From ‘wishful thinking’ to intelligent linking: How integrated care is finally happening

How pro-active NHS trusts are linking data across the care continuum

Hicom’s Mark Vizard explores how pro-active NHS organisations are linking data across the care continuum – and finally unlocking the benefits of integrated care

It is crazy that GPs and hospitals still struggle to share digital records. Only with world-class information systems will the NHS deliver world-class care

In 2013 the UK Health Secretary, Jeremy Hunt, unveiled an ambitious target to make the NHS paperless. His keynote speech laid down plans to ensure digital information is fully available across NHS and social care services and reinforced the pre-existing goal to give NHS patients online access to their own GP health records. The language of his announcement was frank, critical and undeniably true: “The NHS cannot be the last man standing as the rest of the economy embraces the technology revolution,” he said. “It is crazy that GPs and hospitals still struggle to share digital records. Only with world-class information systems will the NHS deliver world-class care.”

At first glance, it seems the reality still hasn’t caught up with the rhetoric. By January 2015 just 34% of patients in England could access summary information of the medical records. Worse still, an HSJ survey revealed that almost three quarters of healthcare professionals, clinicians and IT professionals believed the paperless NHS was ‘a great ambition, but unrealistic.’ Furthermore, 70% cited concerns that the integrated care agenda would not be possible because ‘insufficient attention or resource is being focused on developing technology to underpin integrated records’.

However, appearances, like political opinion polls, can be deceptive. Integration is no longer considered over-ambitious – it’s actually happening. Moreover, where it is, it’s helping to deliver the much-promised transformational benefits to patient care. There are growing examples where effectively-linked data sets are empowering multidisciplinary teams of healthcare professionals and carers with timely access to vital information, reducing the burden on NHS resources, removing unnecessary administrative duplication, and improving the efficiency of healthcare services. The net result – and the most-important benefit of all – is a demonstrable improvement in the quality of care and greater patient satisfaction across the care continuum.

The concurrent top-down clamour for data sharing across health and social care is providing a renewed catalyst for innovation now the shackles of restrictive technologies have been released

Technology drivers

Technology has long been held up as a barrier to progress – and the lack of a uniform NHS IT framework has only ever strengthened that view. However, while recent surveys may suggest that concerns about technological immaturity still pervade the NHS; the opposite is in fact true. Technology has evolved to the extent that it is no longer an obstacle to integrated care. Whereas legacy systems were often localised to clients’ machines or fixed in departmental silos; advances in web technology have brought greater accessibility to data and precipitated a shift towards a more-modern IT infrastructure in the NHS. In turn, software and systems developers have reconfigured their solutions to deliver web-enabled services – at a stroke reducing the perceived disruption of large-scale implementation programmes that was so often considered a deterrent to change. Web-based solutions are generally painless to implement, easy to use, and provide secure, instant access to real-time information. Moreover, the best are built to be interoperable with other adjacent solutions, making integration a relatively-simple process.

As a result of this shift in the technological landscape, NHS organisations are increasingly implementing new interfaces into their existing systems to provide greater connectivity, broader functionality, and integrated data intelligence to their workforce. Moreover, the concurrent top-down clamour for data sharing across health and social care is providing a renewed catalyst for innovation now the shackles of restrictive technologies have been released.

Integration in action

The journey towards a paperless NHS, along with the drive for universal access to GP records, is helping to unlock new opportunities that, in a step-wise fashion, build on relatively-recent innovations. For instance, 10 years ago, the idea of digital dictation in healthcare settings was dismissed as futuristic wishful thinking – now it’s not only the default method for clinical correspondence in many hospitals, it’s also being used as an engine to populate EPRs and share vital information around the whole care system.

In Northern Ireland, healthcare professionals from primary and secondary care across all five healthcare trusts are able to access centralised Electronic Care Records (ECR) that give them real-time visibility of individual patients’ clinical information, irrespective of their location or care setting. The ECR integrates with local information management systems relative to services in all major disease areas. For example, in diabetes, the ECR is populated with data captured through the trusts’ diabetes information management system and automatically transmitted to the centralised record via the standard clinical correspondence processes that follow outpatient appointments. As a result, health professionals across the continuum can monitor the status of individual diabetes patients as they move along the pathway. The implications for patient care are significant – clinicians can be assured that treatment protocols are being followed in an appropriate and timely fashion, helping to accelerate and escalate intervention where necessary.

There are growing examples where effectively-linked data sets are empowering multidisciplinary teams of healthcare professionals and carers with timely access to vital information, reducing the burden on NHS resources, removing unnecessary administrative duplication, and improving the efficiency of healthcare services

Moreover, in an ageing society where the high incidence of patients with long-term conditions and co-morbidities is having a substantial impact on healthcare resources, access to integrated data sets give healthcare professionals visibility of the whole patient record, rather than just one isolated component of it. This enables them to make clinical decisions based on a full knowledge of all clinical factors such as past history, existing conditions and medication regimes. Multiple morbidities are particularly common in patients with diabetes and can lead to increased costs in treating associated complications. Through the effective sharing of data using interoperable systems, these costs can be mitigated.

Similarly in England, as the reconfiguration of local health economies continues with a steady stream of reorganisations and mergers, progressive NHS organisations are recognising the benefits of integrating and sharing data across care settings. Healthcare leaders are seizing the opportunity and collaborating with technology partners to develop new innovations that integrate data across a variety of platforms and settings. The most-pro-active have already introduced patient portals, mobile applications and clinical workflow tools that plug into existing patient information systems to provide rich and valuable informatics.

A virtual reality

The road towards integrated care has been long and winding, but despite ongoing rhetoric to the contrary, some of the long-standing roadworks that have delayed progress are finally being removed. Trusts are increasingly exploring the opportunities to link data, with many recognising that it’s an incremental journey that begins by making small steps towards a more-integrated future. A logical place to start may be to examine your existing patient information systems and establish how data stored within them could be leveraged to enhance electronic patient records. By partnering with a trusted technology partner, NHS organisations can design powerful tools that optimise existing systems to intelligently link high-value data. Such integration can help drive more productive and cost-efficient services, improve clinical workflows and deliver better patient care.

Healthcare leaders are seizing the opportunity and collaborating with technology partners to develop new innovations that integrate data across a variety of platforms and settings

Although the 2013 words of Jeremy Hunt may, at face value, still resonate today; there really is no need for GPs and hospitals to struggle to share digital records. The technology and expertise required to make change happen has advanced significantly and is helping to nurture a culture of innovation across the health service. As NHS organisations recognise the operational and patient benefits of sharing information, integrated care is no longer a distant vision – it’s already happening.

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