- The Year of Care Pilot Programme
- The policy context
- Why Year of Care? The case for change
- What works for LTCs
- Care planning - what is it?
- The benefits
- The care planning training support programme
- Information technology
- Commissioning and Year of Care
- About us - Year of Care Partnerships
- How to get going with care planning
- Year of Care resources
- Year of care document library
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Year of Care pilot sites quickly identified that traditional electronic health records do not contain codes and fields to record key patient generated data items such as individual goals, action, plans and unmet need, in a systematic way so they can be accessed during routine clinical contacts, be made available to patients in usable formats or feed into better commissioning.
IT serves the following processes in Year of Care and Care Planning:
- Supporting the administration of the structure of the appointment system and the care planning process
- Easily enables the sharing of information prior to a care planning consultation
- Enabling the structured recording of patient information and care planning consultations, including goal action plans and unmet need
- Easily identifying patient concerns and supports audit and monitoring of resource use
- Generating a care plan for the person with diabetes, which becomes integral to the clinical record
- Enabling integration of Care Planning within diabetes system
- Linking outcomes from non traditional providers into the referring practice system and making them available for commissioners
It is important that IT templates suit the needs of the practice teams who use them but also that they have a common language and structure to that demonstrated on training
The Year of Care team has developed supporting technical information for practices to support the process of sharing information prior to care planning appointments, and collaboratively developed a set of requirements for system suppliers to integrate within their routine systems.
- Templates, codes and user manuals are now available to support care planning for the commonest electronic heath record systems.
- Providing IT alone will not deliver care planning. Training and attention to attitudes, skills and systems are more important.
- However, appropriate IT available soon after training will speed up implementation and embedding.
- IT systems are essential to capture service use and unmet need for commissioning.
The Year of Care team has developed supporting information for practices to support the process of sharing information prior to Care Planning appointments and continues to work with national IT providers to develop national templates and resources that support the commissioning process.