Urgent care staff in London have been giving more informed advice to vulnerable patients with COVID-19 symptoms, thanks to an expansion of record-sharing via the Medical Interoperability Gateway (MIG).

The MIG, from Healthcare Gateway, is enabling a real-time view of the GP records of around eight million patients, following an initiative to grow its use across the capital. The MIG, in conjunction with other technology providers, has enabled thousands of staff from NHS 111 services and major hospitals, community units, hospices and mental health services to view vital information, with patients’ permission. Clinicians have hailed it as a ‘revolution’ in joined up clinical care.

The work is part of the OneLondon Local Health and Care Record Exemplar (LHCRE) programme. Led by the region’s five health and care partnerships, OneLondon is working together with Londoners to transform health and care services by joining up information to support fast, safe, effective care.

Stephen East chief technology/delivery architect for Lewisham and Greenwich NHS Trust said: “When COVID-19 hit us, NHS 111 and other urgent care staff were inundated with patients who needed the right advice on where to go for care and what they should do if they had COVID-19 symptoms. They urgently needed access to crucial medical information in patients’ GP records.

“The MIG provides a clear view of clinical information in real-time, and it can be easily and rapidly rolled out at scale. Within five days, we were able to extend its reach from six to 18 CCGs covering the vast majority of London GPs.”

The expansion of the MIG has also enabled safer, more efficient care for other patients during the outbreak. Clinicians using the Cerner Millennium system at seven major hospital trusts can now view a detailed care summary from the GP record. Provided as structured data, it includes a patient summary and demographics, problems, diagnoses, medication, risk & warnings, procedures and investigations, encounters, admissions, and referrals.

John O’Donohue, a consultant gastroenterologist and chief clinical information officer (CCIO) with Lewisham and Greenwich Trust said: “The MIG has revolutionised the way we do things. Patients often travel across London to see specialists, and being able to see the GP record, particularly medication, is so important if we are to give the best care.

“The key to the success of the MIG is having the GP data integrated into a contextual view of the patient. We don’t need a separate login and it is giving back junior doctors up to 30 minutes a day, as they don’t have to chase faxes or ring colleagues to get information. There are fewer delays and interruptions to clinics. GPs are also able to view our data, enabling continuity of care when patients go back home.”

Zainab Hussain, lead pharmacist and associate CCIO at Lewisham (pictured) said: “Getting an accurate medication history used to involve lots of phone calls and faxes to GPs. The MIG has been a massive factor in enabling pharmacy technicians to take a more accurate medication history. It takes around 10 minutes less per patient, which can add up to 40 minutes a day per technician.

“The MIG is more reliable than the Summary Care Record (SCR) because the data is obtained in real-time. It is enabling us to review possible drug interactions and freeing us up to improve our care to patients, for example, dealing with cases of polypharmacy.
“I would absolutely recommend the MIG to colleagues in other areas, no question about it. Patients have a right to the best care, and accurate data is necessary for that.”

Steve Chaney, lead nurse in clinical informatics for Lewisham (pictured) said: “The MIG has really come into its own during the coronavirus outbreak. A lot of things wouldn’t have worked so well without it and everyone is now waking up to how important it is. For example, when admitting patients, nurses are using the MIG to confirm what patients report about their medical history. Some of these patients have cognitive issues but are unaccompanied due to COVID-19.”

“Colleagues doing pre-assessment for surgery are able to view each patient’s medical history before they arrive, so they can approach them with confidence and knowledge. It’s a brilliant way to get a 100% accurate overall clinical picture of the patient.
“When everything was on paper you would struggle to get a picture of what had gone on with a patient at another trust. Some of the notes weren’t complete or there were letters to GPs missing.”
Peter Anderson managing director at Healthcare Gateway said: “In response to the coronavirus outbreak our priority was to ensure patient data continued to flow to clinicians who need it most. Working with customers across the OneLondon LHCRE, we’re proud the MIG has been one of the trusted technologies to enable patient data sharing across the capital. Clinicians now have a holistic view of their patients to enhance care and make informed decisions efficiently. We aim to continue supporting record sharing to improve the full patient journey, building a better, more joined-up healthcare economy.”

Offering sophisticated and flexible integration technology, the MIG currently connects 4,500 health and social care providers in the UK, sharing a total of 30 million patient records. More are being added all the time.

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