Integrated care systems (ICSs) will struggle to achieve even the most basic objectives, such as virtual wards and integrated clinical pathways, without a fundamental change in approach. These digital transformation initiatives must be delivered against a backdrop of mandatory EPR deployments, convergence of systems, escalating trust mergers, creation of diagnostic alliances, hints of a centralised model care record, and unprecedented demands on clinicians.
Integrating Health and Care Data
ICSs face the challenge of merging multiple SCRs and trusts, whilst deploying electronic patient record (EPR) solutions to achieve consistent, cross-organisational clinical information. Therefore, the NHS is calling to collaborative technology partners for a greater focus on interoperability.
Yet while many vendors are talking an integration game, the reality on the ground is very different. Faced with the need to get multiple solutions to work together, the typical response from vendors is to demand the NHS organisation picks one of the incumbent solutions and migrates the merged organisation across to that single platform.
However, one size does not fit all, and it is important to assess the different stages of digital transformation and maturity across the NHS in a far more nuanced way such as:
- What integrated data flows between systems exist within a trust.
Which shared care records (SCR) are deployed at trust level, which bring in data feeds from primary care, mental health, ambulance, community, and social care. Except for primary care, a lack of digital maturity and inability to easily integrate into the SCRs is constraining the shared data vision objective.
- What data is shared between SCRs within an ICS. Simply throwing out all SCRs except one is not an acceptable solution for most ICSs. Additionally, the first wave of SCRs deployed as part of the LHCRE programme are now showing their limitations and may not be suitable for ICS requirements.
- How collaboration will be achieved between ICSs, especially for services provided across borders.
Interoperability Strategy
Every NHS organisation, be it at trust or ICS level, needs to have a solid data strategy. This will include interoperability, to achieve the short-term gains of convergence without throwing away the greater opportunity of moving to a truly patient-centric platform.
There is now an urgent need to achieve integration between systems – of vendor and data standards, be they proprietary or open. Any suggestion that hugely expensive, often recently implemented solutions are thrown out and replaced with just one EPR/SCR solution are impractical, often unnecessary, and expensive.
For the NHS trusts currently exploring plans to implement a new EPR by 2023, significant investment is required to replace inadequate current solutions and achieve a foundation for a digital future. Part of this investment will be to make sure that the new EPR maintains all the mission-critical interfaces to external systems which requires an open technology approach to deliver effectively.
Finding a way through
The NHS needs to find a way to integrate health and care data, to pull together information from multiple sources across areas to support effective clinical and social care decision making.
For years, vendors actively refused to open their products. But now (when procurement entry requirements are focusing more on interoperability of systems) integration tools are part of the offer. But these tools are not always truly open, and are often just another form of “stealth” lock-in. In this way, the NHS is unlikely to be able to eradicate budget draining annual license fees or achieve the level of flexibility and scalability required because organisations will still be beholden to this proprietary technology approach.
Open technology for scalable, flexible interoperability
Open technology is proven at all levels of NHS digital maturity. It leverages rather than discards investment in existing systems and reduces the need for expensive rip and replace programmes. It quickly reduces reliance on proprietary solutions, reducing recurring costs. Plus, by minimising disruption and upheaval, the entire process is not only cheaper, but also faster; allowing an acceleration of digital transformation programmes that deliver real benefits to both patients and clinicians.
Most trusts are already using interoperability to create interfaces between a trust integration engine (TIE) and various applications, from clinical radiology systems to administrative workforce scheduling.
The same open technology principle is also being used for more complex, multi-trust and / or multi-TIE interoperability. Interoperability is allowing trusts to merge and become one virtual entity by pulling together the information from multiple SCRs into a single interoperability record. Furthermore, this interoperability record can offer so much more than the inherently limited SCRs by rapidly integrating any number of clinical systems to provide not only basic patient data, but the depth and breadth of insight required to truly support effective clinical decision making, and in addition allow interaction with this data to support truly integrated care pathways.
The interoperability model can be used to enable alliances between different trusts. For example, enabling multiple trusts in one region to share pathology and radiology results.
As ICS digital maturity increases, the open technology approach will be required by the majority of trusts to ultimately provide the connectivity required to achieve the long-term goal of longitudinal patient records. This should be supported by an experienced integration partner with the skills to deliver interoperability at every level.
Delivering interoperability at scale, irrespective of the next generation of NHS policies, standards, criteria and funding, open technology led interoperability will be the foundation for NHS development for the foreseeable future.
Every NHS organisation needs to have a coherent data strategy to be assured that information can be best utilised across a geographic region to meet the challenges presented as virtual wards, integrated clinical pathways, population health strategies, system convergence, and trust mergers over the coming years. Interoperability, based on an open approach is at the heart of that data strategy, providing assurance through a robust, durable data model irrespective of vendors, standards, and political whim.
In addition, except for the handful of trusts with the internal capability to deliver the strategy themselves, NHS organisations will also need an expert partner and the necessary software platform to deliver interoperability across all levels of digital maturity.
By Andy Meiner, Chief Revenue Officer, ReStart.
