Mental Health

Information Core for Integrated Care (ICIC).

Vision

What is the Information Core for Integrated Care (ICIC)

What information will the ICIC capture?

How will the ICIC information be collected?

Policy Drivers

Benefits of the Information Core for Integrated Care (ICIC) type system?

Previous work

ICIC test implementation

- Evaluation of ICIC test implementation
- Consultation of ICIC dataset

Organisational Structure of ICIC Test Implementation Project

ICIC Test Implementation Report

ICIC Executive Summary

Vision

The Information Core for Integrated Care will capture information on encounters and interventions between service users and community specialist mental health services. Collection of standardised ICIC information will ensure that nationally consistent information will be collected and held in health and social care systems across Scotland. Members of a joint care team will have routine access to the ICIC in order to aid the delivery and continuity of inter-disciplinary multi-agency care.

What is the Information Core for Integrated Care?

The Information Core for Integrated Care (ICIC) is an information sharing dataset intended to capture key information on significant encounters between service users and community specitalist mental health services. It's purpose is to allow members of a joint care team (including social work, health, non-statutory and other agencies) to have access to basic shared information on what care is being delivered, which can aid delivery and continuity of interdisciplinary multi-agency care.

What information will the ICIC capture?

The ICIC captures information on who was seen, where, who saw, what was done (interventions) and why it was done (diagnosis/ symptoms) and what is going to happen next.

It contains information on:

• Service user details
• Associated person(s) details
• Associated professional(s) details
• Referral/ transfer details
• Legal status
• Encounter details
• Risk factors
• Current Problem(s)
• Intervention(s)
• Medication
• What's next

The table below shows the differing levels of information within the ICIC dataset

Further details on the content of the ICIC dataset including data items, categories and definitions can be found on the Health and Social Care Data Dictionary (in 'Clinical Datasets' under mental health).

How will the ICIC information be collected?

Following an encounter with a service user and member of the joint care team it is hoped that the ICIC information will be entered/updated in existing systems. The web-based mock-up has obviously had to adopt a particular format to illustrate, but we envisage the ICIC will be collected using whatever clinical system a care team routinely use.

The information contained within the ICIC can be split into two parts:

• The personal details section of the Single Shared Assessment (SSA) captures all of the core person summary information within the ICIC. To avoid duplication of recording we would hope that person summary information captured through the SSA process would auto populate the ICIC (or vice versa) to avoid duplicate recording.

• Event summary - The event summary information will capture information on encounters and interventions with service users and community specialist teams. This is essentially the who saw, where/ when seen, why seen, what done and what next which will over time build up an encounter history between the service users and the joint care team. This information will then be able to be accessed routinely by CMHTs to aid care delivery, particularly during times of crisis out of hours when key information can often be difficult to access.

Policy Drivers

Partnership for Caresets out the case for investment in clinical information systems by reaffirming that:

"NHS staff need access to the right information at the right time, if they are to meet patients' needs. We urgently require an eHealth culture to be established, driven by clinical leaders."

eHealth has been recognised as a national necessity and, as part of an all-Scotland eHealth Programme, a Clinical Information Steering Group has been established to develop common data definitions and standards across Scotland. The group oversees theNational Clinical Dataset Development Programme , which has been established to support clinicians in developing a set of interoperable national clinical datasets, to facilitate the implementation of integrated care records across NHS Scotland. As detailed in the eHealth strategy:

"...establishing agreed datasets and codes to be used in all exchanges so that information is correctly interpreted by everyone who shares it. Standardisation of definitions and integration between datasets will be clinically-driven in future to ensure that NHSScotland's information systems support national clinical priorities."

A revised eHealth Plan, founded on a vision of a single record for NHS patients, will reduce the diversity of information systems and standards across NHSScotland and increase investment to deliver information support to care.

Benefits of the Information Core for Integrated Care (ICIC) type system?

The table above highlights some potential benefits the ICIC could bring to both the providers and recipients of care. We envisage that the ICIC dataset would be collected at each significant patient/ client encounter with acare provider. At present the capture of information is often fragmented, with records being held in separate locations, often not accessible by those involved in the delivery of care when a crisis situation occurs. For example, consider the following scenario:

Out of Hours (Mental Health) receive a phone call from a distressed relative whose son is already known to Mental Health Services. The duty nurse is informed that the son has locked himself in a room, is verbally abusive and appears to be responding to both auditory and visual hallucinations.

Out of hours staff have no access to case records. They are therefore unable to tell if/ when this patient was last seen by either MH staff or his GP. They have no idea if for example his medication has recently been altered or if perhaps he has failed to turn up for a Depot injection. They are also unaware if there are any predetermined "risk factors" or an existing "management plan" which they should be aware of prior to visiting.

Non-access to shared records in scenarios such as this can put both the patient and clinician at risk. It is envisaged that access to encounter and intervention summary information (the ICIC) would aid delivery and continuity of interdisciplinary multi-agency care. Five other scenarios of situations where access to a shared care record derived from ICIC records would be useful are also available.

Previous work

Extraction pilot

We have already conducted a pilot extraction of data from the mental health clinical information systems of three NHS board areas. A report on this work, with recommendations for further action is now available.

The retrieval pilot has been very valuable in showing us what information is already collected locally, and where national attention needs to be focussed. For example it appears that we will need to assist organisational development locally so that current problems/diagnosis and the care delivered are both more routinely documented. The retrieval pilot has shown that the ICIC presents an opportunity to track the patient's journey in the community, and provide better information on encounters and interventions. The design of the tool reflects the continued growth in joint working between health and social care, to deliver a better standard of care. The ICIC has the scope to provide valuable mental health care information, which can inform policy makers and budget holders.

Refinement of ICIC dataset

In December 2004 a project manager, Fiona Black,was appointed to take forward "real-time" test implementation of the ICIC. A fullProject Initiation Documentis available.

Following the recommendations in the retrieval pilot report a multi disciplinary working group (including service users and carers) was established in March 2005 to refine the content of the dataset. The group met monthly from March to October 2005 to agree the detailed content of the data items, definitions and categories.

Details of the terms of reference and membership ICIC refinement SLWG are available. Minutes and other relevant papers from the ICIC refinement SLWG meetings can be accessed from the table below:

ICIC test Implementation

The objectives of test implementation were:

• To identify and reduce barriers to the collection of ICIC using existing mental health systems
• To facilitate information sharing
• To improve information mindedness and support joined up working by CMHTs
• To provide community information currently in deficit
• To determine the usefulness of the data at national and local level
• To assess whether the ICIC is fit for purpose and sufficiently robust for rollout across Scotland

Three Health Board areas have volunteered to participate in test implementation. These are:

• Borders
• Forth Valley
• Lothian

Evaluation of ICIC Test Implementation

Following test implementation of the ICIC dataset a formal evaluation report has been produced. This will measure the success of the ICIC test implementation project using a combination of:

• The findings of the evaluation
• The quality of the data collected e.g. completeness and accuracy
• The usefulness of the data analyses e.g. do they appear to reflect clinical practice
• Whether people want to continue to collect ICIC data after test implementation

At the end of the data collection period in each site participants were interviewed about their experience of test implementation.  The interviews took approximately 30 minutes per person and captured a combination of quantitative and qualitative information. The quantitative section identifed perceived barriers to data collection e.g. lack of time, limited computer access etc. In addition participants were asked to rank data items such as mental health problems/ symptoms in terms of their importance and usefulness. The interviews also captured qualitative comments from participants in order to gain an insight into how fit for purpose the ICIC was, and whether it is suitable for rollout across Scotland, and the benefits that collecting/ sharing information has brought to participants e.g. how it facilitated information sharing or improved access to key information.

Consultation of ICIC dataset

In addition to the feedback received from test implementation we have also undertaken a formal consultation of the dataset in collaboration with National Clinical Dataset Development Programme . The Information Core for Integrated Care and Psychiatric Inpatient Clinical Discharge Summary datasets were issued for consultation on 8th February 2006. The consultation closed on 28th April 2006 and a total of 41 responses were received. Individual data items were amended as appropriate following consultation feedback and the changes were signed off by members of the multidisciplinary dataset-working group who agreed the original content.

The final ICIC and PIC-DSIS datasets was approved by the NCDDP Board for publication in the Health and Social Care Data Dictionary http://www.datadictionary.scot.nhs.uk/ as a national standard on 15th September 2006.

ICIC test Implementation Report  1.02mb

ICIC Executive Summary   53.7kb

Main contact: Karen Brown

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