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
CREDIT: This is an edited version of an article that originally appeared on Digital Health
These digital transformation initiatives must be delivered against a backdrop of mandatory electronic patient record (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 shared care records (SCRs) and trusts, whilst deploying EPR solutions to achieve consistent, cross-organisational clinical information; therefore, the NHS is calling on 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 SCRs 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 local health and care record exemplar programme (LHCRE) 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, in order 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 with external systems and this requires an open technology approach for effective delivery.
Finding a way through
The NHS needs to find a way to integrate health and care data and to pull together information from multiple sources across areas in order 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. However, 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; this allows 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 also 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. 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.
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