Parallels in healthcare integration: from Lincolnshire to New York

Millions of people in the UK will live beyond 100 and the scale of integrated care needed to manage ageing populations is now possible, according to speakers at Joined-Up Health and Care 2016

What does Lincolnshire have in common with New York City? The answer: both represent the near future of healthcare for many millions of people throughout the world.

On opposite sides of the globe they may be, but push aside healthcare funding differences, and similarities quickly become clear.

Each of these regions is working to address the holistic needs of their populations, where high levels of complex co-morbidities are prevalent.

This was one of the highlights of InterSystems’ Joined-Up Health and Care 2016 conference, held recently at The Belfry in the Midlands.

Speakers shared a mix of stories of how different health economies are overcoming obstacles to integrate services across the full range of health and care.

The aim is to allow early and appropriate interventions, improve outcomes and patient safety, and to deliver care in a more-sustainable way for increasingly-frail populations.

New York City has achieved this integration for 16 million people, overcoming information security and privacy challenges not so dissimilar to those encountered in the UK.

By creating a fabric of trust across many stakeholders, including patients, more than 1,350 facilities now have access to information on their patients from across a full range of acute, primary care, social care, including mental health and community settings.

Tom Moore, vice president for innovation at Healthix, the publicly-funded health information exchange that is integrating this data from hundreds of health and care providers in New York City and Long Island, explained just why the organisation’s mission is so important.

He said: “We have some of the finest medical centres in the world. But we also have high levels of chronic disease, mental illness and poverty.”

Evidence of the scale of complex health issues is demonstrated by the number of people moving among different sites across the city.

Millions of patients in New York visit up to four separate care sites, with more than 120,000 patients also moving among as many as 20 different facilities across the care continuum.

“This is why it is important to link patient records from different sources together, why we are co-ordinating care, and why we are letting people see all the information about their patients,” said Moore.

Healthix has used InterSystems HealthShare to share information through interoperability standards to integrate patient information directly into the clinician’s electronic health record (EHR), where digital maturity permits.

“We have tried to design our system in a way that minimises the hassle,” said Moore.

“The system also alerts clinicians when new data has been added to Healthix from another provider, when a new event has happened, and where consent has been granted.

“Increasingly, this is sent directly to their EHR dashboard, thereby streamlining the clinician’s workflow.”

Medical professionals across New York also now receive alerts when their patients’ activity, in different parts of the care continuum, calls for immediate pro-active intervention.

“We pro-actively push information out,” said Moore.

“The clinician or facility provides a subscription of which of their patients they want us to monitor. We listen to anything of interest. If the system perceives a change, we send a notification back, either through a secure messaging centre, or directly in the clinicians’ EHR.”

With benefits around better clinical decisions, improved outcomes, reduced duplication, and better patient safety, achievements are significant. But Healthix is by no means the only pioneer in this area.

Lincolnshire is embarking on a journey that draws many parallels with its American counterpart, and which could represent the future of many health economies across the UK.

Lincolnshire Health and Care (LHAC) brings together 13 health and social care organisations in the county, including clinical commissioning groups (CCGs), acute trusts, mental health, community services, and the local authority.

We have some of the finest medical centres in the world. But we also have high levels of chronic disease, mental illness and poverty

Gary James, accountable officer at Lincolnshire East CCG, spoke at the event about how LHAC’s Care Portal Programme meant realising integration to enable preventative, co-ordinated care across the county.

And, just as in New York, the real focus is on helping people with complex health requirements.

“We have an aging population,” he told the conference.

“In my CCG area, 11% of people are 75 years or older, and 14.2% of the population live in some of the most-deprived areas in England.

“We have high levels of obesity, high levels of smoking, high levels of hypertension, and high premature mortality from coronary heart disease. There are GP practices with diabetes prevalence in excess of 15% of the population.”

Lincolnshire must carefully manage costs, too. These challenges are why LHAC has been taking action.

Linking together information has required collaboration among stakeholders, just as it has in New York, explained James.

He added: “This was a key ingredient and stakeholder engagement had been achieved with different providers, the local Healthwatch, the voluntary sector, and others.”

And the effort is about to pay off. Using InterSystems’ HealthShare, LHAC is now joining together information and agreeing standard consent models that will now improve clinical decision making and quality of care.

It will enhance patient management, through the use of portal information to alert and case manage, and it will reduce duplication and speed time to care, with projected savings of £23m over five years.

Privately funded UK healthcare is also embarking on similarly-ambitious integration programmes, the conference heard.

Nuffield Health, a not-for-profit organisation, is now creating a holistic approach to health – a common health and wellbeing record across the entire Nuffield Health network, by using the same technology embraced by Lincolnshire and New York.

The plan is to implement a standard electronic patient record across its 31 hospitals using InterSystems TrakCare, a unified health information system, and then to join-up information across other Nuffield Health sites such as its five stand-alone medical centres, 112 fitness and wellbeing gyms, 212 corporate fitness and wellbeing centres, and one diagnostic suite, according to David Liverseidge, Nuffield Health’s integrated clinical solutions director; and Jo Dickson, the organisation’s clinical informatics partner.

The project, which also has significance for transfer of care in the NHS, aims to ‘link together preventative health with hospital care,’ said Liverseidge.

Technology has now matured to the point where integration can be achieved at scale. This is about interoperability, and everything needs to be underpinned by open standards

So why are these pioneers so important as examples of what can be achieved?

Populations are changing, and the future of healthcare has to be prepared, the conference heard.

Professor Sarah Harper from the University of Oxford told the conference that although it was possible to push back the onset of frailty, longer life expectancy meant that people were maintaining that state for longer.

This is demonstrated by high-impact findings on the growing number of people in the UK who are living past 100 years.

Referencing various reports, Harper told the event: “By 2050 there will be half a million centenarians, and 1.4 million by the end of the century. 15 million people alive in the UK today will make it to living a century.”

Such a change in demographics, and the rising impact of those living longer, requires a cultural change, as well as an embracing of technological advances.

HIMSS regional director, John Rayner, spoke of a need for whole systems leadership, something that New York, Lincolnshire and Nuffield Health were all working towards.

Cultural change and the need for strong leadership were sentiments echoed by Jessica Bradshaw from Channel 3 Consulting, who urged delegates to become ‘futurologists’ to ensure intuitive technology is seen as an enabler rather than an imposed burden.

It became clear from the event that the future now requires integration at scale to cope with the needs of demographics to come.

Paul Grabscheid, InterSystems’ vice president of strategic planning, highlighted that this scale means cost per user for technology could be reduced to just pence.

Importantly, technology has significantly developed in recent years to deliver that scale, said Mark Palmer, the company’s country manager.

Reflecting on the event, he concluded: “With sustainability and transformation plans, the NHS Five Year Forward View and more, I believe there is now a vision, a clear sense of direction, that is all about joined-up health and care.

“Our customers, too, have demanded that we do more.

“Technology has now matured to the point where integration can be achieved at scale. This is about interoperability, and everything needs to be underpinned by open standards.”

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