Special Report: Interoperability

2020 has seen the digital health landscape rapidly change in a matter of months, so what has this meant for interoperability in healthcare? Jennifer Trueland investigates.

Back in February when NHSX launched its Tech Plan, interoperability was understandably a key focus.

The events of the following few months have only served to make the case stronger by underlining the need for a system that ensures that a patient’s information can be accessed at the point where it is needed, no matter where it originated.

Connection is key

According to Luke Readman, regional director of transformation for NHS London and senior responsible officer for the OneLondon LHCRE, connection is key both in pandemic and “normal” times.

“At the point of care, any health professional with a legitimate right should be able to see what’s happening across the whole of that patient’s care, not just the bit they’re looking at currently,” he adds.

“We [at OneLondon] accelerated some of these connections in the first part of Covid, in six weeks we did maybe three or four or even six months of the work that was planned to drive the pan-London connections in particular, because we knew patients would be cared for in the Nightingale and the ExCel.

“We wanted to provide the clinical teams with the history of those patients from their locations when they were transferred.”

Beyond Covid

With increasing numbers of staff working across a number of locations, and patients being treated across multiple localities and settings, the value of connectedness stretches beyond Covid, adds Readman, who is also the co-chair of INTEROPen.

“We’re building a whole set of high-volume elective hubs and patients may go there for their operation from anywhere in the sector, so they do need to be well connected,” he adds.

“I think it’s been great that we’ve been able to show the benefits of it throughout this period.”

Still a UK-wide problem

While some parts of interoperability have been solved, the bigger issue of UK-wide interoperability remains variable, says Justin Whatling, vice president of global public health with Cerner.

“I don’t think it’s a done deal everywhere in the country,” he adds.

“There are places that haven’t sorted this out or they’ve got smaller scale projects but nothing ICS [integrated care system] or STP-wide [sustainability and transformation partnership].”

However, Whatling does believe there has been progress in some areas, such as the adoption of standards which helps ensure different systems ‘talk’ and ‘listen’ to each other.

He also stresses the importance of ensuring that the whole of the UK is joined up, not just between local areas.

“What we really want to do is wire the country up, not just London,” he says.

“London is a great example of doing it at scale, but you want to connect out to surrounding areas because London is also a tertiary, quaternary hub, for the country, so ideally we need to connect it all together.”

Regional link up demand

This idea of linking up local areas is echoed by Chris Scarisbrick, sales director at Sectra, who says while there is a demand to link up NHS organisations over regions, for example at STP level, there is also a need to do so within individual organisations.

“We’re seeing a lot of requirements – as the standards progress – for exchanging information and interoperability within the enterprise,” Scarisbrick says.

“It’s not only about sharing information between enterprises, but also about blurring the lines between different systems inside the enterprise.”

A longer journey

While the pandemic has accelerated many digital transformation projects in the NHS, such as virtual consultations, that has not been the case for interoperability.

“In terms of interoperability, it’s a longer journey,” says Ben Wilson, product specialist lead with Orion Health and INTEROPen board member.

“It’s not something you can react quickly to, like some of the other tools – even though they seem like new ways of working, they were already available and essentially just needed to be turned on.”

However, it has not been all bad news for interoperability in 2020, with Wilson believing that some areas have advanced since the outbreak of Covid-19. He cites making GP Connect quickly available across GP systems, and adding more information to summary care records, as an example.

He adds: “Interoperability allows organisations to do things really quickly and what we saw during Covid was the need to do things really quickly – for example, to quickly share a shielded patient list in a shared care record, or to share Covid lab results within a shared care record.

“Having really robust interoperability would have enabled us to progress those sorts of things much faster. Rather than taking months we could turn these things on in a matter of days if we had that level of interoperability between systems and vendors and the willingness to do it.”

Highlighting the importance of data

With charts and graphs becoming a regular feature in the daily Downing Street Covid-19 press briefings, the importance of data collection has never been greater.

“One of the features of Covid-19 pandemic is that it is highlighting in a very stark way the importance of data and of data sharing, and this, of course, has to be supported by interoperability,” says Piers Manser, the director of product design and strategy with Graphnet Health.

“This is why at Graphnet, we’ve seen an acceleration in shared record use, and shared records are now a key part of national policy.

“Technical standards are absolutely key to allowing important information to be shared across a care community and core NHS information standards are also very important.”

This idea of the pandemic having a dual impact – hastening and slowing aspects of interoperability – is also backed by Manser.

He adds: “On the one hand, Covid has served to push interoperability right up the agenda in terms of recognition.

“But inevitably some of the background work on standards setting (by NHS Digital and NHSX) may have been slowed down in the immediate necessity of focusing on a response to Covid.”

Issues still remain

For Steve Burton, head of sales at Civica, the drivers to achieving greater interoperability – and the barriers that prevent it happening – have not necessarily changed.

In particular, he stresses that organisations, whether regional or local, need to have their own strategies rather than waiting for central guidance or action.

“One of the challenges around interoperability more generally in the NHS is about just getting suppliers’ systems to talk to each other,” he says.

“Those barriers need to be brought down and I think the industry needs to take ownership of that, be more proactive with each other, work within the frameworks that do exist – certainly we should be looking at that more broadly as an industry.”

Though 2020 has been a year where the digital health landscape has changed rapidly, it is clear that the conversations around interoperability still remain the same with the pandemic even emphasising the need for good interoperability across healthcare.