Since the onset of the pandemic, our healthcare system has shown its capacity to adapt and innovate to deliver improved services. Greater Manchester is leading the way, having accelerated the development of its single care record system for almost 3 million people in the region.
We spoke to Laura Rooney (LR), director of strategy and corporate affairs at Health Innovation Manchester, and Binita Kane (BK), a consultant respiratory physician at Manchester University Foundation Trust, about what has been achieved, future plans to use the data to further improve patient care, and how clinicians can support digital innovation and the redesign of services.
What is the Greater Manchester single care record, and how has COVID-19 affected its development?
LR: Up until March of this year each of the 10 localities in Greater Manchester could only access patient records from their own area. The Greater Manchester (GM) Care Record joins up health and care data from across Greater Manchester.
The project was already in the works before the pandemic, but when the Control of patient information (COPI) notice was introduced in response to COVID-19, it mandated that NHS organisations shared data as part of the COVID-19 response. This helped to unlock some of the information governance barriers, but we still had to negotiate with over 500 data controllers.
Now 99% of patients in Greater Manchester are covered by the GM Care Record, and the usage stats are very high.
How has the GM care record helped clinicians?
BK: It has had a huge impact. For example, now I can see the GP records for a patient who lives in Wigan, which was impossible before. As a consultant in a big tertiary centre it makes a huge difference. Most patients wouldn’t think that would be such a transformative thing, but it is. Clinical decision making is simpler as we now have up-to-date information on test results, care plans, medications and social care support.
How do patients feel?
LR: When we spoke to patients, we found they were expecting the NHS to be doing this kind of thing already. Clinicians have to inform patients that they are accessing their record, and they have to justify why, so there is an audit trail if needed. The plan is to run focus groups with patients as things ramp up.
What are your future plans for the GM Care Record?
LR: The past few months have been focused on getting the care record up and running, and now we need to evaluate its success. We want clinical insights to tell us where it is being used most, where does it have the most value. This will help us decide how to develop the project further.
There is a lot more to do. As well as direct clinical uses the record is also a huge source of data. We are looking at ways we could use it to plan the recovery from COVID-19. How would care homes benefit from access to this data? What about discharge summaries? We’re getting more and more ideas from the clinical community all the time.
Thankfully the COPI notice has been extended until March, which gives us more time to test and develop the record in collaboration with clinicians, data controllers and patients.
Manchester has devolved powers over healthcare. Has that had an impact on this project?
LR: Devolution has helped massively. Progress is founded on trust and relationships, and that is one of the consequences of devolution. I’m not sure all areas have that. Plus, with COVID-19 it means everyone is focused on one thing.
We aren’t the only area looking at innovative ideas like this. The local health and care record exemplar program at NHSE has been going for a few years, but I’m not sure if other areas have the breadth and depth that we have quite yet.
How can clinicians support digital innovation and the redesign of services?
BK: Leadership at systems level is very important, but clinicians must be engaged. Clinicians must make sure the system is doing the right thing for patients. We need doctors to become digital champions, or the system won’t change in the right way.
Digital transformation means more than simply replacing your face-to-face consultation with a virtual one. It is about working with people and processes to change capability and culture. You need to think about whole pathways of care from primary/community to secondary and vice versa. Digital redesign can completely change the way you run your service. Think of Amazon, a digital service that has completely changed the way we shop. That is the level of disruption we should be aiming for.
One example is the SmartHearts project, which uses the data from implantable devices to detect early deterioration in patients. This allows us to go out into the community to administer treatment. It saves the patients an unplanned hospital admission and can prevent their condition worsening.