Special Report: Interoperability
Is it time to stop reaching for ‘interoperability’ and start thinking instead about ‘intelligent decision-making’ that will benefit patients? Jennifer Trueland reports
“Lack of access to an up-to-date medical history can affect the way patients are treated. The impact on treatment, particularly in an emergency situation, can be significant.”
These words appear front and centre on NHS England’s Interoperability page. The situation they describe will be familiar, and frustrating, to many working across the health and social care sector in the UK, and beyond.
Interoperability has been on the agenda since the last century – but gaps remain, and they are affecting patients on the ground, as well as clinicians and other health and care staff at the sharp end.
It’s a situation all too recognisable to Jas Cartwright, who is now director of continuous improvement at Worcestershire Acute NHS Trust, but who has a long track record in digital strategy and clinical information.
“When our patients and our populations are seeing multiple providers for their care it becomes more challenging for the clinician if they don’t have the right data in front of them,” she says.
“If someone presents to the emergency department in a mental health crisis, for example, you need to be able to see the relevant information about what’s been going on in the community or with our partners. Without the full picture, it’s less likely that people will end up with the right care and in the right place.”
Time-consuming and stifling
As NHS England freely admits, health and care services are using multiple clinical systems that do not act with each other – leading to repetition of tests, reliance on patients for a clear medical history (even the medications they are on). It’s time-consuming for clinicians and administration teams. But increasingly, it’s also stifling innovation.
Keith Chessell, chief executive of Whzan, says those with innovative solutions need to have better and swifter access to healthcare systems. At the moment, the process is time-consuming and wasteful.
“What would be really nice is if the NHS had one interface, and behind the scenes, that interface went to all the other record systems,” he says. “As a company, I think we’ve got something like 20 record system interfaces and we’re building more all the time.”
Companies like his are forced to do this if they want to do business with the NHS, he says, but it takes its toll. “Last year we probably spent 40 per cent of our software effort on interoperability. It’s a lot.
“We’re forced to do the interfaces to the record systems because nobody wants yet another interface to look at. Effectively every software company working with the NHS and local authority systems are trying to do the whole lot themselves, and it’s a massive waste of effort.”
Phil Richardson, is currently chair and chief innovation officer with Mtech Access, a consultancy that works with pharma and medtech clients to help them get their products into the hands of clinicians, patients and consumers more generally.
Until last year, he was an executive director of NHS Dorset, responsible for digital transformation, innovation and research and development. This means he has a unique appreciation of the issues at the interface of industry and the health and social care system – and he’d like to see a change in mindset.
“The interoperability question has traditionally been about the data lakes of information that the NHS has and how do we all get access to everything,” he says. “And one of the offshoots is that secure data environment which is trying to normalise everything.
“But the other bit is the conversations that, for example, ChatGPT takes you down, which is ‘Well what actually is a good outcome for a patient?’ ‘What is a good way of organising how care is delivered?’ ‘What information do we actually need to answer these questions?’.
“If we stopped working in a parochial way and started thinking about how to look at it intelligently together, I think it moves away from ‘interoperability’ and much more to intelligent decision-making.”
Richardson, who is also an associate lecturer at the Open University Business School, says an “interoperability industry” is too focused on the need to bring systems together rather than how to make care better. “The problem they think they are trying to solve is how do you make data interoperable, but actually the problem they are really trying to solve is how do you get safer, better decisions.
“How do you make sure the data is in the right place at the right time? And how do you stop people having five blood tests in a month because they’ve seen five different specialists in two different locations? That makes no sense whatsoever.”
He believes it’s a question of translation rather than interoperability – that is, making sure that everyone understands the relevant information, regardless of where it comes from. He also believes it needs to be dynamic and flexible – and to be able to take in information from what he calls “New World” sources, such as data from patients’ own fitness devices.
Focus on patient care not infrastructure
Jamie Clifton, vice president for product management and solutions at BridgeHead Software, says conversations around interoperability are already changing. Rather than a focus on infrastructure, customers are talking in more pragmatic terms about what they can do to get to where they want to be in terms of providing better patient care.
“We’ve moved away from [talking about] moving interoperability up to where it should be now, to much more of a business conversation about what we want and how we get it directly into patient care, not literally, how’s the ‘plumbing’ going to work to join two things together.”
AI will be a gamechanger, says Guilherme Carvalho, UK sales manager with Sectra, because there are a large number of new suppliers to healthcare markets – and they need to be able to work with existing systems. NHS organisations are already finding ways around this, he adds. “AI aggregators are becoming quite prevalent across the NHS – trusts will purchase a platform that can connect to multiple AI applications, which lowers the barrier of entry, and the requirement to integrate with each and every one of the new AI suppliers that come about.”
Isaac Fredericks, director of client relationships with Oracle Health UK, has noticed a shift in focus across health and social care – and is hopeful that 2024 will bring even greater connectedness. “Interoperability in previous years has been largely about sharing health information across primary, secondary, community and mental health settings,” he says.
“Over the last year we have seen much more engagement in information sharing with an expanded set of service providers, such as ambulance services and social care services, which has helped create more connected data to help improve patient and staff experience across both health and care.”
As the shared care record becomes much richer, he adds, integrated care systems (ICSs) are now also focusing on data quality, data consistency, “upgrading” data sources to provide structured data versus unstructured data, and working towards standardised views for users.
Back in Worcestershire, Cartwright says that a multi-faceted approach is essential to improving interoperability – and that everyone will have to work together to make it happen.
She would like to see suppliers opening up their systems to allow better information sharing. “The national landscape is very varied, but for us to provide better joined up healthcare, we need our suppliers to start opening up,” she says.
“Interoperability is on NHS England’s agenda. The strategy is there. But we also need supplier buy-in, and funding.”
Looking to the future, Cartwright would also like more emphasis on listening to clinicians. “Clinicians say that they want joined up care and they want to share information, but when it comes down to it they’re having to pick up the telephone or bleep someone if they want to find out what’s going on with a patient. That’s a real barrier.
“I’d like to see the clinicians themselves being asked what is important to them, what information they want to see, and to take it from there.”