For our digital ICS feature, we spoke to a team from Alcidion: Tom Scott, UK Commercial Director, and Vivek Krishnan, Chief Technology Officer.
Introductions
Tom: I’ve worked for just over a decade in digital health across a variety of roles and I’ve been with Alcidion for three years now. I wear three main hats for Alcidion- sales, marketing, and partnerships. I lead on Alcidion’s UK growth with new and existing customers.
Vivek: For close to 15 years, I have been immersed in the health care industry, delving into the intricacies of digital health solutions such as EPR, shared care record, data warehousing etc and their development. Throughout this journey, I’ve seen the transformation and modernisation of healthcare IT. At Alcidion, my role is to build and deliver great products and supporting technologies.
Joining up data across regions
Tom: I would say that a key way to achieve data flow across an ICS is to utilise an open standards platform approach. Regions need to be able to consolidate data into what we would call a data orchestration layer, bringing disparate sets of data into an open standard platform to create a longitudinal view of the patient or the citizen.
We find that ICSs will have differing levels of digital maturity; they all have very different solutions already in place and the component organisations will often have different digital strategies. ICSs are complex organisations, as are the demands of the populations that they serve.
The open standards platform approach allows you to create that longitudinal view across a region quickly, because it doesn’t necessitate a ‘rip and replace’ approach. Individual organisations don’t necessarily have to replace their digital strategy in order to achieve the goal. It provides a foundational layer to enable patient flow, data orchestration across different organisations, and a single record across the patch. But it’s important that you can do this in an iterative way, without overburdening an ICS – because the problems that ICSs face are very much here and now. We don’t want to add to their challenges.
We are an Australian headquartered organisation, so we draw on our experiences in Australia to support ICSs here.
Vivek: As the name suggests, the integrated care system is about integrating the care along with the supporting technologies that provide the care to the population. It’s about having an interoperable solution that integrates with various different systems rapidly and make the data available in an agreed format i.e. open standards. This will directly encourage innovation in Healthcare IT. The whole point is to have an ecosystem where different vendors and platforms collaborate to solve the age old system integration problem.
Tom: ICSs will all have their own nuances that come with having different geographies and populations. The flexibility of the open platform approach allows for a focus on different populations and enables population health through that single pane of glass as Vivek said. The approach supports initiatives like flow across different organisations. Patient flow isn’t just about moving patients through a single organisation, it’s about the system view. That’s the way that the agenda – and technology – has to think about it.
Using cloud-hosted technologies helps with this, too; it breaks down the traditional barriers to organisations sharing data or being able to access solutions.
Vivek: The technology obviously plays a very important role in the ICS, not only through the adoption of cloud, but also through use of modern systems that are browser, web or mobile based. We need a system that is highly available, resilient, scales with demand, and can also provide information in a “bite-sized” condensed format – that’s also important in terms of supporting patient flow.
Technologies
Tom: Bringing modern technology into healthcare allows for innovation – it is an enabler, and it allows the scope for what else we can do with technology to widen. The increasing demands and strains on the health service are well-documented; technology should be there to support organisations rather than hinder them
There’s clinical decision support (CDS) technology, for example. Our Miya Logic engine is used to make sure that the right data is pushed to the right person at the right time. This starts to remove some of the memory tasks that we see burden clinicians and allow them to focus on judgement tasks instead.
Vivek: An ICS, in concept, is about bringing different facets of healthcare together. It presents a huge logistical challenge that the boards and trusts will be working to solve.
If you focus on the technology side, historically we’ve seen legacy systems and platform providers lock in the data for their systems. This has happened for various reasons – including the maturity of the technology stack, lack of standards and governance etc.
With modern, open standards based platforms, we’re talking about having access to the information from day one in a format that can be easily ingested, curated and presented to the user who needs it for patient care. It’s about creating an opportunity where innovation can happen and different providers can come together to solve the challenges of providing integrated care.
Another area to focus on would be decision support and automation. Clinical Decision Support technology along with explainable AI will have to play a huge role in ICSs. ICS will greatly benefit from a platform where care can be provided without any bias, judgement errors or fatigue. That’s where the technology (AI) will play an important part.
On key opportunities for patient flow technology to support an ICS
Tom: Patient flow is really important within an organisation, particularly in an acute setting. The key thing is being able to continue the care for the patient regardless of their setting. Using patient flow technology to support virtual wards, for example, allows for a degree of step-down care or for a patient to be put onto a particular pathway or remain under the care of an organisation without taking up a bed.
We need to drive onward care and we need care to create visibility to allow ICSs to take a command view of what is happening. They need to be able to see where the bottlenecks might be occurring across the region, for example.
So although flow is enormously important at an organisational level, we also need to bring that agenda and discussion up a level to talk about flow across multiple organisations. As patients, we don’t think about these things in siloes; we just think about our care.
Vivek: Patient flow is about the movement of patients through a hospital including knowing what they are waiting for, so that care providers can move them in and out of the hospital quickly and safely. To enable that, it is important for the different systems within an ICS to talk to each other.
With my CTO hat on, I would emphasise how important it is that the different systems are interoperable and able to communicate through open standards. The organisations procuring these systems need to drive the need for data to be available and interoperable in the contracting phase so that sharing across the ICS can be a practical reality as opposed to conceptual. We don’t want healthcare organisations to have to spend their time and resources engineering integration solutions.
On Alcidion projects supporting flow
Tom: In the UK, we have a sizeable flow base in the UK, and we’re working with a number of organisations in delivering our solution. For example, our solution is being deployed in East Lancashire Hospitals alongside Cerner, which means we’ve got the experience of delivering alongside existing digital strategies whether that’s EPR or what might be called best-of-breed.
Another project is around supporting the Digital Control Centre in Salford which is quite a big programme run by one of our partners.
We’re also seeing real benefits delivered to Dartford and Gravesham NHS Trust, where they are using our platform for patient flow alongside a number of other modules.
Vivek: In Australia we don’t have ‘ICSs’, but there is a similar concept in place called local health districts. Different hospitals within a district come together to provide care to their patients. For example, Sydney Local Health District in New South Wales has a sizeable catchment and population and our solutions help them to provide virtual care at scale. We orchestrate their data across the Miya Precision platform and present that information via a single longitudinal shared cared view.
Another example is the work Alcidion is doing with the Australian Defence Force. Last year, Alcidion partnered with Leidos to provide a health knowledge management system for the Australian Defence Force. Alcidion’s Miya Precision platform plays the critical role of aggregating data from all the partner solutions and other systems in the defence environment to provide a single consolidated longitudinal view of every participant’s health status and history.
On benefits and impacts
Tom: As Vivek said, flow is all about identifying where the patient is, what pathway they are on, and what is needed to support them on their next steps. When do we expect to be able to discharge them, how do we plan for a discharge? How do we put the right care packages in place or hand a patient over to the next organisation and give foresight of upcoming discharges? What do we need to happen in order to let these steps happen?
There are benefits in being able to achieve all of those steps. The first is around having real clear visibility in terms of where patients are and resourcing as an organisation – there’s a benefit in seeing all of that information in a command centre. Essentially, for a digital ICS, being able to see that data allows for informed decision making in real time. That’s often a challenge that we find our customers have faced – they don’t have that information, it’s stored on spreadsheets in different places, or it’s sourced via phone calls.
From there, we can start to think about the activities required in order to discharge that patient. We can start improving the accuracy of expected discharge dates (EDD), which leads to better quality handover and better patient experience.
Organisations can start to reduce the length of stay, because ultimately the machine is well oiled and everybody knows what needs to happen in order to get the patient into the next stage of their care.
We see a number of these benefits across organisations – often it depends what their starting point is. But they are really hard-hitting, measurable and financial impacts that can start to relieve pressure on the system. Take length of stay, for example – if we reduce that, we can free up beds and that means we can move patients around the system.
Virtual care brings another angle to that, because there isn’t a bed cost involved but they are still under the care of the organisation. The technology and technical infrastructure has to support that in visualising the data. The key benefit in virtual care isn’t putting a patient into a virtual ward, it’s being able to see the data on what is happening with that patient in real time and allowing informed clinical decisions to take place.
Vivek: I agree with what Tom has said, and there is also a positive impact on improving patient safety too. Once you have the data available in a digital format, the care providers can make informed decisions to provide better patient care and at the same they can also look at preventing hospital-acquired complications. Patients shouldn’t be in the hospital if they are ready to be clinically discharged so working on your patient flow and tackling re-admission risks can help with this.
As we digitise and collect data on an ICS level, it also opens up opportunities for research and development. We can look at emerging patterns to see how we can provide care for a particular sector that may be under-serviced, or explore how we can provide value-based care. It opens a lot more opportunities for the future of healthcare.
Tom: In terms of the ICS agenda, that broad view of the data also allows for informed decision making with regards to commissioning of services. They can look at where to invest in order to have the biggest impact on the population.
ICS-specific challenges
Tom: It’s the complexity. It can be complex at an individual organisation level because you have a number of solutions, but this is heightened at ICS level when you think about the digital ecosystem that is already in place. You can get lots of variation in digital capability between organisations, too, and the ICS brings in more players as well.
I think the art of tackling these challenges is to focus on the thing that is really important. Agility is key – you want to be able to deliver solutions quickly that fix real problems for a population, region or service. Also, you want to fix things iteratively and approach it in a phased manner.
Vivek: No two trusts within an ICS are the same. We need to focus on the governance and make sure that the systems, process and policies are well-aligned. It’s important to establish trust between organisations and have policies and a structure in place which allows them to operate in a cohesively. This also relates to how IT systems are procured and implemented for example, how users are trained, how change management is carried out etc.
Security is another major topic that will need attention. As we collect more data and share that data between organisations and sectors, it will be imperative to have adequate controls in place. As Tom said, the size of ICSs is a complex challenge, and making sure that they are all talking to each other is another is carried out safely.
What would great look like?
Tom: To me, it would be the further adoption of data orchestration layers across ICSs that join up those data sets from disparate systems. As I said earlier, because you’re not having to ‘rip and replace’, it means benefits can be delivered quickly, and because it can support each ICS’s local agenda. The ability to innovate will allow them to move forward at pace.
Rather than having static records in each organisation, to me ‘great’ would be the data orchestration and solutions that enable these records to become active ones that clinicians can use to the benefit of the patients.
As Vivek said, the adoption of smart technology, CDS and AI also plays a role in enabling that across geographies.
That supports levelling up and the frontline digitisation programme amongst other central programmes that we see in the NHS.
Vivek: I’d say it’s about having a platform and modern modular system where the data is available as an open standard, not confined to a particular vendor or format i.e. no vendor lock-in. That’s the fundamental, I think. It’s a problem that we have been trying to solve for decades now, trying to ensure that data can be accessed to accelerate development and innovation in Healthcare.
Hopes on the future
Tom: Looking at patient flow, I would hope to see a quicker and broader adoption of virtual care and the capabilities that this brings. I would also want to see more joining up of organisations in a way that is intrinsic to patient care – acute into community, into social care, and so on. I’d hope to see this become more seamless and therefore alleviate some of the pain and pressure in acute organisations.
Vivek: I would hope to see more use of automation through AI and Machine Learning models. The decision-support engine and automation will play a huge role in de-noising healthcare data and to reduce cognitive burden amongst healthcare workers. As an example, explainable AI could identify the patients best suited to virtual care, or those who can be transferred back to primary care.
Many thanks to Tom and Vivek for taking the time to join us. They can be contacted via email at tom.scott@alcidion.com and vivek.krishnan@alcidion.com, and you can find Alcidion’s website here.
