Digital Health interview: Stuart Miller

“Affordability and lack of capital” are the biggest challenges for healthcare IT suppliers in the UK who are aiming to help trusts digitise their patient records, according to Allscripts’ Stuart Miller.

“That’s what I hear, resoundingly, everywhere we go; even from trusts that ostensibly seem to be financially successful. It’s becoming a serious obstacle to trying to move business cases forward,” the company’s senior vice president – Europe tells Digital Health News.

Miller believes this may change as the next financial year approaches and government initiatives such as the ‘integration pioneers’ that are testing out new models of health and social care, and the ‘vanguard’ sites that are looking at new models of healthcare demanded by the ‘Five Year Forward View’ start to show results.

“There’s a lot of market drivers, but across our customers and prospective base, they are all struggling to be able to identify where they find capital to be able to facilitate transition costs.”

Money front and centre

While this financial situation is not unique and is evident in similar health systems such as Canada and Australia, Miller observes that in the UK “it’s definitely front and centre.”

Despite this difficult economic reality, the company is in conversation with a range of organisations depending on where they are in their digital journey.

Until recently, Allscripts has focused on supplying its Sunrise clinical system to the UK. It was therefore something of a surprise when it decided to acquire Oasis, a specialist patient administration system supplier.

However, Miller says this gives it flexibility. Allscripts is still happy to support trusts that choose to keep their PAS and add Sunrise clinical modules. Equally, it’s happy to talk to trusts that only want what has now been rebranded as the Allscripts PAS, while and implementing a different clinical system.

Unsurprisingly, he sees most action in the EPR market taking place in the North, Midlands and East of England, where contracts for systems delivered as part of the National Programme for IT are coming to an end next July.

“Probably a majority of organisations tendering or inviting to tender are in PAS replacement cycles,” Miller says. “But several have said they want to leave that alone and concentrate their very scarce resources on where they can get maximum benefit – which is deployment of clinical EPR functionality.”

Allscripts is also in discussion with current PAS users about expanding their functionality. “There are two organisations in particular that are actively working through business cases just now after evaluating demonstrations of Sunrise,” he says.

Others are evaluating how to move forward a business case because they are financially challenged.

From agnostic to believer

Allscripts has always been a PAS-agnostic company, willing to work with any PAS supplier to roll-out its Sunrise clinical modules to willing NHS trusts.

Two successful deployments at Liverpool Heart and Chest and Salford Royal NHS Foundation Trust showed the benefits of not replacing a like-for-like system and instead going for the instant wins of rolling out clinical systems.

However, as part of a push into the UK market it has bought Oasis and recently opened its European headquarters in Manchester.

Miller explains that the company previously partnered with Silverlink and Oasis for procurements and “decided to proceed with a very close relationship with Oasis”.

“The acquisition of Oasis last year gave us a piece we already had through a partnership, offering the PAS as part of an overall solution set into the UK market,” he explains. “But this gives us the opportunity to have more control over our own destiny and to ensure we were able to achieve an appropriate degree of integration between those two solutions.

Allscripts is now working on developing the PAS, including further connectivity to the NHS data Spine and enhanced referral to treatment time work flow.

“We have already significantly increased the headcount in our development team and support organisation for the PAS solution to allow us to accelerate some things,” Miller tells Digital Health News.

“Our existing customer base is small but perfectly formed, all of whom are broadly very satisfied that we have not only maintained commitments previously made, but been able to accelerate and expand some things they had been waiting for.”

Integrating care

Miller also notes a rise in activity for solutions called population health management in the US and integrated care in the UK, to allow the leveraging of information technology across the boundaries of traditional siloed organisations that deliver or commission care.

“We’ve seen a very big uptake which is quite gratifying. A year ago it was still a very early market but 12 months on it’s definitely expanding quite rapidly as people wrap their arms around what it is they need to support those ambitions,” he says.

The company’s dbMotion interoperability platform pulls information from multiple care settings into a patient-centric record that harmonises the data into a single common construct.

Miller says this allows data to be re-consumed, not only at an analytics level for population stratification and analysis, but also at the clinical level.

Semantic interoperability is different from data interoperability as while data can be brought together, if it is not in a format that can be easily associated with other data it is not very useful.

“There obviously have been long standing efforts both in the NHS and other markets to try and get much greater standardisation around particular coding,” says Miller.

“The challenge is that clinicians and social care and others don’t necessarily either have access to the tools that describe patient problems in that way or necessarily use the same nomenclatures across organisational boundaries.”

Miller believes Allscripts’ range of solutions means that if affordability and lack of capital were not so much of an issue for NHS providers, he could give “quite a rosy optimistic view” of where the company could be in a few years’ time.

“But right now a lot of organisations are saying they very much want to support clinicians in moving forward with EPR technology, but they are just stuck,” he adds.