London has a longstanding ambition to become the ‘healthiest city globally’.
And one mechanism to achieve this is through innovative digital solutions and regional transformation.
This is underpinned by the sharing of data, standards and best practices, and platforms that support regional collaboration.
The London Care Record has allowed data to be shared in the best way possible. But enabling London to move to the next level of maturity, where care plans can be co-produced across organisational boundaries, required a new approach.
This is what the team at Better, together with partner organisations, helped OneLondon to achieve.
The approach required Better to overcome the challenges associated with ‘dirty data’ – data that is inappropriately modelled and captured, classified incorrectly, coded improperly, and not fit or safe to use.
It needed to be able to support multiple use cases, with the ability to quickly and easily scale.
And it needed to provide shared access, linking multidisciplinary teams across multiple organisations.
Critically, it also needed high levels of usability providing benefits such as single sign-on access for all users, easy access to forms and applications from existing systems, and structured data for reporting in near real-time.
Persistent data platform
In order to achieve OneLondon’s vision, it was crucial to adopt a ‘data-first’ approach with persistent separated data that can facilitate low-code development.
This provides the foundations from which any number of use cases can be developed.
It is specifically designed to enable a faster pace of change, local flexibility, and to reduce the dependencies on application vendors – and it works.
Together with partners, we worked with OneLondon to implement the first use case – London’s Urgent Care Plan – in just seven months.
End-of-life care planning
In choosing the first use case, OneLondon wanted to select a service that would enable benefits to be realised early and demonstrate the potential the approach could foster.
In order to achieve OneLondon’s vision, it was crucial to adopt a ‘data-first’ approach with persistent separated data that can facilitate low-code development
End-of-life care planning was identified as it is a complex area that involves multiple healthcare providers and multidisciplinary care.
It required integration with regional and national systems, integration to all point-of-care systems, and access by patients for bi-directional engagement.
However, most importantly, as a service that supports people and their loved ones through one of the hardest times of their lives, it was important we could provide a service that ensured people could receive the outcomes and care requested at the end of their life.
Overcoming complexity
Previously it has been difficult to provide a service that could meet these requirements.
Patients, supported by their carers, will typically engage with a range of health and care professionals, each of whom uses their own local systems, with their own local copies of data.
And, as a person moves between care settings, a complex set of integrations is typically required to move data around between systems to provide a consistent view of key information, such as a DNACPR instruction and a person’s wishes at the point of need.
It is, of course, possible to deliver this solution using traditional approaches, but it will typically require changes to front-end applications and/or system interfaces that don’t solve the real problem of unstructured and inaccessible data.
Each healthcare organisation or ICS would need to prioritise these changes against other local demands.
Putting this together is a long, complex, and costly exercise that many regions have historically found insurmountable.
An open data model
To overcome this, OneLondon opted for a platform approach with persistent separated data combined with low-code development tools that are designed to enable a faster pace of change, local flexibility, and reduced dependency on application vendors.
One key thing we do differently is combining an open data model approach with application integration via contextual launch which provides multiple benefits.
As a person moves between care settings, a complex set of integrations is typically required to move data around between systems to provide a consistent view of key information
In the case of primary care, community care, and hospice care, users will typically use one of the three GP Supplier Systems used across the NHS – TPP SystmOne, EMIS Web, and Cegedim Vision.
We use a desktop client from one of our partners, CareIS, that acts as an authentication and data broker, facilitating single sign on and the exchange of structured clinical data.
We also provide a service called the General Availability Service, or GAS, that can be used to notify a source system when a care plan exists, so users know when to click through.
Central control with local functionality
These ‘application-level’ integrations provide a foundation that enables change and governance to be controlled centrally, but functionality to be delivered locally across an entire region.
As we develop additional pathways in the future, this will be a key enabler in doing so in an agile, incremental manner.
It allows us to move away from traditional models of ‘interoperability’ that involve moving information around via lots of complex and costly point-to-point integrations to an approach where a common set of data models are adopted, and the user interface components are embedded inside existing systems, ensuring everyone has real time read/write access, in line with defined access control policies.
Low code development
In addition to the benefits already cited, our low code platform means that OneLondon users can become ‘citizen developers’, meaning they can use Better Studio to develop all the artefacts required for the care planning application, including the openEHR archetypes, templates, and associated eForms.
These ‘application-level’ integrations provide a foundation that enables change and governance to be controlled centrally, but functionality to be delivered locally across an entire region
These artefacts are all published to the Better Clinical Data Repository – a foundational piece of our architecture based on openEHR, which we use to store all clinical data.
From zero to live in seven months
The project went from zero to live in just seven months.
Thanks to the dedication and hard work of multiple stakeholders and partners, and to the talents of the Better team, people across the capital are now able to have their care and support preferences shared digitally with health and care professionals.
However, our work is not done. We are continuing to further develop the technology and are currently working to integrate the shared care planning service with patient applications to enable people to view their care plans and in future add ‘what matters to me’ information, which is just as important as ‘what’s the matter with me’.
We are also looking to extend beyond the first use case to support future care planning services further expanding the benefits to the people of London.
