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Project Insight

Focus on Secure email to share Admission and Discharge Notifications across Hospitals and Social Care Departments

Overview
NHS London is working with a number of hospitals and Social Care departments to enable them to share legal documents called Admission (Section 2) and Discharge (Section 5) Notifications securely and more efficiently using secure email.

The process
The Admission and Discharge Notification process is a good example of cross-boundary working.
When a patient is admitted to hospital and is likely to require social care support once discharged, an Admission Notification is issued to the Social Care department where that patient is resident. This alerts the Social Care department to start preparing a home care package for the patient. Once a date for discharge is confirmed, a Discharge Notification is issued to the same Social Care department which allows a two-way flow of information between the hospital and the Social Care department. The Social Care department will often confirm receipt of the notifications, send back confirmation of the care package and confirm whether they are able to meet the discharge date.

The project
Admission and Discharge Notifications are still primarily faxed across London between hospitals and Social Care departments. This creates a number of issues around security, timeliness and legibility. NHS London are promoting the use of secure email to support this workflow through the implementation of a generic NHSmail email account within hospitals, and a corresponding generic GCSX/CJSM email account within Social Care departments. This will enable hospitals and Social Care departments to share patient identifiable information more efficiently and securely.

More about secure email
NHSmail has 420,000 active accounts with more being added on a daily basis. It is a secure, web-based email service which has the capability to send free faxes and text messages. It is approved for the exchange of patient identifiable information with other NHSmail email accounts and with users of other approved secure email networks such as the local governments’ email accounts for example, @gcsx.gov.uk and @x.cjsm.net.  
 
Background
The project was piloted within Ealing Hospital and Ealing Social Care Department who went live with secure email to support their Admissions and Discharge Notifications workflow in January 2011.
NHS London ran process mapping sessions to identify the current process of sending the admissions and discharge information between the hospital and social care. This was followed up with a session to identify how future processes could operate if secure email replaced faxing. Further sessions were held every fortnight to track actions and report progress.
As the project progressed, it emerged that the neighbouring West Middlesex University Hospital and Hounslow Social Care Department were already sending information securely between their hospital (using NHSmail) and Hounslow Social Care Department (using GCSX). With this already up and running in January 2011, West Middlesex University Hospital also started sending notifications to Ealing Social Care Department for patients who were resident in Ealing. Plans are in place to enable Ealing Hospital to additionally send notifications through to Hounslow Social Care Department.
Since starting the project with Ealing, NHS London has been engaged with a number of Boroughs and NHS Trusts who have started similar projects.

Timescales
Within Ealing, the project took four months to go live from the initial ‘kick-off’. However, timescales for other similar projects will vary depending upon the amount of change required to introduce secure email. Some of the key factors which will impact timescales:
 

- Are notifications being created electronically already? 
         o Some hospitals may be able to pre-populate notifications with information from their Electronic Patient Record system. However, this often results in delays whilst the functionality is developed. 

         o Alternatively, document-based e.g. MS Word forms can be used. 
         o As an interim, some Trusts have introduced scanners with secure email functionality so that hand-written forms can be sent securely to a selected email account.
 - Who’s involved in the processes?
          o Depending upon the extent of change, the new processes could require staff that were not involved in the original discharge process to play a more active role. This will have a      bearing on training requirements for staff.
 - What is the status of secure email within the Trust/Social Care Department? 
         o It is important to note that Trusts are not expected to ‘migrate’ to NHSmail such as to use their NHSmail account only, although this is an option.
         o The status of GCSX and CSJM email account roll-out within the Social Care Department has caused delays within some projects.
 

Resource requirements and implementation costs
Costs will vary between projects. For Ealing, apart from limited resource requirements, there were no implementation costs. In terms of resources and commitment for Ealing:
 - NHS London provided Project Management resource at approximately 0.5 days per week.
 - Staff representing areas from each step in the process, for example Ward/Nursing staff, Discharge Planning staff, and Hospital Social Work team etc. with representation also from IT and      Information

Governance, attended meetings and progressed actions at approximately one day per month.
 - Technical resource to set up generic accounts and make forms electronic if required at approximately one day per month.

The process

NHS London has developed a Project Checklist with suggested activities and outline benefits to support Social Care departments/Trusts wishing to roll out secure email for the admissions and discharge workflow. The key tasks for Ealing and subsequent projects have been:
 - Identify scope (which organisations, which teams?)
 - Ascertain secure email status
 - As is (current) process mapping session
 - To be (future) process mapping session
 - Baseline benefits
 - Create capability to produce admission and discharge forms electronically
 - Set up generic secure email accounts (this could be one generic email account on the hospital side and a generic email account on the council side)
 - Train staff

Benefits
The key benefits from introducing secure email to support the admissions and discharge workflow:

 • More efficient use of administrative resource within the Council – Social Care administrators will no longer need to scan information in and can upload notifications directly into their Social Care

   System. As the forms are electronic, they are able to copy and paste relevant information into their own system rather than entering information from scratch. This will result in the council saving an estimated 74 days per year in staff efficiency.

 • More efficient use of administrative resource within the Hospital – There is often numerous information hand-offs before the information is faxed to Social Care. Through the review of processes, this can often be cut down significantly with ward staff sending the information directly to the relevant secure email account. This will result in the hospital saving an estimated 171 days per year in staff efficiency, when rolled out to all wards.
 

 • Reduced time to clarify data – Data capture fields can be made mandatory in electronic forms and therefore the amount of missing data requiring follow up calls is reduced. Faxes and handwritten  documents are also often difficult to read and therefore electronic forms reduce the numbers of calls made to ward staff to clarify information. An estimated 245 days will be saved due to time and efficiency benefits across Ealing Hospital and Ealing Social Care Department.

 • Reduced risk to patient safety – Faxes have several vulnerabilities which could result in the wrong person reading the document. With older fax machines, it’s possible that pages of the same form  can be split with other forms when received by the recipient. Using email will enable senders to send data securely. Email between users of NHSmail and GCSX accounts is fully secure and is approved for the communication of patient data.

 • Reduced time taken to communicate Admission and Discharge Notifications between the hospital and Social Care department – Many hospitals rely on fax to communicate notifications with social care. There are a number of common issues which can result in a delay in receiving a fax communication for example, if the recipient’s line is busy, there is no paper at the other end, or the quality of the faxes requires the information to be resent. NHSmail and GCSX are both considered business-critical enterprises and as such are obliged to keep time down to a minimum. This could also have a positive impact on any reimbursement fees as forms will be received quickly.
 

• Less time required for staff to follow up on whether a form has been received – Currently, many hospitals are required to get telephone confirmation that a form has been received. The fax ‘delivery receipt’ only confirms that the fax has entered the recipient’s phone system, not that it has been received. However, a delivery and/or read receipt can be applied to email messages which provides assurance that the information has reached the recipients inbox or been marked as read.
 

• Provides an improved electronic audit trail – Organisations often file forms and the fax delivery receipts. Social Care departments usually then populate their electronic system to reflect the information sent. By sending the information electronically, this provides an opportunity for social care users to save the electronic documents as an attachment against the patient on their system.

 • Reduces the amount of paper – The notifications themselves are often two to three pages however, with fax headers, delivery receipts and multiple hand-offs, this can result in many more pieces of paper. Secure email will reduce the cost of paper, ink and electricity. It will also save approximately £592.80 per year for Ealing Hospital and Ealing Social Care Department.

 • Fewer instances where information is sent to the wrong address/fax number – With email clients such as Outlook, previously used email addresses are saved within the title and make it much harder to send information to an unintended recipient.

 Systems involved: NHSmail, GCSX. 
 
 Organisations/ Groups involved: Department of Health, NHS London SHA, NHS Connecting for Health, London Social Care Departments, National and London Social Care Information Management Groups. 
 
 Key Contacts: Keith Strahan, NHS London Keith.Strahan@nhs.net Mobile: 07799 340 001.