Delivery of care is currently fragmented, so there is a lot of energy being put into supporting greater integration. The aim is to reduce the fragmentation, increase quality, reduce duplication, improve efficiency and hopefully reduce costs.
The local health economy is increasingly seen as the right size unit for collaboration to work. Although the exact size of the unit will vary across England, a local health economy will consist of the local acute trusts, community providers, mental health providers, GPs and clinical commissioning groups. Social services also form an important part, along with voluntary and community organisations.
There will be overlaps between local health economies (particularly in large cities such as London) and it is important to consider how information will flow between them, but it is likely that in the region of 80% of patient flows will be within the local health economy.
What that means is that making connections between local organisations is an increasingly important part of the chief clinical information officer role. In this chapter, we explore how such relationships can be built.
What is needed
For information to be shared across a local health and care economy, it is necessary to have:
- Technical capability
- Adoption of agreed standards
- Funding
- Clinical buy-in
- Consistent consent and data sharing models
- Appropriate governance
- Effective patient engagement
- Appropriate communications to both patients and those working within the local economy
The CCIO is important in supporting the development of all of this. He or she is also crucial in forming and maintaining a local network of collaboration, as the CCIO can bring together the different players across the system, particularly across the clinical, IT and managerial axis.
The benefits of collaboration at this level are that it that will allow a shared understanding of what are often difficult issues, particularly around the common challenge of clinical engagement.
Where to start
It is often challenging to decide where to begin on the journey to building local relationships, as most people who need to be involved are often under significant time pressure. There needs to be engagement across multiple levels within organisations. This will involve:
- Ensuring the senior management team are aware and supportive
- Linking the IT directors in each organisation to ensure that planned development support the interoperability agenda
- Ensuring clinical teams, particularly those already working in an integrated environment, are engaged and given the opportunity to contribute. Collaboration requires trust which is built on mutual respect.
There are likely to be high level senior groups already in existence across the local economy and these should be made aware of the work and asked for their support.
Finding funding
Building local connections and integration is likely to involve several different pieces of work that fit together like a jigsaw, but are discrete in their own way. They are likely to link to potential funding sources and projects that may be underway.
It is important to identify high profile projects that could act as a driver for change and require integration such as the Prime Minister’s Challenge Fund, vanguard sites supporting the ‘Five Year Forward View’, and integrated care pioneer sites.
The concept of several different projects working towards the same goal is important as it allows the programme to be delivered in manageable chunks. It should also support engagement, particularly with clinicians if there are some high profile, quick wins.
Engaging IT
Engagement with IT teams is essential. It will help establish agreement on direction of travel across the area, ensuring that any developments and investment are guided towards supporting the desired outcomes.
It is important to remember that complex technical solutions may be required, but these need to be kept as simple as possible for the end users. One challenge is ensuring there is a balance between security and usability, so that a technically perfect and secure IT system does not put too many obstacles in the way of clinicians using the system.
Engaging clinicians
Clinical engagement is an important area in building links in a local health economy. It may be that the CCIO can link into existing teams and work with them to understand the clinical outcomes they would require from any local system. This ensures that these requirements help inform technical solutions rather than the technical solutions limiting the vision from the outset.
Negotiation may be required to bring together the vision with the current technical constraint. This will allow the discussions to focus on the gap between vision and current reality.
In this way, plans can be put in place to bridge the gap in the future, expectations managed, and a clear timeframe put in place along with funding requirements. Identifying potential clinical leaders is a great way of improving support and getting the message to other clinicians and the rest of the organisation.
Engaging CCGs
In the current environment, it is important to engage with CCGs. These organisations will be commissioning integrated services from providers and are increasingly interested in understanding quality metrics collected across care pathways.
Aligning commissioning intentions, funding and incentive across the system will help to dictate direction of travel and create a sense of urgency around the change. The risk however is that if this is not fully aligned it may divert attention and change the direction of travel to gain short term advantage at the cost of the longer term strategic vision.
Engaging suppliers
Collaboration with suppliers is an area which can offer significant rewards. Groups of organisations can support suppliers in developing new functionality or enhancing existing functionality. There may also be a cost to this, however, since it will be necessary to find expertise within the organisation to support such developments.
It is worth noting that there is also growing use of open source within healthcare, which again requires collaborations between several different individuals – often moving beyond local boundaries.
Building connections between local and national initiatives
If care is fragmented across the NHS, then so too is IT and informatics support. IT development is currently occurring at four different levels:
- Within individual organisations
- Across local health economies
- Across NHS regions, which include formal areas supporting collaboration such as academic health science networks
- At a national level by organisations including NHS England and the Health and Social Care Information Centre.
There is often a perception (and probable reality) that these levels are not linked together. National projects often take several years to become reality due to their complexity and need to engage very widely. Local initiatives are often more agile and if there are good relationships across the area, they can reach agreement on complex issues in a reasonably quick timeframe.
One important area of collaboration is looking at how we can bridge the gap between these domains. The challenge is to provide a mutually supportive environment where the national teams work closely with local teams to understand requirements. In turn, local teams are able to test ideas and communicate their vision to the national team. Local clinical engagement is particularly important in this regard.
Local development also needs to have a view of the national direction of travel so they can plan to join up in the future.
Conclusion
Informatics and IT will be key enablers in delivering more integrated health and social care. That in turn means that CCIOs will find that building relationships across local health economies is an increasingly important part of their role.
About the author: Dr Phil Koczan is chief clinical information officer for the academic health science network UCLPartners, and for North East London NHS Foundation Trust. He also works part time as a GP.