The first of our seven live sessions on the ‘Digital ICS’ theme at the latest HTN Now Focus, a series of one-day events that feature talks from health tech experts on specific topics, was a presentation by the team from the healthcare informatics company, Alcidion.
The panel for the opening discussion of the day was comprised of professionals with a wide range of career backgrounds and perspectives, including Dr Malcolm Pradhan, Chief Medical Officer at Alcidion, and his colleagues Vivek Krishnan, Chief Technology Officer, and Tom Scott, UK Sales Director. Carolyn Manuel-Barkin from Ethical Healthcare Consulting also joined to share her views and chair the webcast.
“That holistic approach is one of the main ways…to build a sustainable and equitable healthcare system”
Digital solutions that can support the objectives of the ICS framework and scalable architecture that can address key requirements were just some of the topics on the table in the morning meeting.
‘Is an ICS more than a shared care record?’ was the wider question addressed in this session, and Carolyn raised the curtain on the event with an ice breaker about Olympic sports, before quizzing Malcolm on aspirations for integrated care systems.
“What do you see as the opportunities [in this area]?” she asked.
“I think the healthcare system and the general social support system is siloed, quite fragmented, and there’s a frustration for consumers [going] through that journey. It’s increasingly the case that a lot of the social and economic factors, and the social determinants of care, [have] so much influence [on] healthcare and, similarly, ripple back into social factors, as well. Trying to keep them as separate systems is somewhat artificial, rather than thinking about the whole person,” Malcolm said.
“We’ve been thinking, ‘oh, it’s a healthcare problem’, so we go to healthcare professionals or we go into hospital, which is very expensive. It doesn’t really take into account what that person wants and needs, what the real issues are, what their goals are, and how do we adapt care for them [etc]…that more holistic approach is one of the main ways…to build a sustainable and equitable healthcare system.
“There are plenty of opportunities to rationalise, in terms of service provision. But continuity for that individual, as well as being able to adapt to where they are at in their lives, that journey through the healthcare system, which may require social support…at the moment it’s just really logistically hard [for information transfer and communications]. I’d argue culturally, as well, for different groups – even if you look at GPs versus hospitals, culturally there are different views. Aligning those views around the patient, around the consumer, I think, is a really big opportunity because we’ve had funding models in the past that can support this kind of care but there are other barriers.”
“There are a lot of pieces that need to line up but I think that’s the healthcare model that we’re all aspiring too,” he added.
“I think the ICS model provides a great opportunity to streamline the technical landscape within the NHS”
Carolyn then passed the baton over to Vivek to speak about the tech opportunities. “From a technology perspective, I think the ICS model provides a great opportunity to streamline the technical landscape within the NHS,” he explained.
“Digitising the data [and] moving away from paper, which has been a goal for many decades now for the hospitals, and for different parties within health care. Having that opportunity to implement accredited architecture [is important]. We all know that in healthcare the centralised model doesn’t work that well…[especially] handling localised issues.”
Vivek added that, “once successfully implemented…I think you’ll start seeing a lot of reduction in your capital operating expenses, as well.”
On reducing carbon footprint, he said: “With the ICS model there will be opportunities to free up the number of systems that are operating out there and provide more centralised, streamlined systems for the data to flow through.”
Regarding the opportunity for an ICS shared care record, Malcom also added: “We’ve been thinking about this for some time. There’s a view from some parts that ‘let’s just get all the data into one spot’ and then people can use whatever app to access it, trying to create that uniformity. My argument has always been [that] even in a hospital, each speciality is almost like its own business, each service has different concerns. Just one view on data isn’t good enough, even within the one organisation.”
“Open standards…NHSX has talked about separating data from applications, I think that’s the really important principle that data is not tied to an individual, specific application. That lends itself then to open standards – you are choosing open standards to represent the data. What that does is it forces people to do some of that hard work upfront.
“Part of the key components of an ICS shared record are…standardising some of that terminology, the representation of the data, the oncology parts, which [can be] mundane at times and hard. Doing that upfront, so you have a clear representation of the data within the health record, you’re then able to build different front ends and apps on top of that data.”
“There’s increasingly more complex data being represented,” he continued, “from molecular to genomics, large volumes of tests…another key part that we advocate is that the system should also be designed around a real-time environment, rather than being a passive data store. We have to start thinking about a health care record as an active participant of the healthcare system, rather than a glorified electronic filing cabinet…that’s just not going to scale.”
“We have the ability to put all this stuff together but we have to be smarter about what infrastructure it’s being held in, not just adding more cognitive burden and stress to everyone involved with the system,” Malcolm concluded.
“It is the opportunity to consolidate all those multiple touch-points”
Tom was the brought in to add his views on challenges and opportunities from a UK perspective. He said: “The key word I’d pick up on is that longitudinal record. It really is the opportunity to consolidate all those multiple touch-points, that we all go through as patients in the NHS, into a single, open standards platform…to be able to build the longitudinal health record. [But] what does that data actually tell us? What are the nuances in the data? Who needs to know about that data without having to go and find it?”
“Clinically and technologically, it kind of rolls up to improving patient outcomes across those multitude of services [and] better pathway management…a whole raft of services. Getting patients more engaged in their healthcare – what does that data allow us to do in terms of patients seeing data and getting closer to the data, what does that tell them about themselves, [and] how do they engage well with that to be able to support the prevention agenda?” he asked.
“The opportunity is to be able to do it quickly through open standards. It can seem quite daunting, in terms of how to get there, but I think the opportunity is realising that there are different digital strategies across multiple organisations that have been well entrenched over years. But the use of open standards, in both storage and integration, allow for a really quick deployment to realise benefits. As we know, if we can realise benefits quickly, we get clinicians more bought in…I think there’s a real opportunity to be able to move at pace,” Tom added.
“How do we move fast and not break things?” considered Malcolm, “in other words, how can that infrastructure help create a safe environment to test out models and engage consumers and patients?”
After Vivek moved onto the topic of interoperability, Malcolm later added: “If you’re trying to optimise workflows then certain aspects of the IT can’t just be owned and controlled by one vendor or one product because it may not make sense in a community setting etc…interoperability these days is not a technical problem, it’s really a cultural or business strategy by vendors to lock in data. I think there’s another angle [that] culturally, it’s how organisations view interoperability and collaboration. I think interoperability is not technically a challenge these days, it’s really other layers that cause problems.”
In terms of what the criteria is for success with shared care records, Tom spoke of the “overlap between clinical, organisational, technical opportunity”.
“For me, it bubbles down into that cultural environment that’s created. Some of that governance with ICS Boards, flowing down from NHSX…in building a consensus amongst a group. On the ground, I see a real breadth of use cases for shared care records, the value they can bring. But what’s the next iteration of that? How can we really use that data to enable improved outcomes and research and standards to accelerate what the data is telling us? That breadth means there needs to be a degree of consensus,” he explained.
Coming back to ‘What Good Looks Like’ he asked, “what does that looks like for a region…and are we all bought into that…what can we do in the middle, in the ICS, using open standards and a platform approach to reduce vendor lock-in, to be able to accelerate all that opportunity that we talked about?”
The group went on to tackle a number of other topics, too, focusing on how to make ICSs successful, agreeing on terminologies, the procurement process, removing barriers to innovators, reducing the cognitive load for clinicians, and how to better support patient goals.
To view the full session, and the audience Q&A, watch the video below:
