Interoperability and information sharing

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.

Pain points:

  1. Who is driving the change – e.g., dominance of health “medical model” over social “care model”
  2. Differing work cultures between health and social care
  3. Financial funding arrangements of agencies
  4. Inadequate technical infrastructure to enable a cohesive working
  5. IT skills gap for some workers
  6. A major concern around confidentiality, data protection and privacy of the patient/ client
  7. The costs and risk factors associated with integrating data
  8. Constructing large databases

Critical success factors:

  1. Developing integrated datasets and information systems
  2. Alignment of financial incentives, and sharing benefits and risks
  3. Developing an integrated workforce and culture
  4. Scope defined and managed by a centrally governed design authority
  5. Enterprise Architecture operations within transformation program governance
  6. Anticipate the demands of the business transition
  7. Deep and wide stakeholder involvement
  8. Mature Digital platform – application integration and ‘model office’
  9. 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:

  1. 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
  2. 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
  3. 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
  4. 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
  5. Legal Considerations – generally applying to and covering
    – consent/informed refusal
    – opt in/out
    – beginning of life
    – end of life care
    – safeguarding
    – accountability
    – negligence
  6. Organisational considerations – aligning their IT Strategies, roles and responsibilities, maturity
  7. 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.

Digital transformation in healthcare

Early adoption attempts at integrated care

A health and social care system should be truly seamless so that people receive the right care and support at the right time, in the right place. Services are under intense and growing pressure due to limited funding and to succeed, radical transformation is required.

We need to embrace and develop innovative solutions and truly integrated multi-agency working so that local health and social care systems work as a whole to respond to and meet the needs of people who use health and care services. In an ever increasing older population who are most likely to suffer problems with co-ordination of care and delays in transition to services, it’s essential that we transform the way care is provided with the ultimate aim being better outcomes of care in a holistic approach.

It was about five years ago when, as the Trust Integration Lead in a hospital setting I first had an insight into what we now commonly refer as Integrated Care.

The Nuffield Trust published a report back in June 2011, defining what I think is still relevant today:

‘Integrated care’ is a term that reflects a concern to improve patient experience and achieve greater efficiency and value from health delivery systems. The aim is to address fragmentation in patient services, and enable better coordinated and more continuous care, frequently for an ageing population which has increasing incidence of chronic disease.

At an event that brought together large and SME organisations across public and private sector based in and around the area, I happened to meet someone from Social Care representing the Local Authority. After the introductions we discussed and shared our mutual concerns, benefits and outcomes of collaboration across the Health and Social Care. We identified a project for sharing of information with Child Protection in mind. I had also produced a feasibility study for a simple role-based user access for

  • Mental health nurses to have access to the Acute hospital system
  • Acute clinical staff to have access to primary care systems
  • Acute clinical staff to have access to social care systems

At the time it was a difficult to progress any further due to a multitude of reasons; costs, who would fund the project, buy-in from stakeholders and resource availability. The project set out to foster a better culture of information sharing across care settings thus reducing delays at the point of need and overcoming some of the obstacles to authorised access.

So what has changed and why is it now right for progress to be made in the “Integrated Digital Care” revolution?

Some of the drivers forcing change now are down to:

  • Chronic Diseases, including an increase in diabetes, heart disease, stroke and cancer
  • Public sector savings
  • Healthy Child Programme
  • Reducing “length of stay” and repeat visits to hospital
  • The Care Act 2014

The NHS is looking to improve quality of service, provide a better patient centric user experience by providing the “right care” at the “right time” and “right place”. We should also not forget that staff in these new integrated multi-disciplinary teams must have access to accurate real-time or near real-time information. By taking full advantage of the information revolution we can meet these targets of:

  • Ensuring clinical staff across care settings no longer have to depend on or complete paper records by 2018
  • Care records being digitised, instantaneous and interoperable by 2020

To support these aims the NHS now has an Integrated Digital Care Technology Fund, an Integrated Digital Care programme in place and data sharing projects.

Healthcare and Social Care professionals face challenges in the current working environment and would be more effective if they could:

  • make informed decisions based on better access to information about a range of services
  • avoid the need for ringing around multiple agencies to identify the right service
  • avoid keying in the same information on more than one system by staff in integrated teams
  • do away with multiple computers to access health or social care systems and reduce IT assets
  • reduce the need for completing documentation to share information across services
  • streamline associated paper processes helping to improve on time delays and quality issues

I’ve only focused on one element of the integrated care lifecycle here, but the benefits are significant.

How do you see the Integrated Digital Care revolution adoption as it gathers pace? Leave a reply below or contact me by email.