
The advantages of sharing info are tangible, says Rahim, who holds the posts of deputy medical director and chief medical info officer at Lancashire Care NHS Basis Belief. Her personal space’s shared care system – the Lancashire Individual Report Trade Service (LPRES) – signifies that with affected person consent, knowledge from the GP report and from acute and group suppliers might be made out there to authorised members of the well being and social care financial system.
Enhancing effectivity and care
That is good for the service consumer, but in addition for the effectivity of providers, she says. Take the instance of a psychiatrist who needed to prescribe a specific drug for somebody’s psychological well being situation however who was conscious the person additionally had a coronary heart drawback. Beforehand, the prescribing determination would have needed to be have been deferred till recommendation could possibly be sought from the GP or heart specialist concerning the coronary heart treatment and any potential interactions.
“It could mean the patient would have to wait a few weeks and come back to see me for another appointment,” she provides. “But what I can do now is go into the service user’s record and look for myself. It can help me make a decision there and then without having to play around with phone call ping-pong or waiting to get information faxed over. It’s very powerful and has made a real, tangible difference.”
Actual advantages movement when communications between psychological well being and different providers enhance, says Nike Harte, options director with Cambio UK. “Where it works, the impact is incalculable,” he says.
From Sweden to Scotland
He factors to expertise in Sweden, which he says is additional forward than the UK relating to integrating and sharing affected person info throughout providers. For instance, Kronoberg County – the place his firm’s Cosmic healthcare info system has been in use because the early 2000s – has an built-in digital affected person report masking all the well being system, together with psychological well being, and has been recognised as a pioneer by the European Fee.
“In Sweden they’ve been doing it for 20 years now, and to them it seems obvious that you provide better healthcare when you share information,” says Harte. The UK is following go well with, he provides. Cambio has been commissioned to assist Scotland take an analogous strategy, by supplying a nationwide medical choice help system throughout the nation, beginning in main care with the purpose to taking in every part ultimately, together with psychological well being providers.
Harte believes that progress will velocity up when methods deployed in psychological well being organisations convey actual and instant advantages to the clinicians who’re utilizing them, together with medical determination help purposes that assist with day-to-day affected person care. “When it makes a real difference to the lives of clinicians, it will develop organically,” he says.
Michael Dolan, chief government officer of CareWorks, is a agency believer within the worth of bottom-up approaches to drive integration and knowledge sharing. He factors to Wales, the place the corporate’s CareDirector EPR system is bringing well being and group care collectively in what is called WCCIS (the Welsh Group Care Info System). “We’re seeing huge potential with organisations working together that previously hadn’t,” he explains. “It’s going really well and achieving a lot, with around two thirds of organisations up and running.”
What has been notably fascinating in Wales, he stories, is that the method has been opt-in, which means no organisation has been compelled to participate. “Nobody is forcing them together, and it’s been a very positive experience,” he says.
“Policy is the driver, but IT can show the way. On integration, for example, IT provides the opportunity for people to have that conversation, and provides the tool to help it to work.”
Recognising the potential of digital
There is perhaps thrilling developments now – and Dolan for one is a believer that the foundations are in place to make IT-enabled integration a actuality – however why has it taken so lengthy? And why have psychological well being providers lagged behind different providers in reaching digital maturity?
Rahim believes that organisations within the sector should recognise the potential of digital, one thing she says is already occurring at her belief. “Mental health organisations have borne the brunt of cuts to the NHS,” she says. “But we have a really informed and enthusiastic board – they really get it. It [digital] is not a little box you have to tick – it’s a golden thread running through everything that we do.”
That’s to not say that every thing within the backyard is beautiful, even the place there’s a will – and the requisite know-how and agreements – to share info between organisations. “You have to make sure your records are in a fit state to be shared,” she says wryly. “You wouldn’t want to share inaccurate data.”
Amani accepts that a lack of monetary funding in psychological well being is one purpose for the shortage of progress, but in addition factors to cultural points. “There’s a tendency for people to horde information rather than share it. Some of this is down to ignorance – people are misinterpreting data privacy law, although some clinicians are better than others.”
The necessity for bridges and sensitivity
There are specific points with sharing psychological well being knowledge, she concedes, with the stakes remaining decrease for details about bodily well being points. “It would be a very serious incident if someone’s schizophrenia were announced to the world,” she says. However, she believes there are vital advantages to an individual’s bodily and psychological wellbeing if providers are joined up – and the digital affected person report has an necessary position to play.
“There’s a real need to build a digital bridge between primary and secondary care and mental health,” she says. She cites the case of a affected person who places on weight due to taking a drug for a psychiatric situation. The load achieve places the affected person at larger danger of coronary heart illness and diabetes, each of which might be prevented if the affected person’s GP is conscious that the affected person is being prescribed the drugs and that it has these negative effects. “If the GP knows about it, they can ramp up the contact and monitoring accordingly,” she says.
She is optimistic that change is coming, and believes that the well being secretary’s public dedication to digital well being will assist. However she additionally believes that senior managers should get behind it by, for instance, by giving extra help to chief medical info officers to fulfil their roles.
As for Rahim, she doesn’t essentially assume there will probably be one “tipping point” the place we transfer to at least one shared report for psychological and bodily well being throughout the board. “I think we’ll get to the point where it’s happening – where it’s business as usual,” she says. “That will be good for clinicians and organisations – but most of all, it will bring benefits to the service user and that’s what we all want.”
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