Last December, the Informatics Planning Guidance for 2010-11 said NHS informatics would shift from a ‘replace all’ to a ‘connect all’ philosophy.
Although the document was issued by the previous, Labour government, it is an approach that has been taken forward by the new coalition.
Since September, and the end of latest review of the National Programme for IT in the NHS, it has been explicit about the need to connect the heterogeneous mix of systems in use in the NHS.
The ‘connect all’ strategy has yet to be spelled out in full. But the part that has been running longest and that has been most fully realised is the Interoperability Toolkit or ITK.
ITK: not an app store
Paul Jones, head of the Department of Health Technology Office, told E-Health Insider that there had been an unusually long enforced silence either side of the general election.
As a result, the ITK has been operating in stealth mode. Nevertheless, Jones says almost 20 ITK services have now been tested and the technology office is working with six or seven trusts on interoperability projects.
The aim, he says, is to create a library of “standard interfaces”, each relating to specific business process or service. These interfaces are accredited by the DH and available for re-use by any NHS trust.
However, the way the interfaces are deployed into trusts remains a matter for them. As a result, Jones is uncomfortable with the early talk of ITK as an Apple-style app store.
Nor has ITK turned out to be a way of opening up local service provider systems. Instead, it has been developed – or been re-cast – as a way of focusing on the interfaces needed to share data between systems to support specific common use cases.
Examples include text messaging, check-in kiosks and getting hospital discharge summaries to GPs. The last of these has probably been the most high-profile because of the demand for trusts to deliver discharge summaries to GPs within 24 hours, with five consortia working on the proof of concept trial.
Easier interoperability at lower cost
Jones says that interoperability is essential to deliver the information flows that underpin the NHS white paper ‘Equity and excellence: Liberating the NHS’, with its focus on measuring quality and outcomes and making the results more transparent.
However, interoperability needs to be easier. “What gets in the way of doing things like checking patients in with a kiosk in hospitals?” Jones asks.
Answering his own question, he says it is often practical problems. As an example, he cites a hospital that was told by its IT supplier that developing an interface to a kiosk would take 18-months.
Overcoming this kind of problem has been the basis of the ITK. Jones explains: “If we created a piece of middle-wear that exposed some interfaces and made them available to all suppliers, wouldn’t it make it easier to implement such innovations?”
A second driver was cost. Jones argues that individual NHS organisations still have to pay suppliers too much to connect systems to one another or to exchange data. As another example, he cites a hospital that was quoted £70,000 to move data between two lab systems.
He argues this kind investment must be re-used within the NHS, and not paid for time after time. “I’m happy for the first interface to cost £70,000 – but the next one should be £5,000 or £10,000. After you’ve done it once, it should get quicker and easier.”
Jones adds that the most interesting response to ITK has actually come from suppliers. “I thought suppliers would be quite concerned [by ITK] as it would mean they were missing out on £70K every time [they did a project],” he says.
“Some have been concerned; but others have grasped the opportunity, because they realise that [a lack of] interoperability gets in the way of deploying systems.
“It means they get their systems used more quickly than they otherwise would be, and start seeing the license revenues earlier.”
Tech Office there to help
Jones insists that ‘connect all’ and projects like ITK are not the departures that they seem to be. He argues that interoperability was always an important part of the work that NHS Connecting for Health did, even as the ‘rip and replace’ aspects of the National Programme for IT in the NHS’ grabbed all the attention.
“There was a sense a little while ago that we would somehow stop trusts connecting IT systems,” he says. “This was never true. [Interoperability] is a good thing, but they need to do it in a standard way.”
He says that the DH’s doors are open to anyone who wants help on interoperability; although there won’t be another round of ITK projects.
“We don’t want to create another 20 to 40 ITK projects, as it becomes ineffective,” he argues. “But if you are doing an interoperability project work with my team, then we will aim to publish that as the standard method.”
He says that the aim is to make sure that if one trust develops an interface to a particular system, it becomes the de facto standard in use across the NHS. He also hopes the DH Technology Office will remain a hub for sharing this kind of work.
With its NHS white paper and the consultation on an information strategy to support it, the coalition government has made it clear that it sees the future of the NHS and of its IT as lying in local decision making.
Despite this, the information strategy consultation – ‘An Information Revolution’ – says ITK is one of the blocks it wants to build on. And Jones argues trusts can see the benefits of central accreditation – done in “as non-onerous a way as possible.”