The CMC service is enabled by a dedicated IT system (provided, hosted and managed since November 2015 by InterSystems), whose user interface is available via a web browser over the N3 network. There is no requirement to install any software or browser plugin on the client PC. Access is also available from non-N3 clients via the Royal Marsden’s two-factor authentication solution, Authen2cate.
Patients consent explicitly to the sharing of their Urgent Care Plan with care providers. A joint Data Controller Information Sharing Agreement, backed by a tried and tested CMC IG Pathway, is in place across all CMC user organisations, and has over 1,000 signatories. CMC is used across both NHS and non-NHS organisations.
Non-urgent care providers (typically GP practices, hospices, acute trusts, and community teams) collaborate to establish, maintain and use the Urgent Care Plans of their patients. Urgent care providers (Ambulance, 111, Out of Hours GPs, A&E, and Urgent Care Centres) are notified automatically by CMC of the existence of Urgent Care Plans for patients in the relevant areas, permitting them to maintain relevant ‘flags’ on their own systems. This allows them to identify the existence of an Urgent Care Plan for the patient at the time of call-out, access it, and thus provide appropriate care.
The content of CMC’s Urgent Care Plan has involved extensive discussion between many clinicians. The Urgent Care Plan covers the SCCI1580 End of Life Care data standard, including demographics and GP information, but considerably extends it. NHS England’s Healthy London Partnership is building new standards for End of Life Care data and for urgent care service interoperability via a generalised ‘Crisis care dataset’. CMC has been closely involved in this work. In addition to end of life care patients, the CMC service coordinates care for many patients with a wide range of long term conditions.
The CMC service is currently commissioned for use across the 32 London Clinical Commissioning Group (CCG) areas; we anticipate geographical expansion.
CMC has an extensive interoperability roadmap. To speed up Urgent Care Plan creation and improve accuracy, CMC makes extensive use of the NHS Spine Personal Demographics Service (PDS); the NHS number is mandatory on each Urgent Care Plan. CMC currently provides polled and on-demand Urgent Care Plan availability web services, plus in-context launching of CMC Care Plans. Single sign-on is under discussion with a range of organisations and software providers and is already in place for GP practices across London which use EMIS Web. Two-way information exchange in compliance with the Healthy London Partnership’s proposed standards-based architecture for London has already been the subject of a proof of concept, involving EMIS, Cerner, Advanced Health and Care, InterSystems, and CMC, and demonstrated live at eHealth Week in April 2016.
CMC provides a patient portal for patients to initiate their own care plans through myCMC and to be able to view care plans which are already clinically signed off by the appropriate clinician.
For the convenience of commissioners and other stakeholders, CMC offers a wide range of management information reports. These are available, usually in PDF format, either on an ad hoc basis or as scheduled monthly/quarterly deliveries.