A recent report by The King’s Fund has highlighted the importance of strong relationships and functioning technology for interoperability to progress in an integrated care system (ICS) setting.

Following analysis of existing literature and a combination of interviews and workshops with staff in the health and care system and national bodies, The King’s Fund concluded that interoperability has three important aspects that are vital for success.

These are good co-working relationships between staff, technology that makes co-working as easy as possible, and an enabling environment in which funding, capacity, skills, education and governance are aligned.

The value of strong relationships and working culture

The report, titled ‘Interoperability is more than technology: The role of culture and leadership in joined-up care’, explains that relationships and working culture are essential aspects to get right for interoperability to progress in ICSs.

The King’s Fund drew on the experience of two ICSs – Cambridgeshire and Peterborough ICS and Humber and North Yorkshire Health and Care Partnership – as case studies to share how practical solutions can address the challenges ICSs face.

They discovered that “staff who do not work well together tend to control digital technologies and medical information in a way that hinders sharing and collaborating” and “leaders who prioritise building relationships across organisations view digital tools as an extension of these relationships which in turn helps interoperability”.

These points were echoed at the Digital Health and Care Congress 2022, where two of the authors of the report, Dr Loreen Chikwira and David Maguire, spoke in a session on using digital services to enable successful integration.

Dr Chikwira, a research assistant in the policy team at The King’s Fund, said the main points that stood out to her as being key were around “staffing and people” and “organisational culture” within ICSs.

Her colleague Maguire, a senior analyst in the policy team, also spoke about the importance of “culture” and explained the reason why some are digitally excluded in society.

He said: “It’s a common misconception that digital exclusion is age-based, it’s much more about deprivation.”

The issue of technology fragmentation

Research from Dr Chikwira and Maguire, alongside the other authors of the report, Pritesh Mistry and Toby Lindsay of The King’s Fund, found technology fragmentation as a big issue and a barrier to interoperability.

Technology fragmentation is where organisations are using different software and hardware with different capabilities, functions, information captured and formats.

The report states that fragmentation “limits how staff across organisations can work together and share medical information to improve care services”. It is also “present in the inconsistent way that data and digital standards are applied to different frameworks and accredited supplier lists”.

The inconsistency means there is no system-wide approach to interoperability standards, so compliance in one part of the system is not matched in other parts of the system.

Interviews with health and care staff by The King’s Fund found that they perceive suppliers as being reluctant to comply with digital and data standards. However, uncertainty on how final a standard is increases suppliers’ reluctance to use valuable resources on making changes based on an unfinished standard.

As well as having relationships based on trust between staff and leaders and technology that makes communication and medical information flow as easy as possible, The King’s Fund have made some other recommendations for interoperability to progress in ICSs.

These recommendations are based on having an enabling environment that provides sufficient long-term funding and targets that support collaborative working while developing complementary workflows across organisations.

They include information governance, access to analyst and data science workforce, appropriate staff training and skills, sufficient capacity for transformation, compatible workflows across organisations, supportive national policies, accessible long-term funding, and targets that support improvements in outcomes.

An ICS perspective

Researchers at The King’s Fund presented their findings and recommendations in their report about how to progress interoperability in an ICS setting, stressing that strong relationships and working culture and functioning technology are vital.

From an ICS perspective, the idea of a whole-system approach to interoperability standards is shared.

Malcolm Senior, director of digital transformation at the ICS for Devon, said: “Interoperability is a team game and needs the adoption of common standards by healthcare suppliers, along with their implementation amongst their customers.

“The InterOpen organisation was a good example where industry, standards bodies and care organisations came together with a common purpose. All organisations, ICS or not, need to sign up to the standards and principles if we are to make progress.”

Senior also shared an example of what Devon ICS are doing to enhance interoperability across the region.

He said: “Within our ICS we are implementing a shared care record, connecting various systems to a single record sharing platform. This will enable ubiquitous viewing of a patient’s record by all involved in their care.”

The goal of driving interoperability across the NHS and social care is one that is becoming increasingly achievable. In May of this year, a draft standards and interoperability strategy was published after being commissioned by the NHS England and Improvement Transformation Directorate.

The overall aim of the document was to improve levels of interoperability across the NHS and social care through the development and adoption of standards.