UKCore Hackathon Supporting Guide

Referrals and Workflow (IoW)

Tasks are crucial to promoting joined-up care between healthcare settings and PCNs. There is currently limited connectivity between primary and secondary care which makes negatively impacts the provision of joined-up care.

This is best illustrated through an example of how this applies in patient care. For this illustration we have chosen the to-be process for a patient wound assessment and treatment in different care settings (in this case primary and secondary / community care).

• A request is made from a GP to get a wound assessment and treatment from the community team, which is messaged through RiO (clinical system used by the community Trust) • Community Team Process Message and (if appropriate) automatically set up referral and pass through to the relevant team
• Community Team Visits and assesses that antibiotics are needed and photograph the wound.
• Community Team then messages the surgery to request a prescription for antibiotics and send the photo as evidence.
• GP assesses and prescribes antibiotics and then message the Community Team to advise antibiotics prescribed
• Community Team phone surgery to check prescription actioned and phone patient to ensure prescription collected / delivered.
• Community Team supervises course of antibiotics and wound management. On completion Community Team generate discharge summary and message to GP that the course of medication is completed.
• Course of medication completed, Community Team may send confirmatory photo of wound back to GP to confirm.

Hampshire and Isle of Wight ICB commissioned PA Consulting to undertake an independent review of Primary and Community Systems to access and develop options needed to address the interoperability challenges faced.

PA met with 40 stakeholders: clinical & digital leaders, suppliers and NHS regional and central representatives to ask what was working well and what was not in terms of system interoperability. The report was focussed on Primary & Community Care CHIE has recently been deployed as the next generation shared care record. This strategy of sharing information by exploiting existing assets rather than a ‘rip and replace’ approach remains as sound as a foundation as ever for improving information sharing to support the delivery of care

Key Recommendations were: • Improving patient safety should be a driver for change • Mobilise the existing cadre of capable and experienced clinicians to lead the design of good system interoperability • Focus on patients not technology using patient stories to agree common working practices that will then inform technical design • Create momentum and communicate decisions widely to build credibility, maintain staff interest and foster commitment

Resources

The FHIR reference server has been preloaded with the following patient test data for this use case: