Where we are delivering interoperability and if we will ever be successful, with some help from Sergio Leone.
Following on from representing techUK on an Interoperability Panel at UK Health Show, techUK Health and Social Care Council Member, David Hancock, reflects on the panel session.
What is happening today, is similar to characters at the end of an epic film drama with this one going for 15 years – at least! Either through their experience, the characters seek and obtain redemption, or they face their denouement (often violently).
“The Good, The Bad and The Ugly”
I have been reflecting on a panel session I participated in at the UK Health Show last week on Interoperability and am left conflicted. How could a session on Interoperability be so popular and be standing room only, yet so many of the questions from the audience show their very basic needs are still not being met? We had some notable positive voices that were “The Good”, but many of the interactions reflected “The Bad and The Ugly” of interoperability. Front line staff and commissioners are still starved of information – the inability to effectively exchange information threatens patient safety, damages productivity and, politely put, is a source of constant frustration. This emotion was written on their faces, with some venting at software suppliers. Attendees were after any good news, even a silver bullet to solve their issues. I, and my fellow panellists had to disappoint these people, because the truth is that there is no silver bullet
Despite that, I am more optimistic than I have ever been and there is an alignment happening between the centre (NHS England, NHS Digital), the Health and Social Care Service and Suppliers. We are on the cusp of doing something great, even if that means we are talking years, because increasing interoperability maturity and capability is a continual process – a journey, not a destination.
“A Fistful of Dollars”
My optimism is buoyed by recognition from the government’s pick for NHS England chair, Lord David Prior who is chair of UCLH Foundation Trust admitted admitting that integration was absolutely needed and that providers needed to stop acting as “islands in the sea”, instead working to help their populations, neighbours, and wider patches.
But how do we do it? Integrated Care Organisations (ICOs), Local Health and Care Record Exemplars (LHCREs) and forward-thinking Health Economies, now driving the interoperability agenda, realise they have to move away from the “Break-Fix” model of Healthcare.
But only two weeks ago, NHS Improvement disclosed that the underlying Provider deficit is £4.3bn (once the non-recurrent “provider sustainability fund” is discounted), even though back in February, NHS Improvement and NHS England stated that the providers should balance their budget this year. With those kind of deficits, where is the “Fistful of Dollars” going to come from?
This fistful of dollars is not some massive technology investment being made by the government though. It’s different payment models that reflect more emphasis on “risk-reward” and focus on prevention – keeping patients out of hospital, ensuring treatment is done “right first time”, reducing duplicate or unnecessary healthcare. By doing this organisations can start to be sustainable and eliminate the deficit.
“For a Few Dollars More”
Eliminating the deficit is one thing, but no one is going to deny that they need “A Few Dollars More”! As the new Health and Social Care Secretary, Matt Hancock is already making an impact in this area. He is very IT literate, “gets it” and expects the NHS and Social Care to do the same. Whatever your political allegiances, in three months he has injected new energy into the integration agenda – not just with the promise of “A Few Dollars More” for technology, but with a new urgency for national approaches to interoperability and information flows.
Lord Prior went on to say that even integration was absolutely needed, if his trust was to help other organisations in his health economy, he would not be thanked by his board as all the incentives are to optimise an individual organisation’s performance.
Hancock, issued a warning to suppliers that they must support required change. He wants to see next generation technology available to staff that integrates information across care boundaries, underpinned by “strict, mandated, open standards for interoperability of systems”. The night shift he did with an ambulance crew in London was clearly very instructive and made a lasting impression. My Twitter feed shows how engaged the IT Leaders of the NHS are directly interacting with him and talking to him – as a software vendor I applaud that.
I also applaud the fact that the Secretary of State is speaking “truth to the health and care software industry”. Put simply, if they do not unlock their data and make it available using open standards, they will not be suppliers to the NHS and Social Care industry. Will suppliers face a violent denouement or will they seek redemption?
Redemption with INTEROPen
Even in Spaghetti Westerns, characters know they have to work together to get what they need. In “The Good, The Bad and The Ugly” Eli Wallach’s character knows the name of the cemetery where the gold is hidden, but Clint Eastwood’s knows the name of the grave where it is buried, forcing them to work together to find the treasure.
We, the Suppliers, the Service and NHS Digital/NHS England need to learn from the past – realise that by not working together, we have been singularly unsuccessful in achieving the prize; widespread, standard interoperability. It’s not just definition of standards but a focus on adoption. As my fellow panellist at the UK Health Show, Indi Singh from NHS England said, “interoperability has to be clinically use case driven and this is at the heart of the LHCRE programme”. One LHCRE may be focussing on Frail-Elderly, another on End of Life and another Child Health. These make sure that the open interoperability standards have demand from the Service; the necessary “Pull”.
We need to ensure that there is also a “Push” – that the standards are defined and adopted by suppliers and the Service. This is what INTEROPen does. INTEROPen is an open collaboration of NHS England, NHS Digital, standards organisations, software vendors, representative from the service (IT and Clinical) to co-develop and test interoperability standards. It is unique and will be copied around the world, because the last 15 years have shown to the NHS that it is the only way to develop and adopt these standards
The final thread of the plot is who pays for the development and implementation of these? Here the mechanisms has already been defined, though this knowledge may have been lost in the mists of recent time. GDEs and LHCREs are being paid to work with their suppliers to develop these key interoperability standards and for them to be part of their standard blueprints. Other organisations that then want to use these blueprints only have to pay for their implementation, so the service doesn’t have to pay twice for the same integration. This maintains total consistency with the techUK Interoperability Charter giving us the joining up of a process that should deliver necessary adoption of interoperability standards.
Next week, I’ll start to cover how do we do this and what should we watch out for.