Case study
Universal Care Plan: Making personalised care a reality
The Universal Care Plan is a digital personalised care and support plan that enables every Londoner to have their care, health status, and support wishes digitally shared with healthcare professionals involved in their care and receive coordinated care that aligns with their individual needs, preferences, and goals.
- The UCP programme supports pathways for urgent and end-of-life care, for patients with sickle cell disease, and care planning sections for patients with dementia, frailty, learning disabilities, and autism. It also includes enhanced support for children and young people, as well as contingency planning for carers.
- The UCP has demonstrated success in improving outcomes for end-of-life care patients, with 70% achieving their preferred place of death, compared to the national average of 50-55%. Unplanned hospital admissions are reduced to 30%, significantly lower than the national average of 46%. Additionally, over 7,700 people with sickle cell disease have a UCP, which is approximately 74% of those receiving treatment in London.
- The solution enables information to be shared in real-time across various health and care settings across the region, while enabling the relevant technical capability to provide interoperability with the existing health and care IT systems.
The latest expansion moves the UCP to a truly personalised care and support plan, where ‘what matters to a patient’ is just as important as ‘what is the matter with them’.
“The UCP platform has become a well-established tool for health and care professionals and is helping to ensure people have their care wishes and preferences respected. Our role is to enable all parts of the system to quickly access relevant patient information at the right place and right time. I am proud that we continue to enable this for people and our health services with these latest developments.“
Nick Tigere
Head of Programme, Universal Care Plan
Learn about the technology that was needed to launch the new London Universal Care Plan in just seven months.
What is the Universal Care Plan for London?
The Universal Care Plan is a conversation between a healthcare professional and the citizen in their care, where the professional will listen, understand, and make notes on their care and support wishes such as what is essential in day-to-day life, care preferences, information about personal contacts involved, and urgent care key information such as diagnosis, prognosis, symptom management.
It is a platform that serves the entire London region and ensures that care is tailored to personal needs and delivered as close to home as possible. It supports a collaborative and data-first approach to improving technology, information governance, and how health and care services are provided and experienced across London.
The Universal Care Plan brings together multiple electronic patient records, personal health records, or electronic palliative care coordination systems in standardised data fields and is accessible to all urgent care services. It is based on the openEHR standard that enables information and data sharing.
Why OneLondon opted for a platform approach?
Single sign-on access for all users.
Easy access to the forms and applications you need from existing systems.
Development of forms using low-code development tools for co-production at scale.
Making changes for all users at the same time.
Expanding to new usecases re-using the infrastructure and captured data with minimal dependencies.
Real-time read-and-write access to data for other applications and research.
Centrally maintaining control of the data model.
Existing content can be shared and adapted between multiple providers.
Key features of the Universal Care Plan
Platform approach
An openEHR platform approach with a persistent data layer, combined with low-code development tools, enables rapid application development. It also provides interoperability and enables systems and users to interact with citizen data. It reduces duplication of data and improves accessibility.
Improved accessibility
Users accessing the UCP via interoperable electronic patient records do not need separate login credentials. The solution is accessible via a standalone portal or via context launch with a single sign-on from a user’s local EHR, including GP systems (EMIS, EMIS Community, and TPP SystmOne), emergency care systems Adastra and Cleric, and secondary and acute systems such as Oracle Health.
Reduced duplication
Care plans can be pre-populated with relevant information from the patient’s GP record. Specified SNOMED codes can be written back to GP records.
Use case development
The technology underpinning the Universal Care Plan enables multiple care plan use cases to be created, thus supporting a greater variety of clinical pathways.
NHS App & NRL integrations
The Universal Care Plan has integrated with the NHS App and the NHS National Record Locator (NRL). This is an important step towards nationwide healthcare accessibility and revolutionises patient care coordination, providing access to vital health information regardless of geographical location within the UK.
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Benefits of the
Universal Care Plan
Shares
data in real-time across various health care settings and geographies in the region.
Consolidates
records across the region, centred around the patient.
Optimises
structure, behaviour, and content of the care plan.
Simplifies
the use with a single sign-on approach that integrates into existing applications.
Presents
a single source of up-to-date information that can be shared between multiple providers.
Enables
shared care plans for a variety of clinical pathways, including, but not limited to, end-of-life care.
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