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HTN Industry View: NHSX to mandate health tech standards

Last week HTN reported on NHSX confirming their intent to mandate the use of internationally-recognised tech and data standards across the NHS to ensure a consistent language of clinical terms to help staff share information, as reported by HTN here.

Following our news article, we asked the industry for their views on this announcement and curated a series of responses from industry experts.

Contributors include: Birmingham and Solihull Mental Health NHS Foundation Trust, Nova, Orion Health, CCube Solutions, DictateIT, PCMIS Health Technologies, Channel 3 Consulting, Highland Marketing, InfoFlex, Difrent, Inhealthcare, Servelec, Ascom, TPP and Ingenica Solutions.

Dr. James Reed, Chief Clinical Information Officer, Birmingham and Solihull Mental Health NHS Foundation Trust

I am very pleased to see the importance of standards being recognised at a national level, it is something we at Birmingham and Solihull Mental Health NHS Foundation Trust have long thought helpful.

This will allow us to build the systems needed to deliver safe and effective care across organisational and geographical boundaries. It’s a welcome step and I am looking forward to seeing further developments as everyone in the NHS and our suppliers move towards the same end goal.

We are beginning to see a new digital horizon for the health sector starting to form.

Gary Birks, General Manager, UK and Ireland, Orion Health

There is significant opportunity for the NHS in NHSX mandating standards which will ensure that the NHS, and vendors alike, align not only on technical standards, but also functional and medical standards.

It is important that consideration is given to the risk of restricting innovation in the market. ‘Startup’ organisations will struggle with the investment to comply, whilst larger vendors, already with a customer base tied to contracts, are given the time to align and develop standards. This is because of the risk in moving from the current vendor and system to a new compliant system.

Standards should not only focus on technical requirements but also consider the opportunity to progress functional requirements and to align technology to meet stringent medical device standards. The opportunity should be taken to align information technology to the domain of medical technology. An approach similar to the Requirements for Accreditation (RFA) process would work well, ensuring that requirements were clearly published to the market with an appropriate timescale to meet the standard.

It is important that the view on standards is not constrained and that the NHS and the market do not pick and choose, for example a choice between FHIR and openEHR.

Orion Health is at the forefront of advocating for, conforming to, and using all common standards for healthcare technology, for example through our membership of HL7 and InterOpen, so we look forward to continue being at the forefront of the debate and the development of standards.

Brian Gorman, Managing Partner, Channel 3 Consulting

The NHSX plan to mandate the use of internationally-recognised tech and data standards across the NHS is a necessary intervention. It demonstrates a step change in digital leadership and will set the required standards and technology enablers to support the NHS long-term plan – a welcome move, with successful delivery dependent on a blend of leadership, direction and enabling technologies.

Successful adoption, however, will require facilitation, supporting transformation and change across clinical and supplier stakeholders and we look forward to hearing more about how NHSX will work with organisations to enable the implementation of new ways of working to tackle some of the health service’s most pressing challenges.

Andrew Dean, Head of Partnerships, Nova

Centralising the UK’s health tech strategy through the creation of the NHSX will hopefully mean much-needed digital innovation can be delivered on a national scale, helping to improve both patient experience and supporting staff to do their jobs more efficiently. The news that the NHSX will be recruiting a Chief Technology Officer, as well as deploying teams of digital and data specialists into certain areas of the NHS, shows that the organisation is seeking to understand clearly what the challenges are and how best to address them.

Nevertheless, the biggest challenge for the NHSX will be dealing with uncertainty, failure and risk – all of which go hand in hand with innovation. New solutions need to be validated with real-world users, and some will not work. This failure needs to be seen as acceptable, as long as the process remained ethically sound. The NHSX needs to maintain a problem-first approach, rather than trying to quickly usher in certain technology solutions that might not be the best fit. Here, they should look at what has already been developed by clinical entrepreneurs, i.e. those who have worked within the NHS and developed a product or service directly because of their experiences. Nova has helped to co-found multiple startups in this way.

We’re pleased to see one of the top priorities of the NHSX is improving the way patient data is collected and accessed. This is something Nova has identified as a big area of opportunity for health tech innovation, as inefficiencies in data gathering costs the NHS billions each year. We co-founded health tech startup Aquarate, a digital, automated solution for monitoring fluid intake, which is a good example of how data gathering can be transformed. Aquarate gets rid of both the inaccurate method of patients estimating their fluid intake, and the need for staff to fill out time-consuming manual fluid balance charts. More practical solutions like this would be a good start for the NHSX.

Vijay Magon, CEO, CCube Solutions

Document management started with turning paper into electronic files, which can save space, be moved around and shared. Lessons learnt from early adoption of such systems are now being realised through more sophisticated Electronic Document & Records Management (EDRM) Systems which include electronic content. Add a dose of systems integration, workflow, electronic forms, content extraction, compliance, and interoperability between systems, and suddenly organisations are beginning to realise tangible benefits from this technology.

Once existing paper and electronic repositories are captured and managed,  it is important to ensure that systems no longer feed storage sub-folders, ie. new patient information can be captured at source, managed, and delivered without resorting to paper. Integration between multiple IT systems and devices that generate patient information must be mandatory to ensure that patient information is accessible and usable regardless of where it is held.

EDRM is widely used for sharing patient information within a Trust, including geographically distributed sites. Sharing patient information across different NHS organisations is key, patients can move around anywhere in the UK (and abroad) and may need treatment wherever they are. This has led to a number of initiatives and technology drivers to ensure that:
a        Patient information is readily accessible and not held within any proprietary system;
b        All required information for medical decisions is both correct and available to healthcare professionals, using established standards like SNOMED and ICD-10
c        Patient information can be readily exchanged between systems using standards like HL7-FHIR

Extracting textual information held on paper records is not new – limitations due to hand-written text remain although recognition accuracy is getting better. Simply searching through extracted text offers limited returns. Organisations want to be able to rapidly analyse both unstructured and structured data. Ingesting large volumes of documents into a knowledge management system so they can be searched is not a practical option in organisations that want real-time or near-real-time insights into their business operations. Moreover, the large-scale corporate knowledge management systems that were popular a decade or more ago are not usually flexible enough to accommodate new types of information or to support new analytics tools.

Text analytic solutions leverage new text analytics technology to deliver the capability to read free-form text in health records to discover both content and context, analyzing the results and transforming those findings into usable information which can then be used for more-efficient patient treatment and to support researchers. Machine Learning and Artificial Intelligence breakthroughs are helping to unlock vital information buried in unstructured data and potentially transform it into actionable infor­mation.

Using technology to discover and extract usable information from unstructured data is helping to realise tangible benefits for businesses across all sectors. The gains in competitive advantage are beyond question; potential life-saving opportunities are a real blessing!

The key message is that careful application of established EDRM technologies is delivering measurable improvements and benefits. These must be applied to address strategic requirements, rather than using EDRM as a short-term measure to solve paper problems. The technology is not rocket-science, but has evolved gradually as customer demands, interoperability, and web accessibility have evolved.

We support the ambition from NHSX and are pleased to see the recent communications and intent at a national level.

Daniel Leakey, Delivery Lead, Difrent 

Difrent has publicly supported NHSX since its inception, we have already blogged about our thoughts on it and some of the challenges it faces. Over the last couple of weeks we have had meetings with Hadley Beeman and Terence Eden to understand a little more about the direction of travel and in our opinion it’s all good!

As an SME we are keen to understand how we can help. Lots of questions are being asked on social media about how NHSX will procure services and a desire to see things like G-Cloud and DOS accepted, we have asked similar questions but it still may be a little too early to confirm this.

Matthew Gould’s role being announced we believe is a very positive step. Social media reaction was also approving, including from Liam Maxwell on Twitter when he said “Great appointment for a great new program that will transform the NHS”, calling NHSX the best mission in tech. We also hold Hadley Beeman in very high regard, she has worked in Health before and at GDS in the “golden era”, she is ludicrously smart and driven to make this work.  We fully support them both in their efforts.

We suspect the focus will be on tackling the big, meaty stuff first; governance and the flow of cash was the biggest challenge for our CEO Rachel Murphy when she was at NHSD. Finding a balanced way forward in this space is key; this is taxpayers money but equally user need-based services are what the country is crying out for, rather than weeks (if not months) of business case approval processes to get the work started.

We are excited both by and for NHSX, we are supportive and super keen to help, share and collaborate.

Gary McCord, Chief Strategy Officer, Servelec

The principles set out by NHSX are much-needed backing for the direction that CIOs and clinicians are keen to take on the journey towards interoperability. A key issue for the NHS is having to deal with a wide range of differing patient data used across care settings and systems. Many systems are legacy and unable to take advantage of modern standards and technologies; however, some are new but lacking the technology to be fully integrated.

To enable the delivery of joined-up care and data sharing users are often required to manually access many systems and duplicate data entry.  Clinical staff engaged in multi-disciplinary activities often need to update many systems with new information. These practices are time-consuming and can lead to serious inaccuracies in records and costly inefficiencies in reporting.

At Servelec, we’re confident that the formation of NHSX will result in patient services and intelligent data working together for digital care.  It is now the responsibility of all technology providers to work closely with NHSX to ensure systems are fully compatible with this new agenda and are optimised to work seamlessly across platforms in health and social care.  This is the rationale behind our cloud-based interoperability platform, Conexes, that provides a safe and secure environment to share data between systems and mobile apps to deliver a fully integrated and cross care-setting approach to patient care.

Jeremy Nettle, a health tech industry veteran who chairs the Highland Marketing advisory board

It is interesting that NHSX feels compelled to mandate standards. It is something that the Department of Health and Social Care has tried to do, working through the National Programme for IT and then NHS Digital; but while its efforts raised the bar, getting standards agreed and used seemed to land in the ‘too difficult’ bucket.

As chair of the techUK (formerly Intellect) Health and Social Care group, I worked on the original Interoperability Tool Kit (ITK) some ten years ago. The issue then wasn’t so much agreeing standards as compliance; and I’d guess the same applies today. Much effort has taken place within the supplier community, with formation of INTEROPen and the development of HL7’s Fast Healthcare Interoperability Resources (FHIR) standard.

That’s been supported by NHS Digital and some clinical bodies, and it is to be commended. But we are still not seeing a big demand for this work from the health and care system itself. Attempts have been made to mandate interoperability in many health IT procurements but, sadly, without any conditional payment incentives the exercise becomes more of a tick-box than a mandatory requirement that is then qualified in testing.

I hope things will be different this time. Certainly, we wish every success for NHSX which we see as a very progressive step forward. It should motivate everybody in the health tech industry to implement standards that are, after all, industry best practice.

Mark Miller, Managing Director of DictateIT and Clanwilliam Digital

Complying with standards is to be welcomed to enable a healthy ecosystem, and it is certainly welcome that NHSX put in place a mechanism such that compliance only has to be assessed once.  Removing any onerous duplication should benefit both suppliers and NHS organisations alike when trying to procure and deliver really innovative technology.

Whilst a lot of the standards are already mandated, it will be interesting to see how the responsibility shift to NHSX will create impact, especially with SNOMED CT and ICD-10 which are well under way.

The focus on ICD-10 is particularly central to ensuring consistent language and effective data sharing across the NHS.  With recent advances in natural language processing, it’s possible constraints around the classification of outpatient care, for example, could be much reduced.  We will wait to see if NHSX seek to expand the types of data items requiring classification as part of their reaffirmation of this standard.

Byron George, Interim CEO, PCMIS Health Technologies

With a long standing and positive working relationship with NHS England and NHS Digital, we are fully supportive of initiatives that aim to improve patient safety and build public trust in Digital Health services. The challenges of fast paced technology in a clinical environment require clear leadership and commitment from senior management and are a critical factor in delivering future health care needs using innovative and proven technologies that are compliant with international standards.

With over ten years’ experience supporting NHS mental health services, we recognise the importance of avoiding silos and ensuring consistency to facilitate the sharing of information safely and quickly. We look forward to working alongside digital experts from NHSX in harnessing the power of technology for the benefit of mental health staff and patients.

Marc Warburton, Chief Executive, InfoFlex

As a leading cancer information solution supplier to the NHS, InfoFlex looks forward to supporting the aims of NHSX by providing easy access to the health services patients require – using smartphones and the sharing of clinical data amongst clinicians and researchers.

It’s essential that the use of data collection standards – such as ICD-10 and OPCS – are mandated and any alternative coding systems used must clearly map back to these coding standards.

Similarly the use of SNOMED-CT is critical if data, and its associated meaning, is to be shared effectively between the IT systems used by healthcare professionals. InfoFlex is fully committed to data and tech standards, with the aim of enabling data-sharing across the healthcare community and avoiding the duplication of IT developments.

Paul Lawrence, Managing Director, Ascom UK 

We welcome the news that NHSX is to mandate Open Standards for technology across the NHS. This is an excellent initiative that will foster collaboration among suppliers who are not normally incentivised to work together.

At Ascom we have always done the necessary work with NHS customers to ensure that our technology is fully interoperable with any and every other system they use. Rather than ask “Where would you like us to deploy our system?” we ask customers “What are you trying to do for patients and clinicians?” Then we close the information gaps to ensure that clinicians have the information they need.

Some larger legacy suppliers have been reticent about opening up their system to interoperating but we continue to make progress. As suppliers, we are ultimately stronger commercially if we work together, rather than trying to create monopolies. No single supplier can solve all of the NHS’s technology needs – so let’s do it together.

Bryn Sage, CEO, Inhealthcare

We welcome the launch of NHSX to bridge health care and technology and speed up the digital transformation of the NHS. Developing, agreeing and mandating clear standards for the use of technology in the NHS will make the UK the best place in the world to start and grow a health tech business.

Clear standards will allow suppliers to innovate with confidence and direction for the benefit of patients, clinicians and commissioners. This could be the Big Bang moment for the UK health tech sector and lead to the creation of thousands of new jobs in centres of excellence like the North East of England.

Dr. Chris Bates, Director of Research and Analytics, TPP

TPP supports the move towards setting common standards for healthcare IT suppliers across the NHS. Having been the first supplier to implement SNOMED CT and leading the way on key interoperability projects such as GP Connect, TPP is committed to delivering these standards. We welcome the direction proposed by NHSX.

Nicola Hall, Founder and CO, Ingenica Solutions

We really welcome the news from NHSX on technology and data standards, its overdue and shows real intent from the department to move forward on technology.  It will be good to understand how the new organisation fits with the overall landscape and their remit. We are excited about the possibilities the establishment of this new organisation brings for the use of technology within the NHS.