Out of the box

Eighteen months on from the launch of the interoperability toolkit, the Department of Health Informatics Directorate has opened it up to NHS.

With more than 20 products now tested and proven to work, the DH has launched a user forum to find out how the health service wants to take the ITK forward.

The first two forum meetings were held in Leeds and London in November, and they showed just how important an item this is for many trusts.

There were 97 NHS provider and commissioning organisations represented – although many of them, in turn, were there on behalf of multiple local organisations.

E-Health Insider spoke to three people who were there – and they were all were extremely positive about the meetings and the direction they set. All saw interoperability and ITK products as the key to unlocking their data in an affordable way.

Problems to solve

Angela Wood, assistant director of informatics at NHS North Yorkshire and York, outlined her priorities.

Like most primary care trusts, hers deals with a mixture of systems; half of its local GP practices use EMIS and half use TPP’s SystmOne, with community services also moving to SystmOne.

Currently, the two systems do not communicate; leaving the local NHS to enter information in one system and then again in another. This is a source of potential error, as well as being extremely inefficient.

“We need these systems to interoperate in order for the local community to work effectively,” Wood said. “As a local organisation, we do not have the ability to go to the suppliers and demand that they write the interfaces.

“It’s a national task and needs to be raised at a very much higher level than a PCT.

“My hope is that what we are doing with the ITK would enable suppliers to talk to each other.”

John Thornbury, director of Worcestershire Health ICT Services, which provides a service for three acute trusts and local primary care and community services, said it was facing similar issues.

“I work across a whole health economy and want to share information,” he said. “We have got primary care, PCT providers, mental health and – let’s not forget – social care.

“We have integrated teams across health and social care, but we do not have interoperable systems and it is not a good use of clinical resources.”

In the short term, Thornbury is looking for practical products, such as electronic discharge summaries (Worcestershire was an early pilot for ITK work in this area), order communications and clinical portals.

But longer term, he said: “My vision is to share whatever information is collected across different sectors – subject to the data protection and information governance of course.”

Godfrey Milbourn, ICT project manager at Surrey and Sussex Healthcare NHS trust, had an acute trust focus. His organisation is in the middle of a “quite ambitious” project to implement order comms and GP ordering that involves integration with its Cerner Millenium PAS.

“At the moment we are very internally focused,” Milbourn said. “But we are starting to look around and see what else we can do with the infrastructure we are developing. We need to do more with our discharge summaries, for example.”

Savings to find

For all three IT managers, the ITK approach of standardising messaging using HL7, developing products locally that match these standards, accrediting them centrally, and then making them available to other organisations has to be the way forward.

Thornbury said: “Currently, each supplier has its own version of HL7 and each supplier has bespoke interfacing and it ends up in a huge amount of work for the NHS. At the moment we are all reinventing the wheel.”

He is looking to the centre to mandate the standards and define the messages. “We have got people at trust level who can build interfaces, but we have neither the time nor the skills to define the messages. We could not afford it, either.

“The ITK means we can all share the skills [within the Technology Office] rather than employing expensive consultants.”

Wood added: “People at the two [user group] meetings were very enthusiastic. This seems to be what trusts and PCTs want. We need help because, while we can battle on alone, why do that when you can do it nationally?”

Value for money is another key reason why directors are so firmly behind the ITK, she argued. “We already have order comms and electronic discharge summaries, but we have them in a bespoke system and we have paid a premium for this.

“In future, products will be available on a value for money basis as they can be shared. This is a key area for us looking at it.”

Thornbury agreed. “Money should be going into patient care not IT systems,” he said firmly. But he is also clear that he wants a say in the business requirements.

He came away from the user forum with the clear sense that the DH has taken this on board. “The feeling from the meeting was that the DH was very much putting the emphasis back on how we, in the service, drive messaging. Directors certainly appreciated that,” he said.

Next steps

IT directors also want the centre to start banging suppliers’ heads together to get them to sign up to mandated standards.

Thornbury said: “You are going to get a continuum with suppliers. Some are working with the ITK but others have a different approach. Unfortunately, it could be losing them money in the long run.”

He strongly suspects that many so-called “bespoke interfaces” are nothing of the sort – although suppliers are charging as though they were.

“This is the big advantage of the user forum,” he said. “It will enable trusts to communicate effectively and then to put pressure on suppliers and demand ITK compliance in their products. It is down to us to make a success of it.”

Milbourn also told EHI: “I hope the future landscape will change so that the large vendors see their future in openness.”

The DH is pleased with the high level of interest in the user forum and the positive backing its members have given the ITK.

Its standards-based approach was not initially universally welcomed, but it now seems to be gaining ground. Participants at the initial ITK meetings with vendors back in 2009 describe them as “fiery”.

But Richard Haigh, ITK senior project manager at the Technology Office, says: “There are some very refreshing and consistent messages coming from the user forum.”

He sees leveraging the expertise in the Office as “critical” to the success of the ITK but adds: “The big thing we can do is to coordinate activity.”

The next steps – beyond regular quarterly meetings of the user forum – will be to set up a management group of NHS trust directors and senior project managers to decide the direction and priorities for the ITK.

Below that, there will be sub groups to share intelligence and common business requirements. And an ITK Tech Forum will bring together suppliers, standards development organisations, trust directors and DH Informatics Directorate specialists.

Haigh says: “This will be where we take initial demand from the user group and discuss how it will be put into practice.”

The Forum could well be the real powerhouse of the new arrangements, but its terms of reference and membership are yet to be decided. They will be watched with interest.

*To contact the NHS interoperability toolkit team email toolkit.enquiries@nhs.net.