Yorkshire and Humber care record

Owner

Yorkshire and Humber Care Record (YHCR) is an open platform Local Health and Care Records Exemplar (LHCRE), funded by NHS England. Lee Rickles is the Programme Director and Chief Information Officer for the Yorkshire & Humber Care Record, and the Humber TTS Foundation Trust.

Substantial parts of the YHCR are licensed under the MIT licence, which allows for free use of the software for modification, distribution, private use and commercial use.

Background

Clinical computer systems hold multiple sources of information on patients, which can come from GP services, hospitals, community healthcare, social services and mental health teams. Each record may hold slightly different information about a patient and when the patient moves between organisations, their records don’t necessarily travel with them.

In addition to this difficult information landscape, each Health & Care Partnership frequently has a different approach to meet its population’s needs. Joint understanding, collaboration, and prioritisation can help them to face common challenges.

Situation 

Healthcare professionals have to spend valuable time recording and checking vital information from patients: from name, to current treatments, to test results and allergies. Variation in record formats creates extra potential for important information to be missed, making it harder to provide good quality, safe, care. In stressful situations such as a 999 call, relevant medicines, passwords, and other vital information could be missed. On a normal day across Yorkshire about 4000 people dial 111 and 999. Time spent searching for information before a healthcare decision can be made is time that could have been productively spent on urgent care or other activities.

Julian Mark, an EMD with Yorkshire Ambulance Service NHS Trust says:

By integrating health and care records across the Yorkshire and Humber region, this program aims to improve care with timely and relevant information provided to care professionals and citizens, securely and safely.

Aspiration

• Creating joined up data management for health and social care: putting information from primary care, secondary care, mental health and social care into one package.
• Providing a holistic view of the patient and their requirements, that will be accessible to the patient themselves, encouraging a proactive approach to their own health.
• Ensuring greater accuracy of data
• Minimising time spent looking for paperwork
• Avoidance of duplicate tests and procedures
• Sharing development with the wider health & social care system
• Creating and proliferating standards through use of open source
• Ensure that the Y&H region is far less constrained by technical barriers when designing services and care pathways to support population needs.
• Improve staff working environments across the NHS with human centric systems, better user interfaces, and a better grasp of workflow to deliver better services

Solution and impact 

Lee Rickles and his team have created the Yorkshire and Humber Care Record (YHCR) system, which is wholly owned by the NHS, to bring together a number of open source software solutions as an open source platform. Through it, real-time healthcare information can be transmitted across multiple providers, working with standards used across the NHS. YHCR may be the world's most extensive implementation of the international HL7 FHIR standard. It is technology neutral, and licence free, presenting unified and coherent information from legacy systems and data repositories that frequently have no other way to communicate.

The platform can provide health and care staff with better and faster access to vital information about the person in their care. When a patient dials 999 medical staff can access up to date patient records, such as those from long-term care, pharmacy records, mental health needs, and palliative care, and make more informed decisions from the start. Having all the relevant healthcare information in one place means not having to contact different organisations, which in turn removes time delays in putting a care package in place.

YHCR have been working with Yorkshire Ambulance Service to mobilise an automated transfer of care process across the region. The time saved is on average 6 minutes per patient and one of the live sites, Rotherham NHS Foundation Trust, tends to receive 70 patients per day by ambulance. In addition to primary and secondary care needs, ambulance clinicians have the opportunity to see when a patient has a mental health crisis or end of life plan, who is responsible for the plan, and how they can be contacted for further information.

YHCR have also used their platform to migrate pre-existing research and evaluation systems to secure cloud hosting for Connected Yorkshire (at Bradford Teaching Hospitals NHS Foundation Trust) to improve patient pathways and models of care, and for the Comprehensive Patient Record project (at Leeds Teaching Hospitals and University of Leeds) to study cancer diagnosis, recurrence and treatment.

In both cases, creating and leveraging standards and using open source software brought the region together with a uniform approach, “Yorkshire and the Humber, previously, probably wouldn’t have worked so closely together, it brought us together to some degree and then we built the core infrastructure. It matched FHIR standards and we were able to build, match and bolt on to Docker, which is open source.” said Lee.

Functionality

The YHCR platform is in use by Yorkshire Ambulance Service, Connected Yorkshire, the Comprehensive Patient Record project, and others. Components of the YHCR platform include:

• connection methods to nationally held data and GP records
• a secure and patient-consent driven (opt-out) mechanism for data transfer
• messaging for care practitioners
• a quality assurance process inclusive of both data and security standards
• federated control of data persistence,
• data mapping to legacy sources
• independent data interface development
• a cloud hosted analytics platform

It is:

• standards compliant
• plug and play
• highly extensible and readily scalable
• protected by multi-layer encryption
• segmented in such a way that different deployments have a high degree of autonomy, security and cost accountability.

Capabilities

• Better, faster access to vital information about patients
• An integrated care record which enables medical staff to access real time information across health and social care providers and between different IT systems safely and securely.
• More informed decisions from having access to across-the-board health and social care information.
• Open source allows the ability to collaborate

Scope

Thanks to being open source, YHCR is sufficiently reusable that it’s currently being rolled out across multiple trusts in the region. With easy access to the platform, its documentation, an ability to understand the way it works, and a lack of licence fees, it has the potential to create a de facto standard approach for information transfer for Yorkshire and the Humber. Open source also allows the region to create skills in-house, with staff participating in communities to collaborate on related projects.

For further adoption, funding models are needed that appropriately handle risk-transfer, project custodianship and management, and a true valuation of open source projects. Such software provides cost-free functionality, and is usually monetised through associated services (instead of royalties). Capital investment models struggle with appropriate value assignment and attribution for less tangible assets, and many of the benefits provided by open source fall into that gap. The NHS’ Transformation Directorate is currently investigating appropriate models to support projects that face these kinds of capital investment issues.

Digital equalities

• Helps to create parity of esteem between mental and physical health records
• Information visibility reduces the chance that vulnerable patients fall through the cracks

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Page last updated: September 2022