Interoperability, an Interview with Neil Laycock

Wed, 02/10/2013 - 21:09 -- Anonymous (not verified)

An interview with Neil Laycock, Managing Director, EMIS

Interoperability - the sharing of information between different systems – is a term rarely out of the healthcare headlines. But when it comes down to it, do we really know what true interoperability is about? Neil Laycock, Managing Director of EMIS, explains why ultimately it’s about one approach to connect all systems and not about one system to meet all needs.

This year we celebrated the 65th anniversary of the NHS. It is a tremendous milestone that deservedly put some great achievements into the spotlight.

It also sparked a frenzy of forward thinking – the most noticeable of which was Price Waterhouse Coopers’ NHS@75 report, which brought together public opinion and healthcare experts to examine what would need to change now to ensure a ‘healthy’ NHS in ten years’ time. Of the six core themes highlighted in the study, two particularly stood out – integration and open data. This confirmed what EMIS has been saying for years. The long term survival of an effective health care system depends on all systems across the health care estate being able to communicate. No more silos. No more walls. And no more need for a “single system philosophy” – a view very much aligned with the government’s GP Systems of Choice (GPSoC) framework. Safe, secure data sharing that breaks down the barriers between primary and secondary care is what’s needed, and that’s what true interoperability is about.

What about point-to-point record sharing?

This is a phrase often linked to interoperability but it’s not helpful. Point-to-point sharing of data between one GP system provider and another is useful in enabling important patient data to be shared in a limited way.

But this is not interoperability as it does not allow record sharing across all points in the health care journey.

Take, for example, an elderly patient with a long-term condition who receives community-based care, hospital treatment and continuing GP care. This is a common scenario for these patients, who make up the bulk of the NHS population.

It may benefit the patient if GPs on different systems within their locality can share specific data. But it means very little if their regular community matron who visits twice a week can’t access and update their record. There is still a break in the interoperability chain.

Unless all the links in the chain can securely add and view real-time data, information becomes rapidly outdated and clinicians ill-informed, increasing the likelihood of patients receiving less than optimum care. systems

But aren't there too many systems out there to make interoperability a reality?

We’ve found that embracing interoperability prompts health care providers to focus on the essential systems - and identify those that could become redundant when communication improves.

Similarly, looking at how to connect data more effectively highlights improvements that could be made to existing systems.

The net effect is that more people benefit from fewer systems that are fit for purpose rather than being bogged down by unnecessary system ‘baggage’.

Working in this way across the health care landscape has always been part of EMIS’ long-term strategy, and with Martin Bell now on board as Director of Community, Children and Mental Health, it’s certainly an area we’re going to focus on more with our community-based partners.

The pieces of the puzzle are now in place to make interoperability a reality on a much broader scale than ever before.

Is the MIG essential?

Whereas point-to-point sharing is exclusive, creating what is in effect a ‘walled garden’ of two GP systems, the Medical Interoperability Gateway (MIG) is entirely inclusive. It is a conduit that enables GPs to securely share real-time information with the rest of the NHS, including other community providers, and secondary and urgent care clinicians.

The implications for safer patient care are significant.

Not only are care decisions about patient treatment as informed as possible, but different care teams share data that will improve the patient’s journey through multiple care pathways. Put simply, the left hand knows what the right hand is doing. It also provides safer care because the MIG is a tried, tested and proven secure vehicle for data sharing, meeting the NHS Interoperability Toolkit (ITK) and HL7 interoperability standards.

It is difficult and time-consuming to establish separate point-to-point sharing arrangements from scratch while ensuring security robustness and scalability (something the MIG has been specifically designed to allow for) – quite apart from the points I’ve already raised about patient care.

The MIG technology lookup service also enables clinician to accurately identify the location of the current GP/community record for any patient, potentially from any system.  This gives the end user a much safer and more accurate view.

What other efficiencies can be achieved with the MIG?

The best way to answer that is to look at real life examples.

  • Clinicians at six NHS trusts in North Mersey and Cumbria using five different IT systems are able, through the MIG, to send electronic discharge information to GPs within 24 hours, when previously it took several days or even weeks.
  • Also in Cumbria, the MIG is enabling information-sharing among four different clinical systems: INPS and EMIS GP systems; Advanced Health and Care’s Adastra out of hours system, and Ascribe’s Symphony system, used by A&E departments.

The fact that clinicians across Cumbria, with patient consent, are able to view the records of over 500,000 patients is expected to reduce admissions to A&E from out of hours GPs, and also reduce the need for unnecessary repeat tests.

Is the MIG the only feasible way to achieve interoperability?

There are short and long-term answers to that.

Interoperability interfaces are time consuming and expensive to design, build, test, implement and support. It is tricky to align suppliers’ roadmaps with customers’ resource commitments. The experience of the National Programme for IT over the last few years underlines this.

Ultimately, EMIS believes that the best way to overcome this and achieve true interoperability is via open interfaces as required by GPSoC-R. But the models for this are still evolving. In the meantime the MIG technology offers the most advanced solution out there for connecting many with many, not one with one.

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