Before the Christmas break, HTN caught up – over video link, of course – with health IT consultancy Cloud21, to talk about interoperability in the NHS.
To get a birds-eye view of the bigger picture as well as technical detail on the nuts and bolts of digital transformation in the public healthcare sector, we spoke to both Director and Founder, Tony Corkett and Chief Development Officer, Neil Taber.
Find out about their challenges, learnings and predictions for 2021, below…
What are your backgrounds and your roles within Cloud21?
Tony: We started Cloud21 in 2010 – 2011 on the basis of [the idea] ‘how can we help the NHS improve?’
My clinical background was in radiology, some 20 plus years ago. We had PACS (Picture Archiving and Communication Systems) – basically how you digitise radiology – similar to how we went from film to digital camera. We [realised we] had the digital image in hospital A, so how do we get that to hospital B?
The early work I did in the 2000s was coming up with the concept of how you moved imaging around, across regions. That was what formed the national programme [and] we brought PACS to the entire country in a matter of years.
From the work I did in my clinical role to digitise radiology, I realised that through getting technology and strategy aligned we could actually do a lot more. We could actually help a broader set of patients.
And that’s been the ethos behind a lot of what we try to do, ‘how can we bring innovative technology to health and care organisations and actually make a difference with it?’ It’s what certainly motivates me as the Founder and Director of Cloud21.
Cloud21’s ethos has always been to answer the ‘so what?’ question. Technology alone isn’t the answer. We have four divisions: consultancy, IT services, enterprise solutions and Neil’s division, interoperability.
Neil: I’m the Chief Development Officer for Cloud21. I’ve been working either for, or with, healthcare since 2000.
For the last 16 years I’ve been working with code and tools to help computer systems understand each other. We work with everything from simple data transfers to information understanding, and use integration engines, ETL tools, and process automation (RPA) suites to deliver the solutions. We’re helping to support the business changes required to make more efficiencies and to support an ever-increasing demand on the existing workforces.
As Tony said, the reason I’m with Cloud21 is that we see technology is an enabler to the challenges that are out there in the NHS and across the services they provide. And that’s not just limited to the acute sector. We understand that healthcare interoperability spans primary care and GPs, emergency services, health and social care but also includes local authorities and government.
It really is a vision to try and help these organisations better interact with each other. Aiming for true interoperability – sharing utilisation of the information that’s so often held in these silos.
What are some of the challenges around digitally-enabled care?
Tony: As your audience will know, the NHS isn’t a single system. The NHS is a complex set of institutional organisations, often competing against each other for resources, for funding and for services.
And in that complex dynamism is [the question] ‘how does a patient – and it should always be about the patient – navigate their way through that? How does the information that would help the professionals flow through the system?’
That challenge has been there since day one but now, with the adoption of digital technology, the public assume that this problem no longer exists.
Patient’s flow through a complex myriad of different points of care. ‘How does their data flow with them, so that everybody knows exactly what they need to know at any point in time?’ That’s challenge one.
Challenge two then is, ‘what can we do with that data?’ How can we take that data and begin to use it not just to improve care for that patient, but actually to improve the care for the population as a whole? And that takes us into areas like AI, machine learning, predictive analytics, population health and risk management.
I spent a couple of years with Google DeepMind – probably one of the leading, if not the leading, AI company in the world, looking globally at how we can use health data. And some other parts of the globe are progressing really well, collating data from multiple sources and re-purposing and reusing it to actually treat a condition or symptom before it gets to the point where a patient is presenting in an acute setting.
That’s another challenge we have: ‘how do we stop people walking in the front door of hospitals? How can we interact and intervene with them earlier?’
Neil: And I have experienced a further three challenges;
The legal [one]: what are you actually allowed to share, and who makes that decision – patient, staff, organisation? [Then] how do you make sure the receiving organisation will capture and process in the right way at the right time? Information that could have been shared may end up being archived or discarded, reducing the effectiveness of the outcome.
We [also] then have the political view of the information that’s available. For a long time, information captured was processed on the premise of ownership of that patient. The immediate delivery of the care needs are always first and foremost, however when the patient moved on, not all of their data did at the same time, if at all. Relinquishing that control has, and still is, a challenge to any interoperability programme.
Finally, the usability and understanding of what can be done with the information. You, whether as an organisation or an individual staff member, may not be aware of what could be provided from other teams or systems; Other information providers may not know you would be interested in the other information they hold. It’s important for organisations to understand the usefulness of their information outside of their direct context and also ensure that data maintains context outside of their core applications.
Knowing the breadth of information you have available, and how it can be presented, is key to the sharing of content and coverage of the data so that it becomes useful in an interoperability sense.
Do you have any real-world examples of those challenges?
Tony: Political decisions are being made, most recently the move to a concept of ICSs has been accelerated.
It’s recognised that care has got to be delivered across the entire continuum. The ICS world will change the political landscape at local levels, it’s going to change roles and responsibilities. It’s going to move some of the powerbase around.
Interestingly enough, legally, the NHS structure isn’t aligned to that currently; we’ve got to get laws through Parliament to enable ICSs to be formed in the correct construct, away from the existing CCG (clinical commissioning group) structure.
Politics and legal movements are there, at a macro level, but Neil has got a really good example of what that actually means on the ground.
Neil: Our role in a 15-organisation-strong collaborative – comprised of acute hospitals, health and social care, local authorities and government agencies – was to bring together a centralised record for a person inside a demographic area.
Our engagement supported the discovery and pre-enablement phase, where we assisted the organisations in better understanding the information that they had available.
This phase was important for two reasons; firstly, to uplift the hidden information that they do have available. Secondly, it highlighted the challenges of information alignment between the different organisations. This enabled the project to undertake an early assessment of the semantics of the information to help to ensure information shared would be ‘usefully usable’.
This is a term that should be in the forefront of peoples’ minds because the ability to make good use of information is a key message in the NHS 10-year forward plan. Just passing someone information is one thing, but that receiver being able to use it in a way that supports their organisation in providing a better healthcare experience for the patient is key.
Part of our role with the programme was to develop a framework that would allow the organisations to document and better understand the silos of data they individually had, and to allow the development of common information alignment and not just a data mapping exercise. The ability to work with, and document, the semantics and lexicon to align meaning was a really important step to having a strong information alignment.
When the project is complete, combinations of the data will be used by advanced data analytics tools. The information that has been shared between the organisations can then be utilised in different ways – to look at modelling, and to look to predict service utilisation across many areas.
Services for our patients can be improved upon by interoperability – sharing information and reducing the repetitive nature of data collection to minimise the chances for errors to creep in.
What are the wider implications when moving towards interoperability? What should organisations be aware of?
Tony: One area we’ve been talking about for years – and I feel we’re slowly getting there – is open standards; the ability to establish and agree a set of standards that makes things easier to be shared.
Secondly, as an industry, we have the silos inside the organisations. But we also have silos from a supplier and vendor perspective, who quite rightly look to protect their own systems and platforms.
And it’s trying to encourage those vendors to be more open and realise that actually – through a sharing of data – everybody wins. That’s started to progress over a number of years and some barriers have been knocked down slowly.
Finally, I think for me, the capabilities of the technology that’s emerging from the fourth industrial revolution – AI, machine learning, nanotechnology – is dependent on the availability of raw data.
We have a huge source of data in the NHS that has a significant value proposition and if the NHS can achieve interoperability it will make a fundamental difference to patients and the health of our populations.
Neil: The NHS’s Open API policy and involvement with the INTEROPen group demonstrate that the NHS are dedicated to having an interoperable service delivery. A current challenge in the adoption of this approach is that that frameworks are still in a building phase.
Although they have been published for some time…they are regularly going through improvements, so there is always a bit of a moving target for the suppliers seeking to adopt the standards. It’s a lot of work for third parties to transfer to a new data standard after spending years aligning their solution to ITK HL7. We are starting to see new versions of software released that are more supportive of new data transfer capabilities but this is not across the board, and heavily impacts smaller dedicated and boutique solution providers.
When a good level of adoption has been gained, we’ll almost be looking at [more of a] ‘plug and play’ architecture, where the information can be directly shared with other organisations very simply, using the aligned data structures and information workflows that would be provided by the solution’s out-of-the-box capabilities. The shared business processes will, hopefully, be much more able to adjust and benefit from the more readily available information provided by the technology layer.
What’s your vision for interoperability going forward?
Tony: We’re only at the beginning of this journey. Interoperability can often get put into the bucket of technology [e.g] “oh that’s just an IT problem”. But actually, interoperability starts at the very top level – strategically [thinking] ‘what are we trying to achieve here? What’s the outcome we want?’ Then it moves into, ‘how do we deliver that service change?’
And when you get down to a technology level, it is just a tool that’s helping you achieve a strategy. If we haven’t got a strategic vision, if we haven’t overcome and removed the power bases [and] political barriers, the ‘not in my backyard syndrome’ – if we don’t tackle those, just giving technology to someone will make no difference at all. In fact, it will probably cause more problems.
We have to answer the ‘so what?’ question; we have a new bit of technology…what difference does that make? It only makes a difference when you go back and think: ‘have I got the strategy right? Have I taken the people with me? Have I got the processes right? And is the technology implemented in a way that achieves the goal?’
Neil: The tech part is the enabler, yes. And if we use the resources carefully, use staff wisely, and share a lot more data, there will be a lot less repetition of input, a lot less rushing around looking for information across multiple systems. There are ways of providing everything that a clinician, doctor, or a social care worker needs on their device at one time.
The mission is to support organisations in assessing their challenges, in understanding how their processes may need to change or be streamlined. During the discovery and planning phases, we can introduce the benefits offered by process mining, integration suites, and RPA (robotic process automation) that can help realise the benefits required.
Is there anything else that organisations need to consider?
Tony: We’ve got to move away from the [idea] that technology, data and digital is a little department that sits there and makes sure your email works. We’ve got to get to the point where organisations realise that technology is now the bread and butter of how healthcare operates.
In trying to get that message across it covers a whole plethora of areas. So, at a very macro-level, ‘have you got a CIO (chief information officer)? Are they sitting at the board? Do the board truly understand what technology can and can’t do? And the impact if you do it badly – the risks, [e.g] cyber security?
At a strategic level, recognising the importance, getting the right skills and investments and the long-term view of what you want, enables the right decisions to be made, the right processes to be made and [then], finally, getting the right technology to deliver.
What’s coming up for you over the next year?
Tony: The progression into the ICS model will open up opportunities to do more of what Neil described in meeting the interoperability goals.
Our team is ready to support – from helping people at a strategic level…and then coming down through the layers to support them at the technology stage with the architecture and the design, all the way through the procurement and the implementation to the benefits and realisations.
The excitement of being able to sit down and look at that from the top downwards and cover all those elements, from a ‘helicopter view’ right down to being able to ‘put the wires together’ and connect them is what I want Cloud21 to focus on.