Patient encounter history discovery report

Recommendations for Alpha

According to the GOV.UK service manual, the alpha phase of a project is where we try out different solutions to the problems we have learnt during discovery. An alpha should spend time building prototypes and testing multiple ideas, not being afraid to challenge the way things are done at the moment. Alpha is a chance to explore new approaches and validate them.

With this approach in mind, we have produced the following recommendations of what should be tested during the alpha phase. We have not specified options for how to deliver on these goals, as this requires further discussion and agreement among stakeholders across the NHS. The recommendations shouldn't change, but the delivery approach may.

Recommendations for alpha

Continue to explore how patient encounter history could form part of a national care record

From the discovery, we have learnt that clinicians don't use patient encounter history in isolation. We believe that holding encounter information as part of the patient record makes sense long term. However, we haven't been able to explore the practicalities of this assertion in the short discovery timescale.

We recommend continuing to liaise with the national shared care record team to understand their long-term goals, and to seek their views on where UEC encounters should reside. We need to be mindful of the technical responsiveness and availability of the shared care record for some of the call routing and prioritisation requirements in UEC. We also need to understand how information governance and data sharing will work within the national shared care record framework.

Work closely with the Booking & Referrals and PEM projects to understand and agree on how the projects overlap and support one another

During the discovery, we learnt that the outcome of an encounter is either a referral to another service, or treatment (including information or self-care advice) which results in a post-event message being sent to primary care.

There are two projects already operating in this space which the Patient Encounter History project needs to be mindful of:

1. The Booking & Referrals project is looking to standardise the way referrals are made between care settings.

2. The Post Event Messaging project is looking at improvements to how patient treatments in other settings are referred pack to the primary care record.

How the Patient Encounter History alpha and these two projects inter-relate needs to be agreed and dependencies reduced to enable rapid delivery. This may require scope changes or re-prioritisation of features. These agreements need to take place to ensure that the projects are joined up and don't result in delivery of siloed point-solutions into the UEC.

Collate more data about encounters from across the UEC nationally in order to analyse how it could be used to improve workflow and alerting

The lack of a central repository for patient encounter information nationwide has been a major challenge in describing how this data could be used to improve alerting and call routing. A key goal for alpha should be to collate encounter information from across the whole of the UEC landscape.

This will allow us to understand the types of encounters and to validate the types of repeat caller -- so far, we have identified 4 types, there may be more. Analysing this data will also allow the alpha team to explore the clinical risks of call routing and alerting based on encounter information, and how this may work alongside the current Pathways triage process.

Experiment with how patient encounter history could be visualised to focus the information on the patient rather than the data sources

We have heard from clinicians that not having a consistent view of encounters across UEC can make diagnosing and treating patients more difficult, especially with complex cases. If we have collated a broader set of encounter information, we should experiment with how that information (and perhaps information from other data sources) could be used by clinicians to build a patient-centred view.

These experiments can be used to validate our finding that laying out clinical information based on the patient, rather than the data source would be beneficial. We would also discover how much of a challenge making changes to systems that clinicians have invested in learning may be for a beta phase.

Pilot providing patient encounter history across all parts of UEC to understand the benefits it delivers

We discovered that the most significant gaps in encounter information sharing were in GP Out of Hours, and Emergency Departments. If we are able to gather encounter information from across UEC and create a means to view it then providing access to GP OOH and ED and exploring the benefits that presents should be a key goal of alpha.

Explore the viability of extracting existing encounter information from proprietary systems

Some clinical systems already have a rich set of patient encounter history captured for specific regions and care settings. A national encounter dataset should extract this information, otherwise clinicians will be left having to look at two data sources. This is not an insignificant challenge, and the alpha should explore how this may be acheived.

Research encounter information in other care settings

The NHS Service Standard specifies that teams should:

"Work towards solving a whole problem for users and provide a joined up experience across all channels."

With that in mind it should be considered whether the team's scope should be expanded to look at encounters in other care settings, such as primary and social care. This would be a start of exploring viability of what joined-up encounter data for all care settings could look like.

Define measurable benefits for the PEH service

In order to prove the viability of the service, the team will define measurable benefits that can be measured in beta and beyond.