Interoperability and the NHS: are they incompatible?

Do you remember what Jeremy Hunt’s New Year’s resolution was? On 1 January, he pledged that by the end of 2016 every patient in England would have access to their medical records online. Quite a bold claim, given that some hospitals are still using fax machines.

Therein lies the nuance: the Health Secretary was only promising access for patients, not for medical professionals. While much of the general public embraces the advances in information technology from our app-filled smartphones to our fitness-monitoring wristwatches, the NHS trails behind – often frustratingly so. If we’re ready to access our care records whenever and wherever we are, is the NHS ready to do the same?

The NHS has been wrestling with IT challenges for years; billions were largely wasted on the IT plans of the early 2000s, in 2012 the coalition government outlined plans for a new digital strategy, and then in 2014 the Department of Health put forward an updated digital plan designed to work alongside the NHS five year forward view. One of its key topics is interoperability – the ability of the disparate and almost innumerable IT systems and software applications in use in health and care to communicate, exchange and interpret data, and otherwise work efficiently together. Many aspects feed into this, from standardised data entry to improving the way information moves across locations and computer programs. The NHS hopes to achieve full interoperability by 2020, but all medical records should be digitally accessible by medical professionals in acute settings by 2018.

The entire health and care sector has the opportunity to implement some long-term, efficient changes that could shake up how care is delivered: improved interoperability would allow the integration of health and social care records, greater ease of use for clinicians and reduced admin. Some providers have already made moves towards integrated and interoperable care records. In Bradford and Airedale, for example, service users are able to benefit from an integrated care record that is accessible across a range of devices and situations by care professionals. Other areas such as Leeds have created similar systems, and efforts are under way in Lambeth and Southwark, Bristol and Hampshire to follow suit.

There are common themes in the work of these providers: they all had buy-in from their clinicians early in the process and involved them throughout; they all aimed to use digital tech as an integral part of wider transformation plans, and made a positive case for the benefits to both patients and staff. But despite some success stories, not all organisations are ready to make changes; the results from NHS England’s digital maturity assessment survey show that many trusts are being left behind. Out of the 148 acute trusts surveyed, more than half disagreed with the statement that other local health care providers could access the patient information held by the trust. When asked about social care services’ access to their information, the situation was even worse with more than 70 per cent of acute trusts disagreeing that local care organisations could access the patient information they needed. The survey results are not all bad news, however. Care providers were more positive than acute trusts when it came to the potential influence of sustainability and transformation plans in delivering the government’s current digital vision, and most mental health trusts were more positive about their information-sharing capabilities than their acute counterparts.

Considering the health and care sector as a whole, it is no wonder that so many providers have found it difficult to achieve interoperability of their systems. Working across health and care organisations is a complex and difficult proposition; from the cultural challenges of aligning different parties to the IT problems of bringing together data from normally incompatible sources and investing time, money and training into new computer programs and systems. Doing so at one of the most financially challenging and pressured periods in the history of the NHS may be a near-impossible task for many regions.

The Department of Health and NHS England are making funding available for digital projects, but there’s been uncertainty around exactly how much this will be and whether or not it will all be protected. Capital-to-revenue transfers were a huge boost to the Department of Health’s financial position last year, and there will be the temptation to do the same again. However, if trusts and commissioners feel able to protect that money from other pressures then the long-term benefits could be huge, not just financially but also for creating better care pathway planning and giving patients safer and higher-quality care. Additionally, it presents local health economies with the chance to prove they can work well together in ways they haven’t done before – something NHS England seems to value greatly.

The health and care sector – and the NHS in particular – needs to act now: if interoperability is not embraced in the same way it is by the public, then one day you might have to bring your mobile device along to your appointment just to let your doctor borrow your integrated care record.

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Comments

#548005 Steve Cumbers
Doctor
NHS

Three principles are: (1) Nationwide non-proprietary global standards. (2) Common interface protocols and data formats. (3) Avoiding proprietary lock-ins especially hidden data formats.

#548015 Tim Benson
Director
R-Outcomes Ltd

I agree with Steve Cumbers. Digital health is digital, which means we need to be precise when it matters about identifiers, codes and data structures.

In particular we need to use HL7 FHIR (fast healthcare interoperability resources) with SNOMED CT and a full set of organisation and people identifiers [1].

Why, for example is there not a national standard to identify a bed on a ward in a hospital? Why do we allow laboratories to code tests in non-standard ways? Why is it quite hard to get a SNOMED CT code for a patient questionnaire?

One reason why GPs have been using computers successfully for 25 years is because the Thatcher government standardised on the Read Codes, which were fit for purpose for clinical use [2]. Codes used in hospitals such as ICD-10 and OPCS-4 are designed for bean counters not clinicians.

References
[1] Benson T, Grieve G. Principles of health interoperability SNOMED CT HL7 and FHIR. Springer 2016
[2] Benson T. Why general practitioners use computers and hospital doctors do not. Parts 1 and 2. BMJ 2002; 325 (7372) 1087-93)

#548019 Lorraine Foley
Chief Executive
The Professional Record Standards Body

Excellent integrated health and social care needs a joined-up, coherent care record system - something the NHS and social care currently lack. The Professional Record Standards Body (PRSB) is a unique UK wide organisation which brings together professional and patient organisations to work with the health and care IT community, suppliers, and NHS Digital as equal partners to ensure health and care information is fully expressed in care records. The PRSB’s work to structure and standardise the content of electronic health records is fundamental to the interoperability of IT and the sharing of care records across organisational boundaries that is an important driver for improving care in whatever setting people are looked after.

NHS England, NHS Digital, the PRSB and its member organisations are working collaboratively on a transfer of care initiative to drive the uptake of professional standards, underpinned by technical ones, across health and care to support transfers of care between organisations and professionals. Once completed, the health and social care system will have vital tools to hand to improve direct service user and patient care. However, putting them into practice is the real test of their success and in the coming year our focus is on driving clinical and professional leadership through our membership to drive adoption.

#548036 Matthew Lewis
Consultant
Sandwell and West Birmingham Hospitals

One catch to avoid is allowing a multiplicity of systems to develop when one has already been demonstrated to work. Once we have developed an effective approach, It makes sense to roll it out widely and quickly, rather than attempting to produce locally-tailored solutions across the country.

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