SE Essex develops EPR for COPD patients

NHS South East Essex has created a shared electronic patient record across primary, secondary and community care for patients with COPD.

The primary care trust decided some years ago to develop an integrated primary care system strategy.

This involved moving the majority of its GP practices onto the hosted SystmOne GP, and deploying SystmOne systems into its community services and prison.  

It has now been able to create the integrated record for COPD patients by giving clinicians at Southend Hospital – which uses McKesson’s Totalcare PAS – access to the SystmOne GP COPD unit.

The PCT’s clinical lead for the National Programme for IT in the NHS, David Allan-Smith, said the hospital was initially looking to buy a bespoke system to handle administration of patients with chest disease.

However, Allan-Smith argued SystmOne could be adapted to meet the requirement for a shared single record between GPs, the hospital and community care.

With patient consent, clinicians at the hospital view the COPD unit and update the record using GP codes. They can then share the information with community services, including specialist respiratory and long-term care services, by email.

Allan-Smith said that as a result of the IT strategy 80% of GPs in South East Essex are using SystmOne, and that these practices cover most of the 400-500 COPD patients in the area.

Of the patients given the opportunity to share their information with hospital clinicians, fewer than 1% had refused.

“It’s a little bit more sensitive when you’re asking for the GP information to be shared because you’re asking for the whole patient record to be shared,” Allan-Smith said.

“We’ve had about three or four patients... who have refused to share their record. But the vast majority of patients have shared, and 95% of the practices have shared as well.”

Allan-Smith said the GPs who hadn’t been convinced to share their data were mostly concerned about providing information to other clinicians that patients might later decide they didn’t want shared.

However, he said the PCT was going through a stringent process of using formally signed acceptance letters from patients and holding these on file.

Meanwhile, he added that the hospital would like to create similar services for cardiac, renal and other patients needing services from a number of providers.

The primary care trust has also been working to develop an end of life register using SystmOne.

This will present an integrated, summary view of a patient’s record to out-of-hours providers before they visit a patient, and give them information about medications, care plans, planned visits by other services and the patient’s preferred place of death.

The idea is for information entered by GPs, Macmillan cancer nurses to be shared with the register in real time, so it is always up to date for the out-of-hours providers. Allan-Smith said the PCT was also hoping to get local hospices on board.

“In the long term the only areas are where we have an issue is the practices that aren’t on SystmOne,” he said. “Until they get onto EMIS, and then at least we can incorporate the summary care record.

“Other than that, potentially we could have a single electronic record across primary secondary and community care across a large number of our services.”

However, he warned that the “disintegration” of the NHS in the coming reorganisation would pose problems to maintaining such services, and called for a clear strategy to promote them.