Feature Content, Interview

Interview Series: David Hancock of InterSystems on shared care records

As the early autumn deadline day approaches for shared care record implementation, more and more contracts and updates are being announced across the sector. But what else can we expect across the next few months and beyond?

HTN recently spoke with David Hancock, Healthcare Executive Advisor at InterSystems, to discuss shared care records, including his tips on what to consider, his views on the 21 September deadline and his learnings from working in international markets.

Hi David, tell us about your role at InterSystems

I’m a Healthcare Advisor at InterSystems. I actually work as part of our development organisation, supporting InterSystems and the way in which they go to market in countries around the world, how they do that and how they start their projects.

We know that projects, in reality, fail at the start, not at the end. I’m often involved at the early stage of projects to make sure we get them off on the right foot.

In the UK I also have some additional responsibilities: I am the Vendor Co-chair of INTEROPen, which is the group that is trying to improve the adoption of interoperability across the NHS – it’s made up of the service, suppliers, standards organisations. And I also sit on the techUK Health and Social Care Council.

What does the shared care records world look like from an InterSystems perspective? 

Shared care records are being acquired by organisations who want to be able to integrate information from multiple organisations and systems, and then provide that for use in many different ways.

The natural purchasers of those, in the past, have been CCGs (clinical commissioning groups), increasingly the STPs (Sustainability and Transformation Plans) and now the ICSs (integrated care systems), who are really the next incarnation – and we’re going to, hopefully, be on the statutory footing by next April if the legislation goes through and allows them to be statutory.

So those groups are essentially buying the solutions in order to be able to provide a longitudinal patient record that can be shared across different providers, to support the patients as they navigate their journey around the healthcare system. And to then be able to provide a basis on which multi-disciplinary teams from multiple organisations can do care planning and there’s a view that they want to begin doing population health management as well.

We see care planning being increasingly important – that’s because when you integrate information from multiple providers, you’re getting information that is from the past. So, you can see what’s happened, the situation now, and also – what’s so important now – is what’s planned for the future. That’s what more and more of our customers want to do.

Do you have any case studies from customers to share?

We have customers like Lincolnshire STP, who’ve been using Healthshare for a number of years. And we’ve been able to integrate information from multiple systems to be able to get that longitudinal record, make it available to GPs so they can see the information from the acute etc. Also, in Lincolnshire we are seeing the need to be able to link to social care. That’s a really important area.

What has happened as a result of COVID, is an increased need to be able to manage the discharge of patients from acute, out into the community. And, therefore, a use of things like discharge care plans. How do you optimise things and improve the way in which patients are discharged, to make sure they are going to have the support that they need, so that they are not going to be re-admitted?

Lincolnshire have been really good [at this], we’ve seen that has encouraged a lot of collaboration between the hospital, community, GPs, and it’s really, really enabled that; the kind of things that everybody talks about, that they want to be able to do. And now they have a mechanism to do that.

We’ve also seen work being done in Lincolnshire around stroke plans, and that’s something we’ve got really high hopes for and has gone live recently. It’s recognised that the earlier you can discharge someone with stroke into the community, as long as you can support them you get far, far better outcomes. You need to keep them active; the longer they stay in hospital they will de-condition because they’re in bed.

COVID has stimulated a lot of this because of lack of hospital capacity. You’re trying to improve the flow of patients so they come in and can go out as quickly as possible. So, you maximise throughput of patients. We know that gets you better outcomes anyway.

They’ve even done some interesting things around care plans with how you move and handle patients as well, to be able to give specific guidance to health and social care. It’s that sharing of great information to make sure patients are effectively managed.

Any others you have been working with recently?

With my INTEROPen hat on, the next “hackathon” we’re doing, which is where we get software vendors to come together and we see how we can exchange data between our systems using some defined standards…the next one we’re doing is around maternity, because it’s recognised as being really important.

You’ve got the right demographic – people who are comfortable using technology and mobile phones, and really want to consume the information on that. NHSX and NHS Digital are realising that this is important. And it’s great to see all these start-ups coming in [too], it’s great for the industry and great for patients.

What shared care record tips can you share with our audience?

It’s fair to say that, when you’re looking at your shared care record, your solution is obviously important. But if you haven’t got alignment across your organisations, if you haven’t got a clear idea of what you’re trying to do as a collective, if you haven’t worked out things like data sharing agreements – which you really do need – you can’t implement any solutions.

These are the really important things that need to be established first. Because you can go and buy a solution but if you can’t agree data sharing, then you can’t implement anything. That’s an important thing to look at.

The second thing to think about is really, if you want to implement your shared care record solution, think about the impact of your data architecture. The reason for that is, if you’ve got some organisations there who perhaps are a little nervous about having their data in a central repository with everyone else’s, for example with mental health, you can come up with an architecture which is going to keep all of your stakeholders happy. This might mean not putting everything into a centralised architecture. Or it might mean that you can centralise some of it but some of it we need to be able to keep separate.

That can often be really important for getting that kind of political buy-in. Recognise that different people have got different levels of sensitivity about their data. It goes without saying that you need clinical buy-in but getting clinician time is really hard. They’ve got this huge backlog now, how do you get enough buy-in to agree what’s going to be done? Don’t underestimate how long that can take. And don’t confuse speed with progress. Things may take longer than you want.

Focus on the minimum viable solution. It says by September but that’s going to be difficult for anyone starting now. But that’s your aim and I think, for those people in the NHS, as long as you’re going in the right direction, I think you’re going to get some forgiveness. Everyone is going through a lot at the moment.

What do you see happening around and beyond the deadline? 

There’ll be some who started some time ago, who will make it, and there will be some who don’t make it. And that’s simply because not everybody can go at the same speed. If people have not been working really closely and don’t have the data agreement and sharing, that’s just going to take time. It takes as long as it takes.

My feeling is that I don’t think it would be productive in any way, for the NHS to penalise people who aren’t there, as long as they’re moving in the right direction, that should be encouraged. Because not everybody can move at the same speed, and not everybody is starting from the same place. So, for them to suddenly say “you have to all be here by then” when some people are starting 100 yards behind the others in a 100-yard race, it’s difficult for them.

The important thing is, are you moving forward? And are you going to get there?

How are you expecting the future to look with ICSs?

Different ICSs are starting in different places. Some have been fortunate to exist for nearly 12 months, but some don’t even exist yet. I think that there is going to be change.

What we need to think about is how are ICSs going to create their records? Some already have shared care records and we’re not going to replace those. So, it is a question of ‘how do I actually join up shared care record systems?’ That’s a pattern that we are going to see.

Do you have any learnings from international markets to share with us?

Certainly – one of the things with other clients I’ve been working with is that very early, they’ve been breaking their projects down into mini, manageable chunks and defining a pretty well-developed road map based on priorities they get the buy-in for. What they want, what they say is ‘this roadmap can change’ – and they do change, based on the slings and arrows of outrageous fortune.

They might do a roadmap over the next 12 months – I think that you can’t plan too far in advance. But at least something like that gives you a frame and an expectation and a commitment, which I think is really important. Even today, when I know how hard it is for frontline staff, setting an expectation so it’s not a surprise, is really important. If it becomes a problem, people can say ‘actually, I don’t think we can do that because we can’t give it that much time’, then you can say ‘ok, let’s change the roadmap’ but let’s be proactive and not get so far down the line and then realise we can’t do it because we can’t get the people.

You have to keep moving forward. In these types of projects, success breeds success. Once people see things being successful, others see it and say, ‘I want something like that’.