In a recent HTN Now webinar, we were joined by Neill Crump, digital strategy director at Dudley Group NHS Foundation Trust; Ananya Datta, associate director of primary care digital delivery at South East London ICS; and John Kosobucki, CEO of OX.DH.
In the session, we discussed how health and care can tackle challenges around interoperability, looking at the key steps that can be taken to make progress in this area. Our expert panellists shared details about their own projects and programmes, providing insights into strategy, approaches and potential improvements that can be made.
Challenges around interoperability in healthcare
After some short introductions, our panel jumped in to discuss some of the main challenges faced by the health and care sector when it comes to interoperability. Ananya shared, “One of the biggest challenges that we face is interoperability with the clinical system itself. I think the majority of practices and PCNs use software that may not be interoperable across different care settings, which is a problem.”
She noted how data flow and referrals are two areas where this struggle is seen more prominently, especially when patients are being seen in different care settings. “If there are medication changes made at the hospital, how does that flow back to the GP practice?” She asked. “When we talk about interoperability, I’ve found that most suppliers will say they are interoperable with everything, but when we start procuring or start using the solution, there have been vast differences.”
In terms of her own organisation, Ananya explained, “Last year we did an evaluation with primary care and secondary stakeholders, as well as some of the community pharmacists. Almost 145 individuals participated to help us understand how we could improve interoperability. And we learned quite a lot of things from them in terms of where they’re struggling as care providers and also how the population is struggling. One of the main things that came up was around patients not having visibility of their own data through technology, such as the NHS App.”
John noted, “In many industries, people can often default to assuming technology is going to solve every problem, but one of the most important things you can do is involve clinicians and the broader team in your digital transformation.” He concluded, “Without a doubt, technology that can streamline and remove friction from a lot of the healthcare pathways exists today and it’s been refined to a high level. But I’m sure we’ve all been involved in different projects where people look at a piece of technology and think that by just introducing it, it’s going to transform the way people work.”
This is where the challenges around interoperability exist for John, with him sharing that one of the best ways to tackle this is by bringing the team with you early on: “Get their input and then make them champions of the solution so they can then roll it out to the broader audience”.
Making progress
Discussing ways to make progress, Neil touched on the importance of understanding the different mechanisms and systems in place. “We need to make sure there’s a real and contextual meaning from a clinical perspective, so that when we’re bringing data sets together, all of the clinicians are actually talking the same language,” he said. “For example, for patient flow there are many different types of data coming from lots of different systems. So, how do we bring that together to give true meaning to it? And how can we transfer that information to whichever setting it needs to go to?”
Ananya spoke about the potential developments on a national scale that could help make progress, stating, “In the future we should be looking to standardise elements in primary care that are already in place on a national level. For example, increasing the usage of GP Connect, not only to view the patient record but to also share information in different care settings.” Referencing her own organisation, she said, “Our community pharmacy can now send consultation notes back to the GP and it goes straight into the EPR system. So, that’s already quite a huge improvement.”
John emphasised the importance of having open systems that can communicate with the broader ecosystem, highlighting this as one of the ways OX.DH seeks to differentiate itself. “We’ve always embraced an API-first structure within our own internal developments and when interacting with the NHS and other healthcare systems,” he explained. “We were one of the first, or if not the first, to have adopted the SNOMED terminology server as a primary source of truth for all of our coding and structure. So there’s no replication or disconnect from that standpoint.”
On the subject of making progress, he noted how the NHS is “increasingly making the transition from spine-based integration to internet-facing solutions with standard API structures, which is making it easier for vendors to adopt this system too. Recent updates to the Data Act of 2025 now regulate the ability to share this information, will help to drive change for some of the legacy providers.”
Neil echoed what John had said about openness, stating, “I think it’s really important that we make sure all of our suppliers are using open standards in the future. They should have open APIs and they should be documented as well. So that when we’re doing the procurement, we actually understand exactly what it is that we’re going to get and how interoperability will work. We need to make sure that suppliers cover all the information governance and clinical safety aspects first, so that we can then move forward.”
How APIs differ from traditional interface engines
Answering a question from the audience, John gave an overview of how APIs differ from traditional interfaces. “With modern APIs, there’s security built into them and they’re well documented,” he said. “This creates a holistic view of all the care for that patient through the interchange between different systems. And you can also trace the origin of where that information came from.”
Expanding on this, he explained, “Most APIs are used on a real-time basis to dynamically retrieve information that’s needed at a particular time. Some of them are used to synchronise and keep different systems aligned throughout the treatment that a patient might be having, which has been one of the biggest transformations within healthcare in the last 10 years.” He noted how there have always been protocols in place, such as HL7 and FHIR, but that adoption has been historically slower than anticipated. “As the use of modern API technology started to become more strict and mainstream in healthcare, adoption of these protocols has accelerated, letting people take bigger steps at a quicker pace when pulling together data from disjointed sources.”
Current interoperability within the NHS
In terms of the current position of the NHS when it comes to interoperability, Neil said, “We’re seeing some good progress, especially with the shared care record. This has made a measurable difference to how each trust is actually delivering care.” He also highlighted how great the digital maturity assessment (DMA) has been this year: “For the first time we brought standards and interoperability into the question set and I think that’s given trusts a lot to think about and will be key to measuring progress. But we’re still waiting on the Data Use and Access Act, especially for secondary legislation, so I think we’ve still got gaps in this area, which is why I’d say we’re probably at a mid-stage when it comes to progress.”
Neil went on to explain the reason why interoperability is so important for the future, stating, “If you think of where we’re heading with AI, there’s no way that we’re going to achieve all of our objectives unless we actually get the basics of interoperability and metadata right.” Providing insights into how the Dudley Group Foundation Trust is currently performing in this area, he explained, “We have a highly skilled, in-house technical team that takes care of interoperability. So, from a technical perspective, I don’t think we’ve got the same problems that other trusts might have. For example, other trusts might choose to buy a tool when it’s needed and we know that’s absolutely the wrong approach.”
Managing the people side of digital change
When considering the people involved during digital change, Ananya mentioned how there are two parts to think about: “One is the care providers who are actually using the platforms and the second is our population.” For the care providers, there needs to be a focus on how comfortable they are with using the systems and the current integration, Ananya said. “What improvements do they think are needed in the short term, mid term and long term? That’s what you should consider before buying a product. Because it’s very important that we understand what the business requirements are as well as what problems they want to solve.”
She suggested evaluating multiple suppliers that can support the users directly and performing acceptance tests to help understand whether the solution is fit for purpose. In terms of the population, Ananya expressed the need to see how patients are benefiting from the new digital platform being introduced. “Can the patient see what data is being shared across different care settings through the NHS App? Is the patient-facing data visible to them? If they’re using a home monitoring platform, does it integrate with other systems?” For Ananya, it’s “very crucial that user-specific design is embedded throughout”, noting that integrating with the NHS App should be a key part of this.
Short-term goals for interoperability
When asked about short-term goals and the minimum requirements for interoperability, Neil offered his insights. “If we’re looking for a minimum viable product, I would say that we’re looking to measure that across three or four different areas,” he said. “One is the technical side of things, which includes having a look at the systems and how they exchange data. And I think we need some metrics around that in terms of linking it to the APIs that we talked about earlier.”
He also mentioned, “We need to have an understanding of the semantic aspect of it all as well. We want to be able to understand the shared meaning of data across systems and I think that’s especially important within our acute and community because we’ve got so many different applications and we’re looking to join them all up. If you put yourself in the place of a clinician at the moment, they’re having to go into too many different systems in order to get the answers that they need.”
Finally, Neil echoed much of what Ananya had to say about the people side of things and making sure the workflow is taken care of in terms of supporting information sharing and using common formats and structures within the data. Adding onto this, John noted how a lot of the people he speaks to “are looking to build a solution from the ground up, using data around demographics, medications, allergies, test results and the problem list. So getting the data side of things right and then continuing to expand out is a great place to start.”
Understanding the complexities of interoperability
By sharing a diagram that demonstrated interoperability within primary care, John was able to show just how complex the various touch points are. He briefly went over some of the different elements, including demographic services, e-prescribing, care records, referrals and connecting into MESH etc. “For each one of these arrows and touch points we had to go through a certification process as part of the TIF programme to start bringing those things together. As a result, we can now reuse these elements for other interesting use cases, such as integrating with the eRS system.”
Leaning on his own experiences with interoperability, John then shared some of the key lessons he has learned. “I think what actually made it much easier for us was when we started connecting with the individual people who had the expertise and knowledge in each of those individual areas. Because when we connected with those people, progress was made very quickly.”
If he were to wish for a way to simplify the process of interoperability, John expressed a desire to work with a dedicated group who would have a more overarching holistic view of the different integrations. He noted how this would make communication easier, stating, “You wouldn’t have to go through different onboarding processes or jump through various hoops.” And even though there is still some way to go in this area, he shared his positive outlook on the matter: “We have seen it improve over the last 18 months and I’m confident that it will continue and improve as time goes on.”
With all of this in mind, Neil suggested having a national registry to bring all the different suppliers and organisations together, before asking John about his thoughts on the idea. “That would be outstanding,” John said. “Every time we have a different component that has to access the PDS, we have to go through another validation process. But if there was a national registry that showed the test criteria needed for a vendor to access the resource, then it would be a huge improvement in terms of efficiency.”
Interoperability and the 10 Year Plan
The panel then moved on to discuss how well interoperability has been covered in the 10 Year Plan, with Ananya stating, “I think it touched upon all aspects of the problems we’re currently facing, including standardisation, a cloud-based approach, coding and the interoperability across different settings of primary care, secondary care and social care. So, it’s very fit for purpose.”
For Neil, “The vision is brilliant. I like the three shifts. I think they’re easy to understand and it makes sense”. “If we apply it specifically to interoperability, it doesn’t have sufficient detail in my view, especially for such an important topic. And because of that, you’re not necessarily going to get the results that you need. So unless there’s a separate way that we can bring this together and then link it to the plan, then my concern is that we’re never going to get there.” He finished by adding, “I love the vision, but I think it’s probably up to us to create a better plan in terms of milestones and funding, etc.”
Agreeing with Neil, John added, “The 10 Year Plan is setting a direction of travel. It’s telling us which direction to go in and what the end goal should be. Then people like us are taking the tactical steps and making plans that help us align with that strategy.” A lot more has to be done and there needs to be more of a focus on that Data Act, John said, as it will yield benefits for everybody down the road. “There wasn’t much in the plan about the challenges that we’re all dealing with today. So it’s up to us to consider where we want to go and to come up with the right ideas on how to implement a solution.”
Neil referenced the plan’s concept of giving patients a doctor in their pocket, with the NHS App being a key aspect. He noted, “This is quite interesting because we’re going to have all these different systems in the background and then somehow try to provide one single view for the patient, showing all the information from various providers in a context that’s easy to understand. That’s a huge amount of work.” For Neil and the team at Dudley, this move towards personalisation of care and people taking accountability and responsibility for their health is exciting and important, but the question is: “How do we work as teams to make that happen?”
Ananya suggested focusing on a single directory of services that becomes the one source of truth for any referral, sharing how this would “make the journey much easier from a patient care point of view.” Explaining this in further detail, she said, “A patient could be self-referred, for example and AI could suggest the various care settings available for that patient based on their current condition”.
Using the NHS App now and in the future
Next, our panellists shared how they’ve been using the NHS App within their organisations and regions to facilitate interoperability. “There’s a huge focus within our ICB to improve the usability of the NHS App,” Ananya shared. “And part of that includes going into the waiting room and talking to patients directly about the app, as well as using digital means and social media to promote using it. We’re also working with the regional and national team to see how the campaign could run across pharmacy and we often send them requests based on the feedback we’ve received about improving the app.”
Neil shared how the Dudley Group are using the NHS App for appointment letters, which he said “has benefitted both the patient and the organisation, while also allowing us to cut costs in terms of paper being posted”. He explained that the plan for next couple of years is to be more ambitious with the NHS App: “We want to allow patients to enter data themselves, which will then flow back into our organisation, enabling that two way engagement, which is a really exciting aspect for us”
Offering one final thought, John said, “I think now is an incredibly exciting time to be transforming healthcare. There are a lot of people focusing their time and effort on making a difference and that will ultimately improve the outcome for the patients. So I’m super excited to be involved in that.”
We’d like to thank Ananya, John and Neil for joining us and offering their insights into this topic.
