Achieving interoperability with the National Record Locator (NRL)
The UK population is both growing and living longer, and while this is a testimony to the excellent healthcare and medicine available in Britain, it also leaves the NHS with a problem: how can the public healthcare system handle increased demand without throwing billions of pounds at the problem?
NHS Interoperability may sound like a buzzword but, as the quote above shows, it’s a crucial part of modernising healthcare. By optimising the way NHS and partner systems communicate and share information, the NHS can save hundreds if not thousands of hours – time that can be used to treat patients, study, or rest.
The Access Group is keen to support NHS Digital in enacting these changes in the NHS and beyond. Rio Integration Hub (formerly Conexes) is our solution to bridge the gap between the NHS and third-party solutions, such as our own Rio EPR. The Rio Integration Hub is accredited by NHS Digital for the following:
- NHS Digital GP Connect programme
- NEMS with the Digital Child Health Programme
- National Record Locator (NRL)
- Assessment, Discharge and Withdrawal (ADW)
Below we focus on the National Record Locator specifically, discussing what it is and how we helped three different trusts onboard our software to achieve the desired interoperability.
What is the The National Record Locator - NRL?
The National Record Locator (NRL) is a data access service for local healthcare providers and their own data systems. The NRL can be used by clinicians, care workers, or administrators, so long as they are authorised to access that patient’s information in relation to their care.
There is a degree of overlap with NEMS (National Event Management Service) which you can read about on the Access website as well, but that is for updating patient records and this is for accessing them and using the information in care.
Joined-up care is a big pursuit of the NHS, and one way to achieve this is by implementing systems of communication and data sharing to allow quicker access to accurate information; saving time, cutting down on mistakes, improving the quality of life of healthcare professionals, but most importantly, improving care quality and outcomes. By using the NRL, there is less need for duplicate patient information.
This is NHS Digital’s challenge: to utilise NRL as the go-to service for pointers to necessary records. Pointers are hints about the patient; things like the data type, metadata about the care setting, how the patient can access their data, and organisation contact details. Electronic patient record software, such as The Access Group’s Rio EPR, can connect through an API to the NRL. Rio EPR would give a patient’s NHS number and search filters, and in return the NRL would point to the information required in the EPR.
As the name says, it is a record locator, so the service has the capability to look up patient data and retrieve it too. By doing all of this from a central location, there’s no issue about where patient records are stored and no issues with organising access permissions. This enables interoperability, and that cooperation is crucial to modern healthcare.
NRL for Mental Health Crisis Plans (MHCP)
Mental Health Crisis Plans are a type of care plan. They state crucial patient information that is necessary when a person suffers a mental health crisis. This includes:
- Contact details
- Medical history (mental and physical)
- Details of previous related medication or therapy
- Any indicators of relapse (do they have obvious signs?)
- Personal care instructions for future relapses
Mental health crisis plans are made with patients’ assistance in non-crisis periods, helping to ensure rationality and accuracy when discussing the experience and the best approach. These plans are securely stored within Rio EPR, and patients themselves get a physical copy, but neither of these options are readily available to other healthcare professionals or ambulance services when the patient is in crisis.
This in turn leads to delays in care due to long waits for specialists, and depending on the severity of the crisis can put the patient in danger but also the healthcare professionals on hand. It can also result in patients being taken to a location such as an emergency department, that can trigger further issues for some. By enabling interoperability between electronic patient records and the NRL, the NHS can drastically shrink this gulf between reaching the patient and actually helping them; minimising risk to all parties and greatly improving care outcomes.
As mentioned already, the National Record Locator points to patient information on an electronic patient record system, such as our own Rio EPR. In the event of a mental health crisis, healthcare professionals would access the NRL at the point of care. Rio Interoperability Hub enables our Rio EPR software and the NRL to communicate and cooperate. This would point the care givers to the appropriate part of the electronic patient record (EPR), which then provides them with the MHCP and the crucial, specific details to safely help.
This is why interoperability is important. It enables access to the right information at the right time, and with appropriate software this is done without risking patient privacy or a data breach by ensuring access is from authorised users. By providing the patient data there’s also no need to duplicate or replicate it on the NRL side, which in turn reduces the chance of error and also saves money.
Helping NHS Trusts
The aim with the NRL is to reach a point where a mental health patient can present anywhere in the country – not necessarily in the region where they are receiving care – and their MHCP can still be accessed by those taking care of them.
Somerset NHS Foundation Trust (SFT) was the first Trust to go live with NRL for Mental Health Crisis Plans. Somerset used both Rio EPR and the Rio Integration Hub to connect patient data to the National Record Locator. The core aim was to empower ambulance services to be able to access these mental health crisis plans (MHCP) at the point of care. This gives them greater capacity to assess a patient and evaluate a situation, which then helps the paramedics decide on the most appropriate care setting. In the words of Steve Wightman, Commercial Director at The Access Group
Rather than potentially end up in a setting which is inappropriate or aggravates their condition – like police custody or A+E – professionals can refer to the MHCP for the best course of action to take and the patient receives the right treatment.
Rio Interoperability Hub was ideal for SFT because it not only works with Access’ own solutions but can also integrate with the software of other providers; saving the trust from the disruption of major software upgrades or the cost of changing provider to a solution that can connect.
The Access Group also assisted both East London NHS Foundation Trust (ELFT) and North East London NHS Foundation Trust (NELFT) to implement the NRL. Both trusts provide mental health care as part of their remit, and working in partnership with NHS Digital, both integrated the NRL and Rio EPR to help with MHCPs.
Just like with Somerset NHS Foundation Trust, the aim was to support ambulance crews to access the most up-to-date mental health crisis plans via the Summary Care Record application when they are called on to help somebody in need. By sharing the patient data at the point of care, paramedics are able to more quickly triage and halt the mental health crisis.
Paramedics will be pointed by the NRL to the appropriate details, which will then generate a simple PDF to show the mental health crisis plan and the crucial information about safe places and key contacts for patients, allowing paramedics to contact the right people and make the patient feel as safe as possible and mitigate as much of the incident as possible.
Evolving your healthcare
Our solution, the Rio Integration Hub, has been through a rigorous approval process before earning accreditation from NHS Digital. It has had to demonstrate the basics of reliability and functionality, but more importantly things such as clinical safety, digital security, and quality reviews have all confirmed that it meets or surpasses NHS standards.
The Hub supports the latest Fast Healthcare Interoperability Resources (FHIR) standards – in line with NHS recommendations that services are FHIR compatible. We will continue to support it and adapt to any changes, as well as pursuing our own avenues of improvement in both user interface and data handling.
We’re proud of all of our work in the healthcare sector, but Access takes special pride in this interoperability platform. We know that this state-of-the-art solution is enabling better healthcare for the public, which is what matters most. The Access Group is already partnered with numerous NHS trusts and other software providers to ensure that we all work for the common good: improving health and saving lives.
You can read more about our interoperability impact on our National Event Management Service (NEMS) page.
