Dorset Care Record – January 2023�What it can do and why you should use it

Contents

1. What is the Dorset Care Record (DCR)

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• What’s in the DCR

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• What are the benefits of using the DCR, and what the current users are saying about the DCR

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• DCR Usage

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• An overview of the DCR

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• Training and supporting resources available

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The residents of Dorset have a Dorset Care Record (unless they’ve opted out) available to the health and social care professionals providing direct care. These residents will also soon have access to their own record, through the ‘myDCR’ citizen portal.

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1. What is the Dorset shared care record?

The DCR brings together a person’s health and social care records from across the Dorset Partners, and is thus able to provide a fuller picture of a person’s history, needs, support and service contacts.

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• It provides a comprehensive single view of all patient data, spanning across Dorset Partners’ systems.

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• It provides the right information and tools at the point of care.

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• For use by health and social care professionals whose role requires access to the DCR.

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• For direct care purposes only (so not for secondary or research purposes of any kind).

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• It covers providing direct care and supporting the delivery of direct care.

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DCR Partner Organisations

DCR Other Partners

Secondary and Third Party

• Community Pharmacies
• Yeovil Hospital
• Help and Care
• Avon and Wiltshire Mental Health Partnership
• Cross-border surgeries (ie Ringwood)
• Lewis Manning Hospice

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A safe and secure system

• The DCR respects and displays the data as provided by the data providers i.e. the Partners. There are various level of restrictions/sensitivity being applied within the DCR:
• From national sensitivity associated with patients at risk and marked as so on the national spine, through to
• sensitive datasets such as in-vitro fertilization, sexually transmitted diseases, terminations of pregnancy and gender re-assignment, as well as to
• individual data items being marked as sensitive or restrictive and not available over the interface to the DCR.
• Everyone has the same level of access to the information shared, to ensure that the most relevant information is given to as wide a user group as possible. However:
• All use and access of information in the DCR is fully audited. The DCR keeps a record of when a record is accessed, by whom and the information viewed.
• An audit check is completed every month to assure that access is both appropriate and relevant.
• Staff who would require a consent model (such as foster care medicals) are considered through a particular process to ensure that it is compliant with the DCR direct care data model.

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The DCR Partners are members of the Dorset Information Sharing Charter (DiSC) which governs the information sharing with each other, in accordance with the Data Protection Act 2018 and GDPR.

All access to information is via a highly secure access portal limited to approved NHS and Local Authority health and social care professionals.

By law, everyone working in, on behalf of, the NHS and social care must follow strict information governance rules designed to respect patient privacy and keep all information safe.

A discussion should take place between a care professional and the individual as it is important that the person understand how their information is shared, why it will be viewed, and be given the option to opt out.

You don’t need to ask a citizen for their permission to view their record.

The DCR provides patients with the choice of having a record or opting out. An individual can change their mind at any time.

2. What’s in the DCR

*From November 2022, you can also find in the DCR GP data from the Ringwood Medical Practice in Hampshire. This GP practice, part of the Avon Valley Primary Care Network, is the first cross-border surgery to provide this information in the DCR.

3. What are the benefits of using the DCR?

• Provides visibility of records (Demographics, Encounters, Alerts, Allergies, Referrals, Correspondence etc.) from multiple settings in one place.

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• Seamless access to the DCR from within your current organisational system via single sign-on.

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• Access to records without needing to ask patients/clients’ permission to view records, with the proviso that an information sharing discussion is carried out with the patients/clients if the timing is right. It then needs to be recorded in the DCR.

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• Saves time through reduced need for phone calls, reduced duplicate tests and fewer emergency admissions.

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• The easy-to-view longitudinal health records enable you to take a patient-centric approach.

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• Enables you to make better and faster decisions based on richer and more timely information.

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• Provides you with the ability to track patient/client’s transfer of care with information accessible and actionable across care settings.

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• Enhances multidisciplinary working across organisational boundaries.

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• It improves the experience for your patients, with the information sharing at the point of care leaving patients with less need to repeat information.

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“Shared records have the great potential to reduce harm and improve care.”

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Dr Rob Willington, Consultant, UHD

“Using the Dorset Care Record is wonderfully simple and is a great achievement.  It compares favourably to other GP and primary care systems”

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Dr Andrew Polkinghorn, Senior Dorset GP, Verwood

“I have used it to find an official diagnosis and medical history for a lady regarding falls. This saved me time making several phone calls to gather information.”

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Claire Collett, Occupational Therapist, Dorset Council

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“The Dorset Care Record has a user friendly interface & I can access it anywhere and get the latest information from primary care on my patients.”

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Dr Matt Thomas, Consultant Geriatrician, UHD

“We receive around 200 referrals a month and it makes life a lot easier being able to access key information (in the DCR) to help inform our assessments and treatments.”

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JG, Memory Assessment Team Leader, DHC

“I use (the DCR) to check…if (they) have seen their doctor, to get an update on their health needs, and whether they are in hospital…

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It’s really easy to use, very user-friendly...

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being able to link straight from Mosaic (adults’ system) to DCR has really helped and encouraged me to use it more…

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myDCR includes Circle of Care/my Support Network, which will allow patients to provide details of care dependency support – whether that’s family, friends or their local GP.”

Gina Orgec,

Adult Safeguarding Triage Worker,

Dorset Council

“Much easier and quicker to find where the patient is and their status when compared to phoning others or using multiple systems.”

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“Information on X-rays, blood tests, medication is available without the need to call other teams or services”

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DHC Staff Survey regarding DCR use

Case Studies available on the DCR Staff website Case Studies – Dorset Care Record – Staff area (dorsetcouncil.gov.uk)

4. DCR System Usage – November 2022

DCR System Usage – November 2022

ISG 2022 Targets: (1) 5,000 trained users.

(2) 100,000 monthly records accessed.

• 5,480 trained DCR users.
• 31% more staff trained in 2022 than the ISG target.
• 2,033 Staff trained in 2022: a three-fold increase from the 624 staff trained in 2021.
• 91,651 records accessed in total (inc. Help and Care and Southern Health)
• just short of the 100,000 ISG target

5. An overview of the DCR:�The Person Summary Tab displays the patient history ‘at a glance’

It provides a real-time summary generated from the latest available information in the Partners’ systems.

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1. The Person banner and Additional Details link on the left side panel show comprehensive and the latest demographic information.
2. The arrow button to the right expands and collapses the information view.
3. You can click on the maximise square buttons to view more details.
4. There are additional links for Primary Care (GP records), Community care, Pathology and Radiology that will show on the left side of the Person Summary if the record you are viewing has content in those areas to show.

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Encounters

• Current Activity is defined as any appointment that is happening on the current day, or any inpatient/emergency department attendance that has not been discharged.
• The History Snapshot (12 months) & Planned Activity shows any previous activity in the last 12 months and any up-coming activity in the next 12 months.
• A flag will appear if any 2 current or planned activities happen on the same day - time is not taken into account, just the date. This only works for conflicts of outpatients appointments, not inpatient.​

The Summary tab shows snapshots of Current Activity, History (12 months) & Planned Activity.

Allergies/Adverse Reactions

• The DCR cannot differentiate between an allergy and an intolerance. The reaction should provide additional information.
• The list of displayed allergy and intolerances could include drug, non-drug (eg latex) and food, but it is not possible to list or group by these types.

The way information is recorded in the source systems and fed into DCR means:

• There is also a possibility that the DCR may display separate entries relating to the same allergy / intolerance due to the various ways information comes in or is displayed in the DCR; these sets of data can’t be directly combined.
• DCR may display conflicting information, where information from one partner’s system differs to another’s.

The same allergy information may be displayed in multiple places for ease of use.

There are 5 places to look for Allergy/Adverse Reactions information:

• The Person Summary tab
• Community (Summary Views)
• Primary Care (Allergies & Adverse Reactions)
• Problem List tab
• Medications Viewer tab

The list of Allergies shown in DCR may not be a full list. Not all allergy information held by partners is currently coming into DCR, and where none is available, it will show Allergies not Recorded.

Please always check with the citizen.

Alerts

• Where active alerts are present on a record, a Known Alerts notification will be displayed on the Person Banner at the top of the screen.
• This will remain visible as you navigate between the tabs.
• Clicking on it and then on takes you to a Full Summary of Alerts from Dorset County Hospital under the Problem List Tab.
• The list of Alerts shown in DCR may not be a full list. Not all alerts information held by partners is currently coming into DCR, and where none is available, it will show

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There are 3 places to look for Alerts information:

• The Person Summary tab
• Community
• Primary Care
• The Problem List tab

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Alerts can be found on Person Summary page, positioned beneath the Encounters area, Current Activity & History Snapshot.

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The first row provides a reminder to check the Primary Care and Community folders for additional referral information.

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Referrals

There are 3 places to look for Referral information:

• The Person Summary
• Community
• Primary Care

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Referrals can be found on the lower section of Person Summary page, positioned beneath the Allergies area and shows referrals covering a 12 month period.

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The first row provides a reminder to check the Primary Care and Community folders for additional referral information.

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Community

The Community view under the Summary tab shows information from community hospitals, community nursing and other community services such as physiotherapy, dementia care and palliative care. It also provides 111 information.

Correspondence

• The correspondence can be sent to a patient’s myDCR record, or if the patient does not have a myDCR yet, it can be printed and posted to them.

• The enables you to filter documents by date and according to the way they are grouped or sorted.
• You can search for documents by selecting the magnifying glass icon. You also have the option here to find the letters that have been flagged as important.

On the Summary screen, the Correspondence is listed within an expandable list on the left hand side. The types of correspondence displayed are:

• ED Discharge Summaries under Unscheduled Care 
• Inpatient Discharge Summaries/Letters 
• Outpatient Clinic Letters
• Ad-hoc Letters
• Additional Documents from Dorset County Hospital e.g. endoscopy, maternity documents

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Primary Care (GP records)

Select the GP surgery that is listed in the Person banner, at the top of the patient record screen.

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The GP Record brings a range of information in the DCR. However this will only be as up to date as the source GP’s system. For example, if the GP practice is still waiting for an ED letter, or the practice has not yet captured the information in their system, it will not be available in the DCR.

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Not all person records on the DCR will contain a GP Record. If a person has already opted out of the Summary Care Record or sharing beyond their GP practice, their GP information will not be available within the DCR system.

Radiology & Pathology

Radiology and Pathology sit on the left hand side of the Person Summary. However, they will only show for those records that have radiology or pathology content to show.

Problem List

• The Problem List offers a reliable, comprehensive, and centralised view of a patient’s health problems.
• Using the Problem List can help remove patient barriers to care.
• You can add a Problem, which can be an Alert, Diagnosis or Allergy, and the Information Source will show you who has added these.
• The External Sources data is provided by the Alerts or Allergies and Adverse Reactions feeds that come into the DCR from the Dorset County Hospital etc.
• The Alerts here highlight any barriers that could prevent an individual from completing care milestones.

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Patient Task List

• Provides a central location for outstanding and upcoming tasks in the patient care.

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• Clinicians can factor in unrelated conditions into patients’ treatment plan.

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• The Diabetes Pathway is also available here for the multi-disciplinary staff involved in caring for patients with diabetes at Dorset County Hospital. It will soon be available for staff at University Hospitals Dorset and Dorset HealthCare.

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• The Diabetes Pathway has standardised workflows based on clinical best practice for complex patients.

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Medications Viewer

There are 3 places to look for Medications information:

• Medications Viewer tab
• Summary tab - Community (Summary Views)
• Summary tab - Primary Care

The aim is to provide an up-to-date, comprehensive view of the patient/client’s medication history to understand the medications that a patient has previously taken, is taking now and what they should take going forward.

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The DCR is working together with CHIE, the integrated digital care record for Hampshire and the Isle of Wight, on bringing together the two shared care records under the Wessex Care Record.

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As part of the Wessex Care Record, the DCR is now part of the ‘One Medication Record’ project, which will create a single, holistic medication record for the region, enabling practitioners to access data between DCR and CHIE records.

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myDCR

The DCR interacts with myDCR, the citizen portal. myDCR empowers patients to take a greater role in their own care by providing them with the appropriate information and digital tools so they can actively participate in and contribute to their ongoing care.

• Goals and Actions enable patients and staff to set goals and the actions required to achieve these as part of their healthcare plan. Tracking a patient’s progress can help patients stay on track and improve their health.

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• Use the myDCR Invitation Form to invite the citizen to register for access to myDCR. You can also re-invite the citizen if their invite is pending or expired.

• Shared Files enables patients and staff to share and upload documents, photos and videos relevant to the patient’s condition or treatment.

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• The Health Library enables staff to share with patients information directly related to their treatment or condition. Having a better understanding of their health encourages patients to confidently and actively participate in their healthcare.

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• The Circle of Care is organised into the friends and family members, care team and organisations involved in the patient’s care and wellbeing. It is available to both the clinician via the DCR and the patient via their myDCR, with each being able to assign access to the patient’s record information to a trusted circle of people so that the patient has the necessary support in managing their care and wellbeing. It builds strong connections between the patients, their support network and their clinicians and social workers. Everyone involved in a patient’s care stays informed and connected.

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Worklists

A worklist is an optional tool that can be used to easily find people you may be interested in regularly viewing or monitoring, saving time searching or needing reference numbers to hand.

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Examples of using worklists include monitoring people under a specific consultant, clinic, or a practitioner’s caseload.

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There are 6 worklists available so you could monitor 6 separate groups of people if you wish. Worklists are initially represented by colour names but you can rename these to make them more meaningful to you.

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Collaborative worklists

• Collaborative worklists provide the ability to organise a group of patients into a worklist that can be monitored and managed by those responsible for caring for them.

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• It’s a convenient and quick way to access patients under an individual or team’s care.

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• Examples of using worklists include monitoring people under a specific consultant, or a practitioner’s caseload, or setting up a clinic and provide information about the people beforehand.

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Send Citizen Feedback

You can send a message to the DCR team by using the Send Citizen Feedback tool. Within a person’s record, under the Person Summary screen, select Send Citizen Feedback from the menu on the left. You can request a read receipt, and you will see this appear as a notification in the Person banner. Clicking on this notification icon will show you a list of your received messages.

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You can also view your received and sent messages under “Messaging” on the navigation menu on the left of the screen.

6. Training and supporting resources