Feature Content, Featured, Interview

Feature: Interoperability programmes, challenges and learnings

In this feature HTN caught up with Gary Rouse, Commercial Account Team Manager and Mark Allen, Strategic Partners and Alliances Manager at Healthcare Gateway to talk about interoperability in the NHS.

We asked Mark and Gary a few questions about their work in this area, some of the challenges and what’s coming up next…

Can you tell me about your current roles at Healthcare Gateway?

Mark:  As strategic partner and alliances manager, I build on existing partnerships, engaging with our 80 plus partner systems that are accredited for the Medical Interoperability Gateway (MIG). I seek new opportunities with health and care systems to provide them with interoperability solutions to enhance their system offering, as we provide our partner systems with a range of health and social care data in a HTML or a structured format.  For the past four years I’ve collaborated with our partners and delivered exciting projects, facilitating new product development with partners such as Liquid logic and the creation of an adult social care dataset.

Gary: My team is responsible for commercial account management, ensuring our new and existing customers are utilising MIG services to their maximum potential, undertaking benefits realisation analysis and identifying data gaps to join up patient care, ultimately enhancing the patient experience and improving outcomes.

What have been working on in the area of interoperability?

Gary: During 2020 our focus was supporting the NHS response to Covid.  At the onset our customers ranging from health and social care organisations to transformational boards, at local and regional scale reached out to us, primarily due to our ability to quickly mobilise connections of patient data. For example MIG data was implemented at Nightingale Hospital at Excel London, meaning clinicians would have access to medical records of patients from the whole of London and its surrounding areas, a huge footprint.

We supported One London Local Health & Care Record Exemplar (LHCRE) programme which involves a multitude of health and care organisations who came to us and told us the existing data needed to flow into the data poor areas; we successfully turned that around in just over a week, where usual deployments can take anything between 10 and 12 weeks. To turn this around in such a short space of time was an incredible achievement for us and our partners but more so, immensely important to patients who required urgent care.

There was also requirements for cross-border sharing of patient data, helping clinicians treating out of area patients to have real-time information about the patients they’re caring for.

Alongside this work, we have also seen an increase in projects relating to local and shared care records and deploying data into health information exchange (HIE) portals supporting the national level up of shared care records agenda.

Mark: Interoperability is massively important to shared care records and as specialists in this field we’ve worked together with our partners and customers to successfully feed patient data into many HIE/ community portals across the country.

Health and care organisations in Kent as an example, have a new care portal (Graphnet). For this programme we have helped mobilise data into that system quickly and at scale; Kent already have organisation to organisation or point to point data connections with us but alongside that the demand was to establish a holistic view into the shared care record. We are not just entering into these global viewers, but also small specialist systems where collated views are not available such as the systems used in ambulance trusts (Cleric) supporting critical emergency care.

What have been the main challenges of implementing these systems?

Gary: We have challenged the normal process and re-written the rules. It’s proven that people can collaborate quickly to achieve goals; usually in the health technology space, there can be a roadmap for delivery that takes up weeks, months or even years whereas we’ve managed to mobilise data into systems in much less time than that.

Not being able to hold face-to-face discussions was initially a challenge, but again we’ve adapted to remote working and now support customer strategies and plans virtually. Personally, I like to use a whiteboard to map plans out in front of people, however online collaborative tools available today work just as well. To support end users once we’ve deployed services it is important to be present (usually in person) – what we call ‘floor walking’ and support via our MIG awareness sessions. Although we’re unable to be on site at the moment, we’re currently running adoption sessions remotely which is important for end users to gain most out of the data presented to them. This has been challenging but not insurmountable.

Historically I spent a lot of time ‘on the floor’ with our users, for example in Hertfordshire floor walking; Watford General Hospital took on our Shared Record Viewer (SRV) solution, but to really get users engaged, it was important to have that two-way communication and demonstrate and realise the benefits. To physically stand in A&E you realise how important patient data is to our users and I miss the chance to do that in person.

Mark: That is definitely key; you can give someone a tour but unless you walk them through it you rely on a user to find the full potential of the services presented in the clinical system. The growth in the usage of MIG has been fantastic and we’ll continue to support our customer in a remote capacity providing our fully managed service, which sets us apart – often it’s seen as the reason for our success.

What would you say are the biggest challenges to the implementation of interoperable systems across healthcare in general?

Mark: Across healthcare there are challenges with developing to the same standards, systems being open and then having the development resource to integrate at pace. MIG has over 80 partner systems that we have integrations with that provide patient data to and from, in the absence of national standards MIG was widely seen as the ‘de facto’ standard for GP sharing. As we all develop to national standards to complement what we already have the challenge is getting them adopted quickly. There have however been massive strides; and it has taken healthcare one year to achieve what would usually take years which is a huge positive and shows how it can be done.

Gary: That challenge puts Healthcare Gateway in a niche space currently; there is demand, but given organisations are not at the same digital maturity level. We have found that we can support by providing the flexibility to adapt to systems at various stages of development. This is something we are very proud of, and in 2020 we can hand-on-heart say we’ve supported the Covid effort across the country. 

What’s coming up this year for Healthcare Gateway?

Mark: Plans for 2021 are based on developing MIGs technical products and services that will enable our customers to meet nationally mandated services where available; to ensure patient experience is optimised. We will continue to innovate and provide data streams that are unavailable today. Programmes of work regionally including the levelling up and continued roll out of shared care records, supporting our HIE partners is important to help our mutual customers meet  their shared care plans.

Gary: In addition, shared care records are one element of what we do, whilst we support that agenda, our focus for us is mobilising more health and social care data for example social care data out of Liquidlogic into the MIG estate of 4500 consuming systems. We provide GP, Community, Mental Health, Acute and Social Care information, increasingly our available datasets to best support the demands of our customers today, and in the future. This builds on our managed service, we will continue to support our customer’s full end to end interoperability projects, from information governance, full project management, technical support and ongoing customer service.

Are there any learnings you would like to share?

Gary: As we deliver health and care connectivity, we do not need to reinvent the wheel to deliver a rip and replace programme to support ICS strategy; there are very successful connected systems across the country and a ‘lift and shift’ approach to reconnect into a different systems/settings may be the cost effective but also best for the patient.

We’re breaking down the barriers; where patient data sits in silos allowing that data to flow, when and where it is needed the most is key. In some cases where MIG solutions already exist, our customers recognise that the available feeds can be reused in any system or setting for little or even no cost in some spaces. For those being drafted in to look at connectivity, look to see what we can do to maximise return on existing investments before moving to a replace agenda.

I think it’s about making sure there’s a full analysis of what they already have before they go out and buy a new system.

Mark: We are all patients of the NHS and as patients we all want the healthcare professional who is looking after us to know our current and accurate medical information in order to provide us with the best possible care. What I’ve learned from this past year is that we need to get the basics right and support the users of our clinical systems better. We all have a right to be looked after by clinicians armed with the most up to date information held on us regardless of where that information is recorded.

Get in touch with Healthcare Gateway to learn how you can access real-time patient data via the Medical Interoperability Gateway (MIG).