NHS North Yorkshire & Humber Integrated Care Board
Black Pear facilitates the sharing of end-of-life care plans to enhance outcomes for all individuals across the healthcare landscape
With so many different issues to consider, so much potential for change, often extremely quickly, and so many different types of care provider potentially involved, it can be very difficult for practitioners to keep up with everything that’s been happening and ensure that the wishes of the patient and their family are being fully respected.
To address this key issue, the Humber and North Yorkshire Health and Care Partnership (HNY) commissioned the development of a new project which would enable information to be accessed, updated and shared quickly across the systems used by different care providers.
Working with specialist healthcare software developer Black Pear Software and digital healthcare transformation consultancy Ideal, the organisation created the Electronic Palliative Care Coordination System (EPaCCs), which delivers an accessible, secure electronic co-ordinated care record for patients in the last 12- months of their lives.
EPaCCS has led to improvements in coordination of care and communication between professionals – and it has now been used by around 98% of the primary care practices, which covers the Vale of York, Whitby, Scarborough, Northern Lincolnshire, Hull and East Riding of Yorkshire.
It is also used by hospices, Yorkshire Ambulance Service, East Midlands Ambulance Service, the 111 and out of hours services, community carers and acute healthcare providers.
EPaCCS is integrated with the region’s overarching shared care record, the Yorkshire & Humber Care Record (YHCR). Currently, the two ambulance services access a focused summary of patient’s EPaCCS records via the YHCR, which provides information at the point of care to support care and conveyance decisions. There are also plans to make this summary available via the YHCR Interweave Portal, to enable organisations such as local authorities to be able to access the end-of-life information in real time via their connection to the region’s shared care record.
John Mitchell, associate director of IT at the NHS North Yorkshire & Humber Integrated Care Board, says:
What was crucial from the start was that this was a clinically-led, rather than technology-led project, and that it was totally centred around the needs of patients, so that the right information ensured the right care was available in the right places.
The design of the solution was driven by the needs and priorities of clinicians and a clinical design authority was established at the outset to ensure that it was delivering what clinicians required at every step to deliver the best support to patients and their families. To support our digital initiatives, we have patient and carer representatives that sit within our governance structures and their feedback and engagement play an incredibly important role in everything we do.
The information contained within EPaCCS covers a comprehensive range of areas that are essential to the delivery of safe, effective and appropriate care.
This includes basic demographic details, such as name, address and date of birth, as well as information on any special requirements that the patient has, such as whether or not the patient would like cardiopulmonary resuscitation (CPR) to be attempted if required, the circumstances where they would or would not want to be admitted to hospital, and whether their family are aware of their wishes and prognosis.
EPaCCS provides the basis for informed conversations between different care providers, even when things are changing quickly, as they often can in end-of-life situations, and when it is especially important that the wishes of patients and their families are understood and respected.
The details of any other health and social care professionals involved with the patient’s care are also included, along with medical information on things like diagnoses, allergies and medication.
Information on patients’ expectations and wishes, and details about Lasting Power of Attorney (LPA) if there is one in place, is also available, which can be crucial if the patient is unconscious or can’t tell caregivers of their wishes for any other reason.
An initial pilot project led to the development of a blueprint for the deployment of EPaCCS to provide guidance to other NHS organisations on how to get started with it, while standardised training materials were also provided by Black Pear which were localised to ensure consistency across the whole organisation.
For those that had adopted EPaCCS when the pandemic hit in early 2020, it also provided an effective method of communicating vital patient information when other options were temporarily unavailable.
John Mitchell continues:
Around 98% of the primary care practices across our area have accessed EPaCCS, along with all our hospices, paramedics from our two ambulance services and 111 services, community carers and acute healthcare providers.
This effectiveness reflects the importance of deploying EPaCCS right across a care system, so that every aspect of a patient’s care can be included in it and everyone involved with delivering it has a clear view of how it should be done.
Chris O’Connell, chief business development officer at Black Pear Software, adds:
Ensuring patient information is available in one place allows clinical decisions to be based on up-to-date information and improves the overall patient experience, with end-of-life care being delivered in their preferred place and in line with their preferences.
Seeing how effectively Humber and North Yorkshire Health and Care Partnership has integrated EPaCCS into its end-of-life care management systems is extremely impressive, while the impact on patient care that it has had reflects our aspirations for it at the start of the project.
It provides a clear example of the considerable care management and efficiency benefits that can be derived from integrating this sort of technology into everyday healthcare delivery and what this means for the care outcomes that result.