Jonathan Waldheim and Tim Warren: June 09, 2020
In this blog, Jonathan Waldheim, Product Manager at NDS, and Tim Warren, Digital Lead for the Integration Division at the Scottish Government, talk about some of the work on Anticipatory Care Planning and the National Digital Platform that has been progressing since March.
ReSPECT, Essential ACP and building the National Digital Platform during COVID-19
Post-it notes are no longer on whiteboards, coffee catch ups are done over video calls and daily stand-ups are now done sitting down! The last 10 weeks have shown that technology is key to forming the new normal.
At NDS, we have been dealing with this change while working to make products and services that support health and care services in Scotland.
Teams have been designing and delivering vital technology amazingly quickly, often in collaboration with multiple parties across the public sector.
You might have read about the following two projects:
ResPECT process and Essential Anticipatory Care Plan
The third project we have been working on is an Essential Anticipatory Care Plan for COVID-19 in partnership with one of NHS Scotland’s special health boards, Healthcare Improvement Scotland (HIS).
The ReSPECT process and a shared record of care
Before we talk about that work, it’s first important to set the scene. At NDS, our vision is to establish a National Digital Platform for health and social care data – a single point of information giving appropriate people the right access at the right time.
We started working on the National Digital Platform through our first product - an emergency care and treatment planning process called ReSPECT, initially developed by the Resuscitation Council UK.
ReSPECT is an actionable shared record for each person, centred on what matters to them, enabling all to stay loyal to it, initially to support their care when they cannot speak for themselves.
Over many years, attempts have been made to realise this vision, including the Key Information Summary (KIS), which is written in GP practices and can be read by others who often find themselves caring for people when they can’t speak for themselves and the GP can’t be contacted.
ReSPECT is the first digital product on the National Digital Platform, and when COVID-19 came along we were working with NHS Forth Valley to trial the use of this application in Forth Valley Royal Hospital.
Like everyone else, our attention shifted overnight to COVID-19, but we are now returning to our original path, and will continue to deliver on the original vision of using the ReSPECT process as a framework for an emergency care planning record.
Figure 2. Forth Valley Royal Hospital - jamesnicoll / Forth Valley Royal Hospital / CC BY-SA 2.0
Essential ACP for COVID-19
COVID-19 led to the production of an Essential ACP, to help with getting vital information included into the Key Information Summary (KIS)
The KIS is currently the primary mechanism for sharing key information to be accessed in an emergency, between primary care, NHS 24, the Scottish Ambulance Service, Accident and Emergency, and front door medical and surgical acute admitting teams.
Improving the quality of information that gets shared in the KIS during COVID-19, and offering guidance to professionals who have been asked to have difficult conversations for the first time, is a short-term priority, being supported by using the Essential ACP.
Figure 3. The Essential ACP for COVID-19 will also give professionals some advice on how to have these difficult conversations together with people.
Building the platform: ReSPECT process and the future
On the face of it, it might appear that with the adoption of the Essential ACP, the work on the ReSPECT process and the digital version has been abandoned – this is absolutely not the case, but the situation does deserve an explanation.
The ‘Lego bricks’ of information about a person, which collectively can be brought together to ‘make’ a ReSPECT form - or an Essential ACP form - have to be stored in in a particular cloud-based ‘container’ or platform.
However, the moment the ReSPECT process is viewed as just ‘a form’ is the point at which it fails. Anticipatory Care Planning is about conversations and people, and it’s worth reiterating that point. A recent editorial in the British Medical Journal outlines this nicely:
“Some of the main benefits that frail patients and their loved ones experience from advance care planning are strengthened relationships with each other and their clinical teams, and support through the experiences of living and dying with frailty and bereavement.”
For any person-centred planning process, the form, and therefore the digital ‘Lego model’, will always derive its legitimacy from the conversation that precedes it.
Rebuilding ReSPECT to scale and supporting conversations
As work on the platform progressed hand-in-hand with the development of the digital version of the ReSPECT process in NHS Forth Valley, it became clear that we needed to rethink and rebuild some of the platform components – some early decisions needed rethinking and work needed to be re-done on a new platform.
The work on the Essential ACP has helped us explore this new platform. This is not a wasted effort, as most of the Lego bricks of information used for the Essential ACP are also vital for creating the digital version of ReSPECT – work on one supports the development of the other. Information held in this way has the potential to support a myriad of decisions and care pathways.
What happens next
In the future, we need to be able to rapidly build technology that supports these kind of compassionate interactions quickly and accurately, always based on the needs of those working in and using the NHS and care services.
With that in mind, we will continue to offer the Essential ACP for the COVID-19 situation, while at the same time working with NHS Forth Valley and NHS Borders to support and rollout the ReSPECT process for the long term.
Supporting the ReSPECT process is critical for everything we do at NDS, as it will inform the development of the National Digital Platform, which will enable us to help create the sort of joined up health and care services that people rightly expect.