The reality of NHS interoperability
If we are to effectively tackle the unprecedented financial, clinical and social problems in health and care most people accept that we have to integrate our local health economies. In this first of six blogs, David Hancock, client engagement director at InterSystems, explores why interoperability is top of the political agenda.
Renewed energy, ambition and opportunity
Health and social care secretary Matt Hancock has undoubtedly injected new energy into the integration agenda – not just with the promise of money for technology – but with a documented vision for national approaches.
Hancock is a believer in technology and is prepared to stake his faith in it to solve many problems. He expects the NHS to do the same and wants to see next generation technology available to staff that integrates information across care boundaries. These technologies will be underpinned by “strict, mandated, open standards for interoperability of systems”, and all suppliers must support the required change.
Hancock is not the only key figure supporting technology investment for integration, the government’s pick for NHS England chair, Lord David Prior who is chair of UCLH Foundation Trust admitted that integration was absolutely needed and that providers needed to stop acting as “islands in the sea”, instead working together to help their populations, neighbours, and wider patches.
It is encouraging to see such clear indications of intent, particularly when you consider that nearly 10 years ago the straight talking IT analyst Boris Evelson wrote a blog after visiting HIMSS 2009 called “Healthcare Industry BI Groundhog Day”. And here we are nearly 10 years later asking the same questions:
• Where are the open technology standards?
• Where is the transparency?
• Where is the common sense that business requirements, not vendors, dictate the rules?
Even though we haven’t made as much progress as we should, 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.
Long term investment
To aid that journey the NHS was promised an additional £20 billion a year in the Budget – but we all know the money will not go far. NHS Improvement has disclosed that the underlying provider deficit is now £4.3 billion, and there will be tension between getting hospitals back on track and delivering on the promises in the long-term plan.
Transforming services, implementing new models of care, is the only way to eliminate the deficit and make organisations sustainable in the long-run. We are seeing the development of payment models that put more emphasis on prevention, now we need the interoperable systems that will enable information to flow across the system, so patients can be treated in the right place and treated right first time.
When it comes down to it, the service can’t afford not to do this. And it has a mandate. Matt Hancock told the Health and Care Innovation Expo: “I am not looking for people to blame. I am looking for people to lead.”
Seizing the opportunity
Interoperability provides an unprecedented opportunity to standardise, re-engineer and improve clinical workflow. We have a responsibility to take advantage of this opportunity, and not to, would render the investment in interoperability useless. As my systems lecturer in the first year of my degree told us 35 years ago, “old process plus new technology = extremely expensive old process”. Therefore, we must use new technology and models of care to change the way care is delivered.
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 to one of prevention and continuous care.
Technical challenge or something else?
With this renewed momentum and a genuine opportunity to act on well-rehearsed arguments that favour integration and interoperability we should not pretend the interoperability needed will be easy.
Dr Graham Evans, the chief information and technology officer at North Tees and Hartlepool Hospitals NHS Foundation Trust, told the Joined-Up Health and Care conference this summer that the challenge to achieving real integration and interoperability is 10% technical and 90% everything else – people, process, culture and organisation. This applies just as much to achieving interoperability across a region as it does across an acute trust.
Make no mistake, there are huge challenges in “the 10%” technical work that must now be overcome quickly, but our eye must be on “the 90%”. This is integration of the next generation. Our standards and systems must negotiate security matters, and access and return structured information so it can be reasoned on (for intelligent display or clinical decision support, etc).
In the next blog in this series, I’ll explore the technical and ‘everything else’ challenges and provide some insight into how to address them.