For the latest edition of our industry view series, we sent out a call for comment to hear the views of industry leaders on the new draft Standards and Interoperability Strategy released by the Transformation Directorate at NHS England and NHS Improvement.
We received a wide range of replies, here’s what we found out…
“The fact the standards are still in draft is a concerning reality.”
Paula Ridd, General Manager UK and Ireland, Altera Digital Health UK shared her views: “The fact that our interoperability standards are still in draft is a concerning reality, when we have been seriously talking about them since the Standards and Interoperability Framework was created in 2011. The strategy states it will ‘provide an opportunity for vendors, other programs and community to engage with the standards developer to identify commonalities and opportunities to reduce duplication and burden’.
“This places an expectation on those of us creating solutions to work together, making it easier for the NHS to reap the benefits of implementing digital solutions, which is positive. While the strategy should be considered alongside the Data Saves Lives strategy, I also think it’s important to use it to better understand what is meant by EPR convergence. While expecting trusts to converge their technology may be unrealistic and impractical, the convergence of standards and interoperability is not. By standardising how systems interoperate, we stand a chance of being able to join up care across Integrated Care Systems.”
Martin Bell, Independent Consultant and Director at The Martin Bell Partnership, explained that having standards to deliver interoperability in healthcare is vital, and “equally, one can’t help but be frustrated that we are here in 2022 and “here we go again”. The document has much in it that is true and common sense, much to be commended. It also appears in parts to be aspirational and expectational, rather than mandating. We know this does not work.
“Whatever the technical solutions underpinning the standards and drive to interoperability are (and the document is strong and long on these in the main), we will be having the same conversation in 10 years’ time (as we have had for the past 20 years) unless we:
- Clearly define the mandated standards that must be used, or supplier cannot play in the NHS market.
- Remove the ability for contracts to be signed where suppliers do not conform to whatever those agreed standards are.
- Remove suppliers’ ability to have proprietary API programmes, that smaller players in the market must then pay to join, to support innovation.
- Have a single, agreed set of standards (including information governance, hosting, commercials, etc) that all suppliers must qualify for, but are then “done once” and portable across frameworks and tenders.
- Given the number of systems in the NHS, a clear roadmap for implementing any standards must be clearly laid out.
“However, all this, as the document is, is largely technical. Standardising systems, forms, workflows, data points to be entered, etc, is all well and good, but how does it map to how people work? How are people supported to transform how they work and standardise more across NHS organisations? How does the existing systems landscape impact on execution of this approach – and the resource and money to actually improve and replace?
“Without the resource and money this paper will remain a policy aspiration or direction of travel at best, rather than an executable strategy.”
James Webb, Head of Sales and Marketing at Ascom, highlighted some of the challenges: “For me one of the biggest challenges that needs to be overcome is a move away from technology that operates within closed architecture. Data needs to be able to flow freely through the NHS, especially at the point of care. Suppliers must understand how their technology will work in the wider health and social care ecosystem and enable it to integrate seamlessly.
“Technology with open architecture enables the NHS to provide patients with better outcomes, create efficiencies and helps future-proof the NHS, not only in terms of the provision of care, but also within other operationally critical areas such as facilities management.”
Vijay Magon, Managing Director at CCube Solutions, added: “It’s good to see focus on standards for data exchange such as HL7-FHIR and use of SNOMED for recording outcomes. As long as data is captured using such standards, there should be no restrictions on data exchange via ‘shared and reusable datasets’ – no technical or commercial restrictions – and all accredited suppliers must sign up to interoperability and be able to evidence and publish their APIs. We’ve seen too many instances where commercial considerations override the need for data exchange – no barriers to implementation.”
Interoperability, rather than integration
Glen Hodgson, Head of Healthcare, at GS1 UK, said: “It is positive to see that the report has highlighted the need ‘to create an approach that puts interoperability, rather than integration, as the main way of enabling information flow’. While integration has been the focus for many years now, the system-wide integration healthcare calls for cannot be achieved without universal open standards in place.
“The Standards and Interoperability Strategy lays solid foundations for the future of digitally integrated health and care. Many of the international data standards already in use are integral to existing health and care regulations. It makes sense to capitalise on the adoption of such standards as a starting point. As the strategy states, ‘standards are powerful when everyone can use them’. Now is the time to harness this power to enable interoperability and deliver greater continuity of care for patients.”
Tom Scott, Commercial Director at Alcidion explained that NHS organisations are working to level-up to digital maturity fast, and the new strategy may be key for progress. He wrote: “The strategy emphasises interoperability, rather than integration, and the development of consistent content models. If suppliers subscribe, extensive time currently spent on systems interoperability and bespoke integration could be saved. Standard, repeatable models could give trusts a head-start on otherwise resource-intensive implementations, allowing greater focus on change management and clinical adoption – the key features of a successful deployment.
“Interoperability is not an outcome in itself – it is an enabler of clinical improvement, something the strategy recognises early. For example, interoperability can drive comprehensive clinical decision support, that can push the right information to clinicians, enable automation and reduce cognitive load. A technical conversation is important – but we must always remember why we are doing this.”
Jamie Clifton, Head of Vision and Strategy at BridgeHead Software, stated that the strategy is heading in the right direction, but highlighted some important factors, saying: “Fundamentally, thinking has evolved beyond just setting the ‘protocol standard’ and progressed to addressing ‘the meaning of data’. I do feel strongly that the purchasing process, and subsequent purchasing decisions, need to be much more closely aligned to these standards. On many occasions, BridgeHead has seen buyers not specify or mandate data standards in the procurement process. Clearly, each purchasing entity has its own objectives and goals. But, the panacea of NHS-wide data interoperability will only be realised if the application eco-system supports standards.
“Lastly, more patients now have access to their medical records, largely through their GP systems. BridgeHead expects to see this grow further with a large increase in a patient’s direct involvement in their care over the next 5-10 years. It will be interesting to see how the implementation of data standards is going to assist or hinder this. The root of ‘safe’ access, regardless of standards, is understanding the person accessing the data and their role. We expect this increased patient access to raise significant challenges when sharing data; and identity and roles may become ‘the’ most significant issue to solve.”
Making it happen
Melissa Morris, Founder and CEO at Lantum, stated why they liked the new strategy: “Lantum is in full support of improved interoperability, and so should everyone operating in this sector if they truly believe in improving patient outcomes and improving efficiency. We encourage any government to drive this forward and break down the barriers put up by legacy technology organisations to prevent this from happening.“There is a highly fragmented software ecosystem in healthcare, and frontline staff and administrators are having to transcribe data between various softwares – it’s error prone, inefficient, costly and can also endanger patient safety. In most other industries, technology providers co-operate and partner with one another to make data flow seamless, but healthcare is so behind.”
Roger Booth, CTO at Alertive, thought the strategic direction is well considered and is supportive of the strategy. “A coordinated implementation plan that emphasises broad adoption that builds confidence will be key and so we are particularly supportive of the approach to ‘start simple and iterate’. A future ecosystem where applications can scan to discover newly available systems that can automatically be authenticated and connected to is an exciting prospect that we believe could release a lot of value for care workers.
“We’re particularly interested in the area identified as event-based data architectures. We believe there is a lot of opportunity not only to improve the coordination of care using this mechanism, but also to remove some of the manual processes that can be a distraction from spending time with patients.”
James Balmain, CEO at Induction Healthcare, added: “Codifying on a national level enables vital interaction between different health and social care organisations, making life easier for patients and providers.
“As a national supplier to the NHS, streamlining standards improves our ability to trust data, develop new functionality and help turbo charge the potential for digital transformation. We look forward to supporting our clients implement this strategy.”
Clear standards, requirements and open APIs
Helen Davies, NHS GP and Clinical Director at Doctrin, said: “For too long inconsistent standards have prohibited interoperability, compromising patient safety and the delivery of seamless care on a daily basis. Historically, delivering integrated care has not been simple and, as we introduce integrated care systems and primary care networks, we need to ensure that we have the right foundations in place to make integration as seamless as possible.
“It is also very important that we have clear standards and requirements for newcomers both within the NHS and technology providers which encourage innovation while giving assurance that procurement happens at a high standard. If momentum continues with this strategy then real progress will be made towards tackling these issues and building the foundations for a fully integrated and interoperable health system fit for all.”
Chris Barker, Chief Executive Officer at Spirit Health, added: “In the context of NHS England’s upcoming 1st July deadline for Integrated Care Systems (ICSs) to be formally launched, this reiterated commitment by NHSEI to achieving interoperability could not be more timely. The very nature of ICSs makes it crucial that universal standards are implemented which allow the seamless exchange of patient data between health and social care organisations, particularly for frailty patients moving between care settings and whose care is supported by virtual wards.
“NHS targets on digitisation and ICSs working toward their virtual ward targets of 2023 make it important that health and care providers are supported to achieve digital maturity, and that they feel empowered to tackle interoperability challenges together. The guidance reinforces the concern of providers working alone or in silos. NHS England guidance on virtual wards published last month made it clear, and here the message is the same, cross-sector working will be NHSEI’s biggest determinant of success. This is a message that resonates brilliantly with me!”
Tom Whicher, CEO of DrDoctor, stated that achieving interoperability will transform the NHS from the inside out. “Interoperable systems are essential to the smooth operation of the NHS and providing safe care for patients, while reducing the burden of unnecessary admin on staff. This document has the potential to pave the way towards a fully interoperable NHS – which is greatly needed.
“The strategy takes the right approach by boosting visibility of current standards, rather than creating new ones. For too long suppliers have had to navigate a complicated process when implementing standards, often struggling to identify which ones are necessary. This slows down the implementation process and bringing in new standards would make it even more cumbersome – which is not helpful when we are trying to build an efficient NHS.
“However, for the strategy to work suppliers should be pushed to provide open APIs, which can then be free to use for other suppliers – our view is this should be an essential requirement when tech is adopted into the NHS. Integration and interoperability can make or break digital transformation in healthcare organisations, so we are cautiously optimistic about the potential this strategy has to reshape the way the NHS is delivered.”
“Technology is only one piece of the puzzle, and for some the easiest”
Dr Owain Rhys Hughes, CEO and founder of Cinapsis, explained that the strategy is a document of huge importance. “The goals it outlines are on-the-mark, especially making full interoperability a ‘must’ for all new technologies and solutions that are procured. However, we now need to see clear timelines and a sizeable funding allocation to make the planned transformation a reality.
“The authors of the draft strategy are right to highlight that solving interoperability requires a collective, creative multi-stakeholder approach. But identifying and overcoming the current barriers is not going to be easy, nor will the creation of a revamped set of standards for a rapidly changing tech landscape. Nevertheless, this is a mission that is well worth the investment. When we give clinicians faster access to the digital information and data they need, we save them valuable time and stress at the same time as accelerating patient care and significantly reducing safety risks.”
Razvan Atanasiu, CTO Healthcare of Hyland, communicated that this is a forward-looking approach and acknowledges the opportunity to draw lessons from other industries like Open Banking to achieve a wider goal of an ICS. He said: “Technology is only one piece of the puzzle, and for some the easiest. Many processes and procedures will need to be defined with guidelines, incentives, and deadlines for adoption. When ready, the technology will be there to support it. Increased EMR adoption will solve some of the current interoperability challenges, but a key obstacle remains the lack of a single source of truth for master patient identity, as data is often kept at the many different places where the patient has received care.
“The adoption of open standards will be a fundamental factor in NHS England’s interoperability journey and vendors must be able to demonstrate a clear commitment to ensuring their platforms are built on recognised healthcare criteria. But interoperability is not a one-off process.”
We received so many great and insightful comments – the HTN team would like to say a huge thank you to everyone who shared their thoughts with us.