It’s a question which has plagued the NHS for many a year: how can we make interoperability happen? For Peter Anderson, the answer is through a mixture of top-down focus and regional action.
As a participant in bodies like the Professional Record Standards Body (PRSB) and INTEROPen, I’m trying to play my part in making interoperability a reality in the NHS. Matt Hancock’s energetic drive for nationally specified open standards – and the secretary of state’s promise that vendors who don’t play ball won’t work with the NHS – is definitely taking us in the right direction, and I say more power to him.
But even if we had all the necessary standards today, it could take years to build on them. New software components must be written, and existing systems upgraded.
That’s why I think that, as well as top-down focus, we need renewed regional effort to get record sharing moving. That means CCIOs and CIOs in NHS trusts accepting and working with current standards and today’s systems. Applying commonsense, proven – yet often neglected – IT project delivery capability and being open minded about what is added to integration toolkits will help give clinical users the information they need.
No secret recipe
There is no secret recipe to the interoperability successes I’ve seen over decades of working in NHS IT. Such projects aren’t over-ambitious and instead recognise that this is a journey. The data sources with the most clinical value are identified, there is a check to see if those sources are available, and then they are prioritised for integration. In these success stories, there is a plan for the long term but also a focus on delivering benefits quickly to keep clinical users motivated.
So making a go of interoperability at a local or regional level means being very clear about early objectives and ensuring full clinician engagement. Build project teams and make sure you second clinicians to them, forming a core project team that will stay the course.
The lure of the big bang approach traps so many. For example, some teams try to make source-system data perfect before allowing it to be shared. Better to accept the existing data quality – but add a data cleansing and enhancement strand to the roadmap.
Take your time
There’s no need to make every system talk to every single other one right away either. The Bristol, North Somerset and South Gloucestershire Connecting Care project started by giving social care out-of-hours access to primary care records, then progressed to an HTML view of community care data. Choosing that approach rather than full interoperability let most of the clinical benefits arrive very quickly.
There are now 180,000 views of patient records every month, and clinicians can also share discharge letters and clinical correspondence with a wide range of health and social care organisations.
Of course, the foundations must be right for the future of an interoperability project too. The infrastructure must be flexible and scalable enough to cope with more users and extra connected systems. And it has to keep working when the source systems do finally talk to each other as standard.
For the same reasons, creating the right data sharing consent model allows programme expansion without having to go back to the stakeholders and re-engage every time. Projects like the Great North Care Record in the northeast of England implemented clear “umbrella” consent policies that let their long term data sharing programmes grow steadily.
Actions like planning for data consent and stakeholder consultation might seem obvious. After all, they are standard IT best practice. But so often, after agreeing on a sensible way to proceed, an interoperability project becomes bogged down in bureaucracy. It’s too easy to get sucked into waiting for some future decision over which you have no control.
Adopting national standards is another example of where this has been happening. The NHS is rightly risk-averse. But finding ways to speed up connectivity approval processes would really help make common standards widely used and accepted.
There are plenty of good case studies to learn from, like the OneLondon Local Health and Care Record Exemplar (LHCRE) programme that Matt Hancock highlighted in his policy paper last autumn. OneLondon covers a patient population of around 6.3 million and there are currently around 1.2 million views of patient data every month.
By connecting legacy technology region by region using the effective tools already available, the NHS can steer towards the common goal of nationwide record sharing. And, at the same time, it can steadily introduce new national data mobility standards and the software that complies with them. This, I believe, is the route to making interoperability work.
Peter Anderson is managing director of Healthcare Gateway