Integration is everything: why joined up care requires joined up systems
Eight years after the NPfIT was scrapped in favour of a modular ‘connect all’ approach to ICT, trusts are ramping up efforts to integrate their information systems and join up care. With the introduction of Integrated Care Systems, hospitals are exploring new ways of using digital innovation to empower clinical teams across whole health systems. Moreover, there’s widespread recognition that the traditional approach – where clinical information is stored in isolated systems and locked off from the rest of the world – is no longer acceptable.
If the NHS is to deliver affordable care, trusts must make better use of all the data that’s generated across pathways and use it to inform high quality services.
It’s no surprise that hospitals are pursuing more integrated ICT models where information from clinical systems is consolidated into data warehouses and visualised through a single interface. It’s a sensible approach. But in the rush for the single view, trusts must be careful they don’t overlook the front-line value of niche clinical systems.
Ultimately, in an NHS struggling with rising demand, integration between core and specialist systems will play a crucial role in designing the sustainable pathways of the future.
Drivers for integration
The drivers for integration are clear. In 2015, the Carter Report cited interoperability between data systems as a key component in eliminating ‘unwarranted variation’. The report recommended the development of data dashboards that integrate information from disparate sources and provide real-time intelligence to support operational decision-making.
More recently, NHS England has called for a culture of data sharing, urging trusts to ‘bring together the data necessary for quality improvement and cost reduction’ and create a ‘single source of the truth’ that facilitates complex analytics to inform the planning of care. The messaging has hit home. Hospitals are increasingly establishing ‘best of breed’ ICT strategies that pull data from multiple clinical systems and interface it into a single view.
That single view will undoubtedly provide valuable holistic visibility of trust performance, but the pursuit of it must not come at the expense of specialist systems that provide crucial departmental insight.
Niche systems play a huge role in driving productivity and efficiency in services that are, at present, under huge pressure. This is particularly the case in chronic diseases. With long-term condition (LTCs) patients already accounting for 50% of all GP appointments, 70% of all bed days and around 70% of acute and primary care budgets in England, Trusts are under enormous pressure to reduce the cost of chronic disease.
However, with comorbidity tipped to grow significantly, those costs will only increase. It’s therefore incumbent upon trusts to explore innovative ways of improving the productivity and efficiency of LTC services. Technology can play a valuable role.
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In the high-cost area of diabetes – where the number of UK diagnoses has more than doubled in the past 20 years – electronic information management systems are now routinely used to capture a range of clinical datasets to monitor patient performance against Quality Standards and NICE guidelines.
These solutions, which operate in adult and paediatric diabetes, have helped trusts reduce both HbA1c levels and the proportion of CYP in DKA at diagnosis. Similarly, diabetes teams are using electronic management systems to conduct monthly audits that allow them to identify patients that either have poor metabolic control, have been admitted as inpatients or frequently do not attend clinics.
Greater visibility of these patients has enabled more effective, targeted education and engagement and ultimately led to better diabetes management. This has helped reduce emergency admissions, decrease diabetes-related complications and minimise the length of hospital stays. These gains are the lifeblood of cost-effective services. They would not be possible without the real-time visibility enabled by digital solutions.
Moreover, the best diabetes management systems are designed to help trusts capture the data required for mandatory national audits and the Best Practice Tariff (BPT). The digitisation of these activities – which previously relied on onerous manual processes that were prone to human error – increases the efficiency and accuracy of audit submissions and helps trusts unlock vital funding through the BPT.
Integration: a two-way street
However, the business case for diabetes information systems – and indeed other specialist systems - must now go beyond gains at the departmental level. The value of the data within these systems increases when it is connected to – and combined with – data from other clinical systems like retinopothy or ophthalmology. Integration is everything. But it can no longer be a one-way street. In the past, solutions have drawn information from systems such as PAS or pathology – but little information has gone the other way.
In the process, departmental systems have often functioned as ‘islands of information’ that don’t do enough to inform more holistic decision-making. It’s not sustainable. In an open NHS striving for collaboration and integration, such specialist LTC management solutions must enable bidirectional data sharing – allowing data to be outputted to other systems and data warehouses.
By combining departmental data with other systems, trusts can harness the ‘power of information,’ facilitating more sophisticated analytics, clearer understanding of trends and smarter decision-making.
As trusts explore ‘best of breed’ strategies to drive quality improvement and cost reduction, the most effective solutions will be those that enable a holistic approach to data integration. Good management systems will not only draw valuable information from related clinical systems – and unlock efficiency with automated functionality like digital dictation – they will also be configured to share information with secondary data sources to feed the single view. Moreover, they will be clinically-led.
The smartest technology partners will be those who work closely with clinicians to build solutions based on a real-world understanding of pathways – and enable high-value data to be shared across the system.
Integration is everything. In the information age where joined-up thinking is all important, the delivery of safe, sustainable care may – quite literally – hinge on the connections you make.
Advances in health "must ensure self-sovereign identity"
The UK government has announced that from September onwards COVID-19 vaccine passports will be necessary to gain entry into places with large crowds, such as nightclubs.
This has reignited the debate between those who believe having proof of vaccinations will enable people to gather in public places and travel safely, and those who view the digital certificates as an attack on personal freedom.
The arguments have increased in intensity since the recent announcement to drop COVID-19 restrictions in England, in a move to reopen the economy that has attracted fierce criticism both domestically and overseas.
Cross-party ministers are set to defy the government’s latest plans to introduce vaccine passports over civil liberties concerns. A number of MPs have already signed the Big Brother Watch declaration against “Covid status certification to deny individuals access to general services, businesses or jobs” in recent months.
However Mark Shaw, CEO of Tento Applied Sciences, says the Big Brother Watch campaign is based on false assumptions. “Big Brother Watch puts forward a compelling argument based around civil liberties, but some of the assumptions they make are simply incorrect” he says.
“For example, the BBW campaign claims that all Covid passes are discriminatory, counterproductive and would lead to British citizens having to share personal health information with anyone in authority, from bouncers to bosses. However, there are already privacy-first digital wallets that give individuals the freedom to store and share anonymised medical documents, work credentials and other types of documentation quickly, simply, and securely.
“I wholeheartedly agree that individuals should not be required to share their own personal health information with unknown third parties or with anyone in authority who demands it" Shaw adds. "But I strongly disagree with the suggestion that ‘events and businesses are either safe to open for everyone, or no one’. It creates a false dichotomy that either everyone is safe, or nobody is safe. If employers or event organisers don’t take action to properly manage workplace or venue safety, then they risk curtailing the safety and freedom of movement for the majority."
The subject of personal health data is under scrutiny in the UK at the moment, following controversial plans for the NHS to share patient data with third parties. These have been put on hold following public criticism.
Meanwhile a new report has found that the majority of the British public is willing to embrace digital healthcare tools such as apps and digital therapies prescribed by a trusted healthcare professional.
Shaw adds: “The vital point to make is this: innovations in health technology must ensure self-sovereign identity. This means the data held about an individual is owned by the individual and stored on their device. And, in the case of medical data, that data can be delivered from healthcare professionals to the device in an encrypted format, and the user chooses how they share their information."