Lunch&Learn: Interoperability Challenges and Opportunities in the NHS

Yesterday we welcomed Health Foundry member, Matthew Roberts, Business Development Director at Egress Group who ran a discussion group looking at some of the ways the interoperability agenda may impact (positively or negatively) SME’s who are working, or looking to work with NHS organisations and Councils across the 44 Sustainability and transformation partnerships (STPs).

Matthew kickstarted the lunch with a short introduction to Egress - a healthcare-focused technology SME with more than a decade of experience and track record in data management, migration and integration within the NHS. Matthew described what the company does as the “glue” between systems in the NHS enabling organisations to meet the challenge of interoperability at a fraction of the cost.

Matthew then gave a whistle-stop tour of the interoperability landscape in the UK today. The NHS has learned from failed IT projects such as a National Programme for IT which cost 4% of the NHS budget and did not return the investment in terms of benefits. These days interoperability is about “standardisation without too much standardising”. Matthew explained that with the NHS stretched to breaking point interoperability needs to happen. Bringing everything into the cloud and linking existing systems will save money for the NHS as well as have all the patient benefits of sharing data.

These days interoperability is about “standardisation without too much standardising”

However, it is a complicated beast which means different things to different organisations and there is a multitude of approaches as he explained.

NHS England has an Open API Policy pushing for a change from closed systems to open ones building on the use of NHS Numbers, interoperability standards and open APIs (Application Programming Interfaces) and supported by the move from paper to digital. A good example of this in practice is Transfer of Care - eDischarge. In 2014, a patient safety alert was published by NHS England that revealed 33 percent of the 10,000 patient safety incidents between October 2012 and September 2013 related directly to poor communication as care is transferred at the point of discharge. Off the back of this secure faxes were no longer permitted for sending discharge summaries to GPs or other healthcare providers and eDischarges became the norm.

Other approaches include the Summary Care Record (SCR) which is an electronic record of important patient information created from GP medical records. Everyone registered with a GP practice in England has access to their SCR.

Data lakes or data reservoirs are also a popular approach which pool and link data set to one another taking a population health approach. Or it could be keeping the data on distributed GP servers with messaging overlay. For example, London CCGs are working to  connect up all health and care providers across London using a pan-London digital interoperabili ty initiative called The London Health and Care Information Exchange. Greater Manchester, East Cheshire and East Lancashire have a data sharing project called DataWell.

But Matthew warned that there can be conflicting agendas in regions that hold back interoperability progress. For example, Manchester has a devolved regional budget and the vision is for all of the health and social care to be on the same system with the various organisations within the region keen to ensure the prioritise their local agenda.

Matthew also explained that interoperability doesn’t have to be big data sharing projects. There are great examples of local, small-scale approaches like sharing Patient Administration System (PAS) Data with ePrescribing through integration within Acute systems. Or information sharing about child protection cases between the local authority and the NHS with Spine (the Child Protection - Information Sharing project.) Matthew also reminded us that community and mental health organisations do not have the same level of choice as the acute sector and as a result are potentially going to be leading the way on open source projects such as openEHR, OpenEP etc.

Matthew then shared an update on the Sustainability and transformation partnerships (STPs) and accountable care systems (ACSs) in the UK. The NHS and local authorities are developing and implementing shared proposals to improve health and care in every part of England which represent the biggest national move to join up care in any major western country. There are 44 different ‘footprints’ nationally, including five in London (North London, East London, North West London, South East London, & South West London). Each STP is setting about the task of delivering their STP vision in their own regionally relevant way. They publish updates every six months where they are comparing their achievements to their plans and this information is publicly available.

Matthew finished the session with some tips on what does all this mean for SMEs trying to work with the NHS.

Firstly, focusing on delivering outcomes not selling solutions. The NHS traditionally have been great at buying technology solutions. But now organisations are keener to understand what the outcomes and benefit are for them and want to work with SMEs that stick around to ensure that they are met, rather than selling a licence and disappearing. Matthew said that case studies are key to Egress’ sales process.

Secondly, be willing to partner or at least have conversations about partnering even with your competitors. Matthew said that he had been to 15 supplier events recently and everyone wants collaborations. Even the big EPR vendor are becoming more open to partnerships now.

Thirdly, don’t just look to the Global Digital Exemplars (GDEs) as the ones to work with. The GDEs been given £5M to do £50M of work and are under huge pressure. Matthew’s personal experience is that the GDEs do not have enough funding to deliver what they are being asked to do. His advice is to work with lower performing organisations that still need to do things and can not afford the tried and tested. His advice for finding these was twofold: most information about how well a Trust is doing will be published online eg the Referral to treatment (RTT) figures are published each month and says how well a Trust is doing against the 18-week referral target. Another strategy is to look at board meeting notes and see what their challenges are and who is responsible for solving the challenges which will give you a lead.

Fourthly, enable your clients not to be tied into long contracts. Partner and contract with them to clarify and achieve outcomes together and be inspired to consistently innovate.

Fifthly, remember that innovation is delivered by individuals. Find a champion with the appetite for what you can deliver. But don’t forget to also engage Clinical and Informatics and Operations and Finance to bring everyone with you at all levels of the organisation. Egress’s first integration client took only one month to get the sale as it was a warm introduction but it took nine months from agreeing to buy to actually starting the project.

Lastly, with NHS budgets stretched, if you can say that you will deliver the benefit within the financial year, you will get further.

A big thanks to Matthew for sharing his expertise. Do join us for our next Lunch&Learn on 15 February when member Sharon Osterfield, an NHS Manager with over 24 years of experience of the healthcare system, who now also runs her own health tech startup, Erza Health, will be giving us insider knowledge on how to work with NHS managers.