The Salford Integrated Record (SIR) is an IT portal designed to improve care for Salford patients and promote research which benefits the local population.
SIR is a key enabler of the Salford Together partnership’s vision for integrated care. The solution currently provides hospital and mental health clinicians with a view of the GP record, and it is being expanded to encompass social care as a priority. Salford’s real depth of experience lies in its use of SIR for research purposes, and it has developed communications and governance approaches which support this aim.
“A few key things spring out regarding the importance of the Salford Integrated Record in advancing the research agenda. First is the breadth and depth of the coded data that’s available for the whole local population. Before, data was often fragmented or incomplete, so this is really powerful.
Second are some of the tools that have come about as a result of SIR, for example FARSITE which performs feasibility calculations for a proposed research study. This sort of thing could have taken months to determine previously, so it really helps remove those barriers.
Finally, it’s enabling new types of research. The Salford Lung Study, for example, represented a shift away from traditional approaches. It was a large scale study using data from patients in their “normal” context, with minimal intrusion into their everyday lives. This is only made possible by interrogating electronic health records.”
Dr Owain Thomas, CCIO, Salford CCG
- The Salford Integrated Record grew out of work relating to diabetes care pathways and was first launched in 2008. It was intended to support individual patient care, population health management, and research .
- SIR is seen as a key enabler of two important local care delivery programmes: The Integrated Care Pioneer (Greater Manchester) and one of the Vanguard programmes for Integrated Primary and Acute Care Systems – Salford Together . Both of these exemplify the delivery of integrated care and the potential for technology to join up and enhance services.
- SIR has been developed hand in hand with the Salford Together programme, ensuring the solution’s architecture, functionality, scope and implementation model supports the vision of the partnership as a whole – including the city council, commissioners, primary care, acute care providers, and mental health trusts.
- In 2008, NorthWest eHealth (NWEH) was formed between the University of Manchester, Salford Royal NHS Foundation Trust and Salford CCG to enable the use of SIR for research. It has developed a number of innovative tools and techniques to help facilitate research projects and is considered an authority on the delivery of electronic health record enabled randomised controlled trials.
- Use of SIR to support individual patient care is more limited compared to the research component, but it is currently used by hospital and mental health clinicians to gain a view of the GP record, and an expansion to social care is planned next. GPs can also access hospital data, but as its depth is currently limited, this has not been widely adopted yet.
- SIR is currently based on Graphnet’s CareCentric product, which uses a SQL-server based central data store to assemble data from the connected systems.
- The overall plan is to combine the local shared care records across the wider region, resulting in an integrated record that covers Greater Manchester .
- Central Repository Model Salford Integrated Record uses Graphnet’s CareCentric solution, which extracts and integrates data from the underlying clinical systems.
- This provides a centralised summary view of the patient’s information, accessible by health care professionals either through a portal or by clicking through from their own system.
- Data is extracted from GP systems every 24 hours.
- SIR will ultimately enable clinicians and care givers to work more collaboratively to deliver efficient and safe care. Realising this vision in full is some way off but, in the interim, hospital and mental health clinicians are using SIR to view the GP record to aid decision making, save time and improve the patient experience by avoiding repetition.
- Priorities for extending SIR’s usefulness in relation to individual patient care include enhancing the breadth and depth of the datasets available (currently the majority of the data is from GP systems), and bringing social care teams on board, both as viewers and contributors of data. Providing single sign-on access to SIR for GPs will also help embed its use in everyday practice.
- A number of research bodies have used anonymised data from SIR to support their studies.
- The Salford Lung Study was the first major (and high profile) project to do so. It examined the safety and effectiveness of a new drug treatment for asthma and chronic obstructive pulmonary disease (COPD), based on nearly 7,000 consenting patients. This was different to other randomised controlled trials (RCT) as it included a much broader range of patients, and provided a more realistic view of how the drug performed.
- SIR has also resulted in the development of some innovative tools. These typically fall into two categories: 1) tools which aid the research process and make research easier to conduct, and 2) tools developed out of research initiatives which support broader health objectives such as population health management. Examples include:
- FARSITE (NorthWest eHealth) A profiling tool for identifying and contacting patients suitable for research studies, while still preserving their confidentiality. It provides an initial view of the feasibility of a research project.
- SMASH Dashboard (University of Manchester) A web application that shows pharmacists and GPs lists of patients that are potentially at risk from the medications they are prescribed.
- PINGR (University of Manchester) Computer software for GP practices that analyses patient data to suggest what steps could be taken to improve their care. More