First added 2 July 2015 / Last updated 1 December 2015
Background of KHP Online
KHP Online is a collaboration between South London and Maudsley NHS Foundation Trust (SLaM), King’s College Hospital NHS Foundation Trust (KCH) and Guy’s and St Thomas’ NHS Foundation Trust (GStT), the three trusts within King’s Health Partners (KHP) Academic Health Sciences Centre.
In response to Dame Fiona Caldicott’s Information Governance Review in 2013, a working group led by the three trusts' Chief Clinical Informatics Officers, clinicians and technical staff on behalf of KHP, started to address the seventh Caldicott principle: that the duty to share information can be as important as the duty to protect patient confidentiality. These discussions were shaped by an existing Information Sharing Agreement between the three NHS trusts and were supported and facilitated by input from Caldicott Guardians, Information Governance & Information Security leads, Trust & KHP Communications teams, Southwark & Lambeth Integrated Care and Trust Executive teams.
Many patients regularly attend for clinical care at two or three of KHP’s partner organisations. For example, data from 2013 shows 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 movement between sites, care pathways were disjointed and important information was potentially unavailable. Patients previously treated in one organisation regularly have their care relocated to another. People with physical and mental health needs may be under the care of several departments in more than one trust, on numerous medications, and may go to any of the partners for emergency attention.
Across the NHS, it has always been possible for a clinician in one organisation to request medical notes from a clinician in another, but the process can be slow and unreliable. KHP decided that essential clinical information about a patient must be available securely within seconds and presented in an easy-access, simple-to-use form. That required giving clinicians electronic access to key information about their patients that was known to colleagues in other departments and other partner organisations. KHP’s solution was to develop “KHP Online”. Clinical staff with a legitimate need to access personal confidential data about an individual in their care may use the KHP portal to view a continually updated summary record centred on a single common identifier – the NHS number – to access, via the patient’s main trust, a portal to bring information from all three sites together in real time. The summary record includes risks, medications and diagnoses that may be relevant to the current episode of care.
The story so far
KHP Online launched in October 2014 across the three trusts. It currently provides access to:
- Search across three NHS sites and notifications;
- Visits with contact type and caring clinician;
- Results of laboratory tests and radiology reports;
- Access to PACS images;
- Documents, clinical notes and correspondence;
- View of RiO community system data;
- View of MOSAIQ Cancer Information System.
Usage of the system has been steadily increasing since it went live. To June 2015, nearly 50,000 requests to view patient records from one of our other partner trusts had been made.
Feedback so far from clinicians using the system has been extremely positive and it has been described as “invaluable” and as an “indispensable resource”. Users have reported reduced repetition of blood tests and brain scans, reduced referrals for physio and occupational therapy, quicker access to blood results, improved awareness of how co-morbid medical disorders are being managed and, significant amount of clinical time saved that used to be taken up arranging transfer of notes.
It has helped clinical teams to understand and maintain consistency around advice given for long term conditions, find out what happens following A&E attendance and check if patients with long term conditions are attending clinics, for example diabetic patients attending eye appointments. Crucially, the system fully supports King’s Health Partners mission to integrate mental and physical healthcare and users have reported a better appreciation of the dual needs of patients and service users. It allows clinicians to more easily identify a previous dementia diagnosis and treat accordingly.
Two quotes from clinicians using the system highlight the impact it has made.
“All in all, I think the portal has made a significant difference to the efficiency of our service and has made communication across the various disciplines significantly easier. It also helps us have a much broader knowledge of all the person’s co-morbidities and the impact that they may have on their cognitive functioning.”
“It is an invaluable contemporaneous source that has improved the quality of mental health care for my patients.”
KHP Online was highlighted as a best practice case study in Dame Fiona Caldicott’s Independent Information Governance Oversight Panel’s annual report to the Secretary of State for Health in December 2014 (attached).
The project was shortlisted in the Enhancing Care by Sharing Data and Information category in the 2015 Health Service Journal (HSJ) Awards.
The HSJ Awards is the largest celebration of excellence in UK healthcare, highlighting the most innovative and successful people and projects in the sector. More than 1,600 entries were submitted, making a place on the shortlist a huge achievement.
Resourcing the project
Each partner has contributed on a matched funding basis with an equal commitment of money, clinical and project management resources. The team was also successful in applications to NHS England’s Safer Hospitals Safer Wards Technology Fund and Integrated Digital Care Fund and received further funding from Southwark and Lambeth Integrated Care.
Accessing information on KHP Online must be in line with the Caldicott principles on a ‘need-to-know’ basis, in adherence to professional codes of conduct and employment contracts. Effort is made to inform patients about the scheme and they are given an opportunity to dissent before a clinician makes use of the sharing facility. KHP Online is used only for patients’ direct care and no access is given to researchers or administrative staff.
Phase Two development for KHP Online is to support join up with primary care records from GP practices in Southwark and Lambeth , which is expected to roll out during late 2015 and early 2016. Further integration with community care records is also planned, and discussions are ongoing regarding social care records as part of our ambition to support joined up care for patients along cross-site and cross-sector care pathways supported by integrated information.