The Local Care Record (LCR) is a clinical portal that provides electronic real-time access to shared service users records across all the participating providers from within respective electronic health record systems (with no additional logins). Clinicians are now able to view the health records from every aspect of the healthcare system (Primary, community and secondary care) for every individual service user.
The Local Care Record (LCR) is a clinical portal that provides electronic real-time access to shared service users records across all the participating providers from within respective electronic health record systems (with no additional logins). Clinicians are now able to view the health records from every aspect of the healthcare system (Primary, community and secondary care) for every individual service user.
By joining up a patient’s physical and mental health records, across acute, community, primary care, and making it available to clinical staff at the point of care, it means everyone is better informed. This allows clinicians to have clinical conversations which include the full breadth of all their clinical information, with service users and colleagues, in real time, rather than at a later date or by letter. Services can be delivered in a more joined-up way, reflecting all of the health needs of a patient.
“LCR has made a huge difference to many consultations (especially those involving SLaM) by allowing access to clinical notes and letters, but also accessing reports of investigations, Xrays and scans, dates of upcoming appointments etc.” – GP Practice Manager
Users have reported a better appreciation of the dual mental and physical needs of patients and service users. Clinicians are very enthusiastic about the real potential of Local Care Record to reduce length of stay and speed up decision making in emergency departments.
“In a professionals’ MDT meeting for patient with Learning Disability, the GP was able to show SLaM staff that she could access their notes and see the care-plan; so the MH practitioner team did not need to email / write to GP and all parties could mutually keep track of patient in both care settings without many letters to and fro.” – GP
If a service users goes into hospital in an emergency, the doctor treating them will know what medication their GP has prescribed for them, any allergies and access to a relevant mental health summary, quickly and easily.
The LCR has transformed how community teams plan assessments for patients and has markedly reduced unnecessary duplication of investigations. In the memory disorders service, for example, it is part of the assessment and treatment workflow prior to the visit which has allowed for faster diagnosis and treatment as investigations have often previously been carried out either at the Acute hospital or by the GP. Prior to the LCR often the only information the treating team would receive would be a referral letter which would not hold the results of all the previous investigations undertaken.
Community teams use the LCR to help monitor comorbidities that the patient may present with and has improved the communication between the mental health teams and GPs to improve the management of these.
The GPs regularly review the LCR and use the shared information on a daily basis. This has improved the risk management of our service users and has markedly improved the communication between primary and secondary care. GPs are able to see live clinical notes and therefore easily access treatment plans and risk management plans which has reduced the need for GPs to contact secondary care for clarification. This has allowed for more seamless care for the service user between primary and secondary care services.
“The biggest impact for me personally is I can see what is going on, and feel much more understanding of the whole care plan” – GP
Also specific examples have been identified in hospitals where diagnoses and drug information shared by GP practices has helped hospital professionals to improve the care they provide and their referral decisions.
The Local Care Record (LCR) is a collaboration between Southwark and Lambeth NHS Clinical Commissioning Groups (CCGs), their 91 GP practices and the three NHS Foundation Trusts within King’s Health Partners (KHP) Academic Health Sciences Centre – South London and Maudsley (SLaM), King’s College Hospital (KCH) and Guy’s and St Thomas’ (GStT). We have also collaborated with the local Citizens Fora for both Lambeth and Southwark and are now collaborating with the Local Authorities to drive this innovation forward and widen out information to the other agencies.
We have a very close relationship with these organisations and meet monthly at a Project Board with the members for every organisation regularly represented. There is strong Board level support from all of the above organisations to continue to develop this product with regular reports to the individual CEOs and Boards on progress.
Most importantly it has a strong support from the clinicians across the healthcare system who now regularly use it in their daily work.
In the last three months over 960 primary care users commenced using the portal, viewing on average 477 unique integrated patient records per day. This is already reporting up to a 75% reduction in phone calls from practices to hospitals chasing patient information and is encouraging more professional to professional discussion about patient care. This has significant patient benefits in terms of improved quality and speed of decision making.
The new system has already reduced the number of repeat appointments, duplicate tests and out-of-date administrative processes such as faxing and phone calls to chase information.
“LCR is seen as a resounding success and one of the most helpful systems introduced in years. It saves clinician and admin time and most importantly provides results to patients in a much more timely manner which increases patient satisfaction and helps to reduce understandable anxiety when waiting on an important result.” – GP Practice Manager
The clinical content published via SLaM via the Local Care Record is a result of consultation with patients, carers and staff primarily through the Trust’s Information Governance network. Our information governance team has both service users and carers within their group. The content accessible was modified as a result of discussions within these forums resulting in agreement by all parties. The service users and carers within these fora were directly involved in the construction of the content that is shared across the health system.
On a broader scale, SLaM participated at various Citizens Fora for Lambeth and Southwark within the local health community promoting, and taking feedback on development and use of the Portal. It is these community fora that now explicitly promote the use of the portal and are integrally involved in further designs and improvements to the Local Care Record. The community fora are made up of members of the local community from Lambeth and Southwark and are service users of the above hospitals.
Staff within SLaM have been actively involved in design and use of the Portal via engagement by the CCIO across clinical forums within the Trust. There is Health Record user forum within SLaM that is directly responsible for design and testing of any changes to the electronic health record. They continue to be involved in further iterations of the Local Care Record. We also review the utilisation data regularly to understand which teams use this and how it is used and hold discussions with these teams to help us to make further refinements.
Due to the success of the project as it is now, we should have had greater belief that the complex technology behind the Portal would work in the way it has. With projects as complex as this, there’s a reticence to promote as widely as we could have, due to the complexity of infrastructure and untested interoperability across multiple systems. In the event, this was unfounded and we should have had greater confidence in the technical solution.
We also slightly underestimated the complexity around information governance and some of the legalities around access to notes. This caused some delays initially to the project whilst these were overcome which put great pressure on the team to bring the technological development up to speed very quickly to put the project back on track. In retrospect we would have spent more time and started earlier engaging the various
Caldecott guardians initially over the information governance agreements that are required for this project.
The main challenge identified early on was the inability of the providers to provide real- time, electronic, safe and secure sharing of patient records. This ‘gap’ was a common theme holding back current and future care models.
It was determined that service users regularly attend clinical care at two or three of KHP’s partner organisations as well as their local GP practice. For example, data showed that 47% of patients seen at SLaM also had a record at GStT and 43% had a record at KCH. For those patients, the flow of information did not match their needs or movement between organisations and sites, care pathways were disjointed and important information was potentially unavailable or was slow to obtain (quality, safety and inefficiency).
“To think, we work in the same community, share the same patients, but IT has been this huge barrier in terms of knowing what care and support our patients are receiving and from where. So this really is a breakthrough” – GP
Therefore, early on work produced an overarching Information Sharing Agreement between the mental health trust, secondary care and primary care. This allow all partners to be confident in how service user information was to be shared, how to inform patients, deal with opt-outs from the Local Care Record etc.
The LCR is now part of the overall Notes system and fully embedded within the operational processes of IT. Rather than have a plan to maintain the service, the plan is on how to grow the LCR into areas of the organisation which it doesn’t currently serve. We are also working with our partners to understand how we can pool the data that is within the system so that we can analyse data and outcomes across the whole system and thereby show patient across the whole health system.
We are part funded by NHS England so have committed to report on the impact of the LCR across all partners. This work has been carried out by core project members. Work is about to commence on further research into the use of clinical technology and informatics via focus groups within Primary Care, which will now include the impact of the LCR in this setting. We are actively looking at the possibility of grant-aided Research projects specifically focused on the role and impact of the LCR across the wider health community as it becomes embedded as a clinical resource.
We have been sharing our work widely across the clinical networks in London. We have been giving talks about this work at various conferences both internal and external and have met with various Local Authorities and CCGs to disseminate our work. We have also shared our work with NHS England and have disseminated it across the Health IT network across the UK via talks, press articles and conferences.
We are currently writing an article for the healthcare press and health technology press on this programme of work.
The LCR has created a valuable resource for clinical staff and we are working to provide access to patient’s in a similar manner. SLaM has pioneered the use of a Patient Held Record within Mental Health through MyHealthlocker that has provided a range of self- management and monitoring tools alongside other content that can be shared by patients with clinicians and others, and we would like to afford LCR access to patients enabling better engagement and understanding of their own health. The LCR is a resource that now makes this a practical possibility, bringing together mental and physical healthcare, often viewed separately but now seen as one and giving the control and information to patient in their hands through their mobile devices.
