What a great acronym! It opens the way to multiple catch phrases some of which convey the meaning or intention better than others. The key letter is of course the ‘I’ for it is the information that is key and the sharing that makes it function. In a world where paranoia about personal information is rife and misdemeanours make frequent headlines, effective sharing of appropriate information about the people we care for can feel challenging. However we all know that patients expect those who care for them to have details of their problems, tests and medication. They are often surprised to learn how poorly this information is shared and frustrated by having to answer the same set of questions time and again.
Ae fond KIS
Scotland took the bold step in 2006 and set up the universal Emergency Care Summary (ECS) which made available a small set of data about patients including details of allergies adverse drug reactions and current medication as recorded in the General Practice record. Following wide consultation within the NHS in Scotland and with the wider public, it was agreed that permission to view this information would be ‘at the time’ the patient presented looking for help. There was, of course, an opt out option for patients (exercised by only 0.01% of the population) which stopped any information being sent from the GP practice to the central ECS store. The initial program was designed to support emergency and unscheduled care. However it quickly became apparent it had application in the wider acute hospital setting and in 2012 it was permitted to access the data to support medicines reconciliation processes for any patients in hospital. It was however the limitations of the dataset that prompted first the development and the electronic palliative care summary (ePCS) and more recently the Key Information Summary (KIS).
Beyond the KIS of Death
As we struggle with caring for ever increasing numbers of older and frailer people, many of whom have multiple medical problems, it was sometimes difficult to pause for long enough to reflect with the patient about their expectations for the future and what care and support they would really like. Even when we did find the time it was often difficult to record and share this information. This gap was partly filled by an increasing move to ‘anticipatory care planning’ particularly with patients who were likely to have a flare up of their problem and needed to know what to do. It is only with the advent of the KIS that we now have an effective mechanism for the sharing of this information.
It started with a KIS
Recording patient’s wishes is now very straight forward and all General Practices are able to do this as part of the day to day job in their practice computer systems. The value of anticipatory care planning has been recognised with it being incorporated into the GP Contract and part of the deal is ensuring the KIS is completed and sent to the central store so the information can be accessed by those involved in providing care should the need arise. At present patients are identified as being at risk of an exacerbation of their medical problem and a possible hospital admission and will be assessed and the relevant information recorded. This will include details of carers, current clinical and caring issues, medication, facilities and equipment available in the patient’s home, care plans, place of care considerations, views on resuscitation and any arrangements in place for palliative care. This is an extensive list of possible information which can be recorded although it is not essential to record it all before some is shared. It is also possible to review and revise the summary as time goes by and in particular add any special note which could be relevant in an out of hours situation. The more sensitive nature of much of this information means the consent to share is sought at the point of recording before it is uploaded into the central store. Without this consent the data cannot be shared.
KIS me quick
So what is the point of telling you all this? Well firstly if you or your patients like the idea of having a Key Information Summary you need to ask your GP practice about how this can be set up and encourage them to do it. As time passes the numbers of patients with a KIS is growing and they will become more available. If you are a clinician working in an area delivering unscheduled care or in any ward or clinic setting in the hospital you need to get in the habit of asking the patient if they have a KIS or checking to see if one is there. Communication is only effective when the sent message is read. If you are not sure how to find them you need to ensure you find out and get the appropriate access set up and passwords organised. If the KIS needs to be altered as a result of a visit to the hospital some feedback to the practice on what needs to be updated would be helpful and if there hasn’t been one set up advise the patient to ask for one.
Full on KIS
This is a project which is evolving and growing all the time but will start to bridge the information chasm between primary and secondary care. Let’s face it, there is nothing better than a full on KIS.
Dr Neil Kelly is a GP in Annan and is Clinical Lead for Annandale and Eskdale LHP.