We need a new ‘layer cake’ approach to interoperability

Providers and integrated care systems should seize the opportunity to refresh and future-proof their interoperability strategies, writes Selina Sachar from Rhapsody

The establishment of integrated care systems as statutory bodies has led to a new focus on strategies to complete the roll-out of core systems, support the introduction of virtual care and patient-facing technologies, and generate data for planning and research.

Interoperability is essential to these plans. Whether you are working on the trust side or the ICS side, there will be gaps to be filled, and the only way to fill them effectively is to have an interoperability layer to integrate new software and apps with the systems that are already in place.

At the same time, social care and the third sector is still outside the NHS network, so work needs to be done to bring them into the interoperability piece.

Interoperability layer cake

This interoperability agenda presents a significant challenge to trust and ICS IT leaders. Traditionally, interoperability has been seen as integrating one system with another, but our chief strategy officer, Drew Ivan, believes that now it’s much more complex than that.

He has visualised interoperability today as a sponge cake with multiple layers, separated by frosting. One layer will be organisational interoperability – for example, integrating data from an electronic patient record with other core systems.

Another layer will be cross-organisational interoperability – for example, integrating data from many provider systems into a shared care record. And a further layer will be patient-facing interoperability – integrating data into the wide range of digital outpatient, virtual ward, triage and advice apps that are coming on stream.

At the same time, data will also need to pass from one or more systems within each layer to others. This can mean from the EPR to a shared care record, or remote monitoring platform, or reporting solution.

Mix in different approaches and standards

This complexity is not helped by the NHS’ history of struggling to agree an interoperability approach since the collapse of the National Programme for IT and the failure to get providers across large areas of England to work with single record systems.

In each layer of the cake, IT leaders will be working with proprietary systems and with systems that are interoperable, but interoperable in different ways. Many vendors have adopted HL7 messaging standards, but they come in a number of iterations.

Some newer entrants have tried to build around the vast openEHR model, while a lot of start-ups are relying on APIs to digest and output data. It can feel as if every vendor is going down a different path; and that can make integration difficult – or at least expensive – in practice.

To make sense of all this, trusts and ICSs need to take advantage of their new opportunity to take a strategic approach. They need to seize this moment to put a robust, future-proof interoperability infrastructure in place, so they can move away from making reactive responses to new demands.

Vendor-neutral technology stack

NHS IT leaders also need to consider the technology available to them. Interoperability in the future will not be achieved with traditional integration engines that act as a hub to move data from one system to another.

Instead, trusts are going to need a vendor-neutral and innately interoperable technology stack, that can bite across the layer cake, and connect the mix of core systems and apps, developed by different vendors, at different points in time.

That stack will need to be built around an integration engine that is healthcare specific, that can be delivered flexibly as a service, in the cloud, or onsite, and meets vital cybersecurity requirements. That stack will need to be capable of handling a wide variety of technology approaches and standards – and iterations of them – and ready to provide a front-door for the integration of new digital tools.

It will also need to include identity management tools because different systems and apps often come with their own patient identifiers, which can lead to duplicate records and increase clinical risk. And it will need to come with tools to make sure records meet international standards for data capture, storage and exchange.

Big challenges

There’s no doubt that providers and ICSs have a huge job ahead of them as they tackle their remit of integrating services, delivering more personalised care, and introducing population health management.

Even so, there are reasons for optimism. The government is committed to completing the roll-out of electronic patient record and shared care record systems, but it is also investing in digitising social care; and NHS England has set ambitious targets to digitise outpatients and roll-out virtual wards.

There is also a new focus on the NHS App, and on making it a front door to healthcare services. The big picture on interoperability is positive.

Certainly, trusts and ICS IT leaders are working in a complex environment. There is a mix of interoperable systems that need to be integrated with other interoperable systems, and patient identities and data need to be carefully matched and managed. But that can be addressed with the right strategy, and the right interoperability stack.

Reasons for positivity

Over the past few decades, it has sometimes seemed as if the NHS has hoped that interoperability will be ‘solved’ by finding the right systems, or standards, or approach. However, it is becoming clear that interoperability will never be ‘solved’, because there will always be new systems, sectors and ideas to integrate with what exists already.

There needs to be a new mindset: instead of trying to ‘solve’ interoperability, we should be looking to create the right strategy, and to make sure that it is flexible enough to encompass new demands and new tools.

With the right interoperability stack in place, vendors will be able to approach the NHS with the technology it needs to meet the demands it is facing. They will have the capability to deliver the innovation that is needed. Providers and ICSs just need to make sure they have the right approach in place to let them do that.

Selina Sachar is part of Rhapsody’s UK leadership team