Healthspace - lessons learned to date and plans for the future

Mark Outhwaite 2008

Lord Ara Darzi

Claire Marshall, Patient

Not just GP-centric

Title is "Clinical Director", not medical director, as wanted to represent the full multi-disciplinary perspectives.

What is unique about HealthSpace?

Patient portal through which the public have a secure online domain for their transactions with the health service 24/7 from anywhere in the world.

HealthSpace EA Overview

People who have basic version 2 accounts

• 56k cumulative accounts
• 400 new this week

People who have a basic account and live at an address which prompts the system to offer them an advanced account

• 2607 cumulative
• 21 this week

People who have them taken up the offer and completed an advanced account application on-line

• 2537 cumulative
• 21 this week

People who have taken their application to a Front Office and have had that application processed successfully

• 930 cumulative
• 3 this week

People who have fully actiated their advanced account after receiving their letter from the Back Office

• 740 cumulative
• 3 this week

711 users logged in to HealthSpace this week

Current utility

• Basic organiser
• Summary Care Record "view only"
• Diabetes electronic record in Salford

Challenges currently

Registration process

• overhead on PCTs
• overhead on patients
• changes planned

Lack of utility

• new features coming
  

Await business case approval to enable the HealthSpace extension to begin

• will allow GPs or other clinicians who know patient well to vouch for them
  

History

Originally aligned with NPfIT

• somewhere, said patients should have some access
• but plan was small and not well specified
• seen as patient to see their record and thus get acceptance of national database, including commenting on errors
• recommended half of PCTs should set this up, but not much interest from patients or PCTs

By now, accepted that should be more than just viewing the records

So started marriage with NHS Choices

• HealthSpace is for transactions
  
• NHS Choices is for browsing
  
• analogy - if want to browse eBay, no need to log in, but if want a transaction, need to log in

Lord Darzi review full of HealthSpace mentions

• key place for patients to access information and contribute, including Personal Health Plan, submitting it to their Summary Care Record

New HealthSpace services

Awaiting approval for business cases of extensions

• credit crunch has been rather bad in terms of slowing things down

Complementary to NHS Choices

• put forward of communicator

Signed up to the Continua standard!

• piloting with Hampshire repository - 1 million records are being shared with patients

Other features

• copying letters to patients, so patient can select a more secure address
• communicator - secure online communication facility between clinicians and patients
• this is fundamentally missing from CfH
• its lack is disastrous as sending messages to patients at the moment
• online booking of appointments
• offering portal into those systems
• privacy and security - ensuring carer access in secure, password-protected way

Looking to enrol 4 million users between April 2009 and 2014

• want the "frequent fliers" of the health system
• focusing on 4 or 5 chronic diseases
• starting with diabetes

Significant benefits with extensions

Patients

• empowerment
• communication - not just from access, but secure messaging

NHS

• better use of clinicians' time
• fewer DNAs
• confidence in reaching patient

Communicator

• secure communication channel between patient and clinician
• web form of communication with reminders through e-mail
• need some agreement that two parties of communication can talk to each other
• recommend discussion between patient and clinician
• clinician invites
• enable better continuity of care for patients
• commuters
• housebound
• too risky to travel
• sending information
• medication reviews
• chronic disease reviews
• regular monitoring of physiological measures can be incorporated into clinical records
• ability to send digital photo of their progress say in ulcer management
• ability to receive back advice on medication levels following the sending of information
• non-urgent communication in a non-time based setting
• where can this help? most contact is not always the GP
  
• community nursing
• community pharmacy
• general practice
• outreach fom hospital settings
• follow up from day care
• long-term condition management
• who  can this help?
• commuters
• long term conditions
• residential homes
• complex needs with multiple teams managing care
• carbon copies to everyone in the team
  
• not a replacement for consultations, but it will help displace inappropriate activities of phone calls to check information

timelines

• start implementing from April 2009
• selected GP practices within SCR early adopter PCTs
• "non-SCR" GP practices in London
• people in Salford using HEalthSpace to access their local diabetes records
• patients in Sheffield diabetes care pathway
• London polyclinic(s)

What next?

• patients on line continuous access to records incluidng results - proposed pilot with Hampshire
• guidance needed for implementation of communicator and how to e-consult safely
• investigate outcome measures when patients have access to results in advance of appointment in diabetes clinic setting
• plan work around care home setting for pilot in year 2

Aligning with the political agenda

• we will have enabled a secure on line facility for the public - so that the public can begin to enjoy the same benefits they associate with the Internet from their health service providers
• PCT will be able to manage access

Wide recognition

• lots of publicity without any active marketing

Questions

• how do we link with other parties, e.g. third party sectors? Answer: true that still NHS focused, but many-to-many chat rooms etc should not go into the transactional domain where concerns about the security.
• Follow-up - that means that clinicians are doing work uncompensated on their spare time. Answers: yes, this is key, and we have to figure out a way of counting the time spent. But first we need to prove that it works.
• how do we know patients want this? Answer: enormous amount of consultations. Very patient-focused. 
• can we see the specification? Answer: I don't know how to show the technical specification for confidentiality.
• follow-up: can we see it before it goes out? Answer: yes, you're right, let me go and check. Problem is that