NHS England has responded to this challenge with the Five Year Forward View, which outlines the changes that need to be made in order to provide a sustainable NHS which continues to provide high quality care for all. The information revolution is a critical element of this view, with an expectation that the digital channels that citizens are able to utilise for consumer services should be similarly utilised for healthcare delivery.
On the face of it the NHS is a sector ripe for improvement through the deployment of information technology given that it is heavily dependent on people communicating using paper documents. This was originally recognised by the ill-fated National Programme for IT, but during the final phases of the programme and since market engagement has flourished with more NHS providers now using IT systems for capturing and storing patient records. This has been encouraged by NHS England’s ‘Integrated Digital Care: Technology Fund’ and similar initiatives.
Now when patients interact with NHS providers, patient information is captured electronically and then shared across that provider organisation so that as the patient moves between different departments they do not have to repeat what they have already said, and also their records are unlikely to go astray (unlike a thick wad of paper records!).
Challenging times
With this development comes a new challenge: the drive towards integrated care means that these systems need to be interoperable i.e. able to share information across providers so that clinicians always have the information they need in order to make well-informed treatment decisions for their patients. If a patient’s GP has captured important information about that patient’s condition, why should the patient have to repeat this information when they visit a consultant at their local hospital?
This is fundamentally not a problem of technology - technical standards for sharing data have been in place for many years, led by HL7 and IHE; there are also many vendors with products that enable this information sharing. Moreover this is not a challenge unique to the NHS - the American Medical Association has called for greater data liquidity - interoperability across care settings.
Historically the barrier to interoperability has been that the benefits of sharing information have not accrued to the organisations who need to make the investments to enable the information to flow. However the broader recognition of the need for integrated care has changed this equation, triggering an understanding across care provider networks - groups of providers who combine to provide care to a shared population - that information needs to flow quickly and seamlessly but in a controlled fashion taking into account patient references around how their information is being used and shared.
BCS interoperability guidelines
Many healthcare providers, whether primary care, acute or even social care, have begun to build interoperability solutions between their respective IT systems. In order to facilitate this trend BCS has launched an interoperability guideline for health and care providers. The guideline, produced by BCS Health, a community of health informatics experts, aims to provide practical guidance to groups of health and care providers on how to set about sharing patient records so that the appropriate information is available to clinicians at the point of care delivery.
Dr Justin Whatling, Chair of BCS Health, explains: ‘As we move towards new models of integrated care it is vital that we have interoperability between systems. We need systems to be able to talk to each other and deliver a complete record to patients and their clinicians to make safe and appropriate care decisions.
‘In England, recent stimulus funds have encouraged many more health and care organisations to embrace interoperability solutions but as they do there is a real opportunity to learn from the experience of others, and not feel the need to invent from first principles. The guideline is a practical, high-level tool that shares tips on approach and best practice learning from others to speed up and reduce risk of implementation.’
The guideline was put together based on gathering inputs from a broad range of stakeholders across the NHS in England, helping the guideline to address specific, practical challenges that health and care providers face when they implement interoperability.
The purpose of the guideline is to assist health and care providers in understanding how to go about sharing information to improve the quality of care delivery. Following reviews, care providers commented that they wish they had this guideline as they embarked on their projects, and one is able to use it as a tool when planning an interoperability programme.
Adopting the framework
Central to the guideline is the information sharing framework which provides a holistic view of the different aspects of interoperability that providers need to think about when embarking upon their interoperability journey. The guideline provides specific guidance for each element of this framework. These are summarised into concise ‘key considerations’ which can be used by providers as a checklist.
As an example consider the following key consideration for outcomes:
Choose benefits that are measurable, consider ones that are patient, safety - and / or business-centric where possible e.g. reduction in admissions of the frail elderly.
This is a practical lesson learnt from an NHS provider who has implemented interoperability. It has been formulated in a non-technical way so that the guideline can be absorbed and appreciated by a wide audience.
Sharing best practice
Justin concludes: ‘An important aspect of professionalism is the sharing of best practice across our communities, so that individuals and organisations can develop skills and learn from others. We hope that this basic interoperability guideline will help give early pointers to interoperability projects and encourage health and care providers to seek more detailed understanding from professional bodies and networks.’
Dr Paul Rice, Head of Technology Strategy, Strategic Systems and Technology, Patients and Information, NHS England adds: ‘I am excited to see the launch of this guideline which I am confident will be a useful source of practical advice for NHS organisations seeking to share information. This guideline aligns with NHS England’s strategy for promoting interoperability between care organisations and is consistent with the ambitions of the National Information Board document - Personalised Health and Care 2020 - so I welcome the contribution it makes.’
A number of industries have been transformed by the adoption of digital technologies, improving quality and customer experience whilst simultaneously reducing costs. As the NHS increases its adoption of digital technology it is crucial that these technologies continue to drive value for the NHS rather than becoming a barrier to progress.
Fundamental to this value generation is ensuring that information assets are leveraged to the greatest extent possible - sharing this information is a prerequisite for this asset exploitation.
The BCS guideline provides straightforward guidance to care and health providers seeking to share information and therefore is a modest but significant contribution to helping the NHS evolve towards new models of care, helping it to continue to provide high quality care for all.
