Experiences of early adopters in information sharing have not found the path to be as straight forward as first envisaged. Through their efforts and lessons learnt, we can now share some of the pain points and critical success factors encountered along the way towards a holistic approach for treatment. These lists are not exhaustive but provide some of the inputs and opinions collated.
- Who is driving the change – e.g., dominance of health “medical model” over social “care model”
- Differing work cultures between health and social care
- Financial funding arrangements of agencies
- Inadequate technical infrastructure to enable a cohesive working
- IT skills gap for some workers
- A major concern around confidentiality, data protection and privacy of the patient/ client
- The costs and risk factors associated with integrating data
- Constructing large databases
Critical success factors:
- Developing integrated datasets and information systems
- Alignment of financial incentives, and sharing benefits and risks
- Developing an integrated workforce and culture
- Scope defined and managed by a centrally governed design authority
- Enterprise Architecture operations within transformation program governance
- Anticipate the demands of the business transition
- Deep and wide stakeholder involvement
- Mature Digital platform – application integration and ‘model office’
- Developing IT service operating models for end-to-end not just a single client organisation
Considering both these pain points and critical success factors show us that for successful information sharing, we need a set of standards.
For years NHS England, the Health and Social Care Information Centre (HSCIC) and their previous incumbents have been advising on interoperability standards. As a result the development of the Interoperability Toolkit (ITK) was introduced for the NHS. This has been beneficial to system integrators by adopting the standard through ITK compliance. Further developments have seen a shift towards Open Interoperability and suppliers of systems providing Open APIs, which have become necessary as the ITK was initially developed for healthcare systems. However in the age of Digital Integrated Care it has become necessary for disparate systems particularly in social care, community services, OOH/111/999, etc., for information sharing to be accessible at the point of need.
The creation of a virtual record enables vital information to be retrieved in real-time, a care plan formulated, and appropriate actions taken to provide immediate help. This implies that retrieval and collation of the above information to form the virtual record resides on the end-user health and social care systems. In this context, following a period agreed by partners (multi agency/professional teams…) – for example 24 hours – the virtual record will expire, and no database or repository has been created.
The initiatives and approach in Scotland (the refreshed eHealth Strategy 2014- 2017) and Wales (Health Social Care and Wellbeing Strategies 2011-14) are also good examples:
- Scotland Ayrshire Councils, in partnership with NHS Ayrshire, have developed a system (AYRShare) enabling effective, timely and secure sharing of information to help address concerns about the well-being and protection of children and young people
- The Welsh Government is seeing real progress through the ‘Community Care Information Solution’ which allows information to be shared “instantly” across different Welsh health and social services. The first deployment is scheduled for later in 2015 in Bridgend County Borough Council to health, social services, mental health, therapy and community services. Other projects that have benefited Wales are data sharing and matching trial to identify vulnerable citizens
- NHS England has also started exploring some of the processes and ways of working for adoption in their own programmes
Citizens and patients are willing to share information across care settings if they feel it benefits their health and well-being, but are keen to still have the option of opting in/out.
These guidelines provide an Information Sharing Framework to work with and a set of early learnings from others that are collated below for easy reference. Each section contains a list of key considerations:
- Business requirements – ensuring that agreement is reached by stakeholders, estimating the size of the project and how much it is going to cost. At the enterprise level it must meet the organizational objectives and still be solution independent
- Outcomes – the results of the work carried out in delivering a solution and could be, for example, supporting the integration of care across a health and social care – a Portal Solution
- Governance – this context would be around Information Governance and that all parties involved in meeting the requirements of minimal data persistence for the portal solution
- Agreements – in most cases the framework agreement as part of a selection criteria process during the tender phase and prior to the supplier being awarded the contract
- Legal Considerations – generally applying to and covering
– consent/informed refusal
– opt in/out
– beginning of life
– end of life care
- Organisational considerations – aligning their IT Strategies, roles and responsibilities, maturity
- Informatics considerations – data sharing and migration planning – the information systems (data and application) and technology architectures
We share information every day of our lives through social media and the internet, but yet when it comes to sharing health and social care information we see and experience blockers. In addition, there exists an age divide in terms of competency in the use of technology, particularly in the elderly as mobile interoperability becomes a the more accepted way in sharing of this information.
What do you consider as some of the critical success factors and pain points in the delivery of Integrated Care? Leave a reply below or contact me by email.