Expert view: Andy Bratt

Andy Bratt

The chief executive officer of Graphnet Health examines the role of interoperability in the era of centralised systems, the need for new thinking and the opportunities presented by ‘next generation interoperability.’

In my years working for the NHS, the most common complaint that I got from clinicians was that IT was somehow separate to the care process. It wasn’t seen as a tool to deliver care.

The debate around interoperability vs centralised systems exemplifies this problem. It’s been reduced to technical arguments, instead of looking at how different ways of implementing IT can support the care process and the way healthcare organisations work.

Increasing complexity

The way healthcare is delivered, financed and measured is changing. The central system methodology is the foundation stone for transforming NHS IT. Yet the increasingly complex context of care delivery, with its diverse care delivery channels, integration with social services and focus on patient involvement, demands new ways of thinking that integrate with both national and local systems.

In the modern NHS, there are just too many systems that need to be integrated – from clinical to financial and HR – for the central system approach to provide the complete answer.

Mainstream technology

The need for interoperability is clear. Yet until recently it was seen as a crude way of sending messages between different systems; at best shuffling data point-to-point overnight between monolithic applications.

True interoperability was held back by a lack of common standards. Interoperability technology found it difficult to adhere to multiple messaging structures and give them a common look and feel. This often meant that the value of information to healthcare professionals was lost in translation.

However, interoperability technology has evolved. Today’s ‘next generation interoperability’ is based on common standards, collaboration between the NHS and technology vendors and clear business and clinical requirements.

The National Programme for IT in the NHS has played a crucial role in evolving interoperability and making it ‘fit for purpose’. Next generation interoperability is being facilitated, at least in part, by the common HL7 messages being developed by NPfIT and utilised by application vendors.

We are now seeing cutting-edge XML and web-based technologies adopted by mainstream technology providers. This is driving forward interoperability, so that the technology can now match the business and clinical need.

Next generation interoperability is like a ‘Rosetta Stone’ that sits at the centre of disparate applications. Each application might be developed using a different standard, but applications can now have a common layer that enables them to talk the same language.

Breaking down barriers

Technically, interoperability works. It’s well proven and we’re now seeing co-operation between suppliers. But that doesn’t mean that interoperability projects always work. The biggest barriers to interoperability are the so-called ‘soft issues’ around data sharing, confidentiality and consent.

At its heart, interoperability is about joining up information between organisations; however this is a relatively new way of working for the NHS. If projects are entered into without a common understanding of what data is being shared, why and by whom, it is difficult for an initiative to get off the ground.

Different organisations have different objectives, priorities, barriers and timescales. These need to be brought out into the open at the outset of a project.

Equally important is putting together the right project team. Projects don’t tend to fail because of technology or lack of funding. They fail because they don’t take into account what front-line staff need.

If project teams are comprised of technical people, rather than the consultants, nurses and community workers dealing directly with patients, it’s difficult to design a system that meets the real resource, service and care delivery needs of an organisation.

For interoperability projects to work, the scope, design and implementation needs to be based on real collaborative partnership between all stakeholders – both NHS and supplier. An incremental approach delivers a low-risk and quick-win environment for all stakeholders.

Interoperability in practice

We are already seeing NHS organisations harness next generation interoperability to facilitate joined-up, patient-centric care. In Hampshire, my own company, Graphnet, has implemented a comprehensive shared care record.

The solution aggregates XML-based patient data from multiple disparate sources, including GPs, secondary care, social services and community care. This data is accessible by all authorised users.

The record provides an essential tool for managing patients whose care is spread across multiple organisations. It also forms the cornerstone of the Common Assessment Framework (CAF) which enables multi-disciplinary care teams to identify and work with specific groups.

The ongoing development, driven by the clinical community, has lead to a functional community system that allows data to be collected and in turn enhance the existing record.

At Heart of Birmingham Teaching Primary Care Trust, shared care records are being delivered for long-term conditions to enhance patient safety, and are also playing an important role in the PCT’s 2010 strategy to deliver care outside of acute hospitals. Here, IT is being utilised as a tool to meet clinical and business drivers.

Care across clinical boundaries

These examples show that when interoperability works, both technically and culturally, it enables integrated care that transcends clinical boundaries, seamlessly following the patient/service user journey. It provides access to a full patient centric record by the right health and social care professionals at the point of care.

NHS regions are already benefiting from interoperability, but now we’re also beginning to see how interoperability can add value to the centralised systems delivered by NPfIT.

For example, in March 2009 South Staffordshire and Shropshire Healthcare NHS Foundation Trust went live with a hybrid system that migrated its original PiMS system into two independent systems: the Graphnet Hybrid EPR for clinical information and reporting and the NPfIT Reference Solution IPM for administrative information and reporting.

A Virtuous Circle

Next generation interoperability is about creating a ‘virtuous circle’ in the local health economy, where rich clinical and business information is re-used in diverse clinical and management contexts.

It is not just a buzzword. It is a tried and proven practical way of supporting the care process, improving patient safety and increasing efficiency across health ecosystems. Successful examples of shared care systems such as South Staffordshire, Hampshire and Birmingham, amongst many others, demonstrate the benefits that interoperability now offers the NHS and its patients.

About the author: Andy Bratt worked in the NHS for 18 years in a variety of IT and information management positions. Prior to joining Graphnet Health as CEO in 2006, he was deputy chief information officer at Staffordshire Strategic Health Authority and before that head of IT at Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust.