How do you solve a problem like interoperability?

We look at how the health sector can realise Matt Hancock's vision of more-transparent and joined-up healthcare systems

In March Health Secretary, Matt Hancock, accused electronic patient record (EPR) suppliers of ‘locking patient data away’ and called for more-transparent data sharing in order to join up healthcare systems.

But this approach will mean a wholescale review of current ways of working and a commitment from across the industry.

In his statement at the Digital Health Rewired event earlier this year, Hancock told delegates: “At the moment, most live patient data is held by the companies who provide the electronic patient record systems, but it isn’t their data, and although it isn’t their data too often these systems act as a barrier to accessing it.

Data might not be accessible and can’t be properly shared, providing a barrier to the research and innovation that we know has so much potential, and hampering the life-saving role that data can play in promoting patient safety

“This means that data might not be accessible and can’t be properly shared, providing a barrier to the research and innovation that we know has so much potential, and hampering the life-saving role that data can play in promoting patient safety.

“We need to make it create services that interact with data from different NHS organisations, so I want to explore whether we can remove this barrier to innovation and separate the data layer from the application layer so providers can offer the application software and the data will be stored separately and securely in the cloud, then we have a consistent data platform across the NHS.

A year of change

“I know this is a big change, but this has been a year of big changes.”

This is an approach supported by Garry McCord, chief product officer at Servelec.

Speaking to BBH, he said: “Data sharing in healthcare is not a new idea and the term ‘interoperability’ is ubiquitous.

“Health tech companies consistently claim to be ‘working on it’, or state that they have existing integration capability with little evidence of building APIs or the essentials for sharing data and tasks.

“And the whole industry is sharing its frustration at the lack of pace in breaking down these siloes.”

He adds: “In summary, Matt Hancock is saying that EPR suppliers sell systems to different healthcare organisations and that system collects the data from the use of the application.

“The data is then stored alongside the software so it can be accessed as needed.

Organisations are creating information-sharing agreements that are ‘opt-in’ by default, and the creation of Integrated Care Systems further points to health and care viewing information integration as a priority

“With Servelec, that data is stored securely in our UK data centre and accessed by our web-based products as required.

“This has been the solution for many years, but now the issue lies in these different systems not being able to ‘speak to each other’ by enabling information to flow freely between them.

“This means that often patient data has to be rekeyed into each system, and waiting for information to move between organisations can be a slow process.”

And Hancock’s vision of a more-joined-up approach to care information flow will revolutionise the care journey.

“People want efficiency and speed,” said McCord.

“If the information moves quickly, the next step in a person’s care will be initiated much faster.

A waiting game

“If the movement of the data can be initiated quickly, and supports the person’s care pathway, then where it is stored is largely irrelevant.

“The waiting time for care should not be governed by clinicians waiting for information to arrive.”

But some suppliers talk about a culture of fear which is embedded at councils and NHS trusts around sharing data, which adds weight to the argument for suppliers that are against interoperability.

“In our experience, the opposite is true,” said McCord.

“Organisations are creating information-sharing agreements that are ‘opt-in’ by default, and the creation of Integrated Care Systems (ICS) further points to health and care viewing information integration as a priority.

It’s not fair to tar every supplier with the same brush; some are working hard on interoperability and taking a different approach to the data that is stored

“Increasingly, information moving digitally in a secure way is often viewed as far safer.”

Trusts and councils are increasingly recognising that in an integrated world you need to expect data to be moving around electronically rather than being siloed in a single organisation’s system.

And that is a topic that has especially drawn focus since the rapid digital transformation catalysed by the pandemic.

“We can now see what can be achieved, and how quickly, when there is a change of culture within the healthcare sector,” said McCord.

“Returning to Hancock’s statement, it’s more logical as a system supplier to view this as more of a conceptual comment.

“I don’t think ‘breaking away’ data from the system and storing it elsewhere is the answer, but I agree with the sentiment of it - he’s saying that the nature of having to store data in a supplier data centre means that some EPR suppliers are leveraging that position by not allowing it to be shared.

“But it’s not fair to tar every supplier with the same brush; some are working hard on interoperability and taking a different approach to the data that is stored.

The market needs to call suppliers out and any supplier with poor data practices should be challenged to change and make interoperability a key factor in their forward thinking

“However, it’s evident from Matt Hancock’s speech that many vendors are still using their position to lock that data away and make it difficult for information sharing to take place.”

In 2018, Servalec built Conexes, a cloud-based interoperability platform that allows organisations to facilitate safe and secure access to patient data from all applications and other systems.

“I can say confidently that we’re an organisation that firmly believes in information sharing and the huge benefit that interoperability can bring,” said McCord.

Changing the mindset

“For others, it’s proving to be a difficult mindset to change and the idea of working with other suppliers or systems seems alien.

“The fact Matt Hancock had to say it shows some organisations are still thinking in the past and locking that data away.”

He believes there needs to be a broader mindset that says that when an organisation is coming to market for a new system, all products being considered should share data. This needs to be a core feature, and not a differentiator.

This approach will create the best procurement environment for driving the supplier community to develop their products, and this is what will enable them to be successful in the future

“The market needs to call suppliers out and any supplier with poor data practices should be challenged to change and make interoperability a key factor in their forward thinking,” he adds.

“And, when considering how the central organisations like NHSX should act, their role is to enforce and define standards for information sharing and make sure people implement them.

“It’s also to make available the funds to support organisations to commit to information-sharing projects.”

For organisations procuring a new system, McCord advises they should cite interoperability as a key requirement and seek confirmation that if it will be able to operate in an ecosystem of other systems that all share data effectively.

“This approach will create the best procurement environment for driving the supplier community to develop their products, and this is what will enable them to be successful in the future,” he concludes.

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