Woodcote Consulting Overview of interoperability challenges for the health sector Ewan Davis Independent Consultant Treasurer BCS Health Past Chair BCS PHCSG Past Chair Intellect Health Group Founder of GP system supplier AAH Meditel

Woodcote Consulting TLA and FAD AFAIK these are: Three letter acronyms (including those with more or less than 3 letters) Fatal Acronym Density – (The point at which the number of acronyms in a presentation reduces it useable information content to zero) IYBMABIWTYWTM

Woodcote Consulting Overview We have a growing demand for healthcare with constrained resources to meet it There is a hope that we can apply technology to mobilise information and knowledge to catalyse and enable transformational change it the way we deliver healthcare What this means is poorly understand, but it is a difficult and complex problem Progress so far has been disappointing Where are we? What lesson have we learnt? Where do we go next?

Woodcote Consulting Growing Demand for Healthcare Changing demographics – Aging population increasing numbers needing care fewer people to deliver and pay for it – Increasing weight of long-term conditions Increasingly capable medical technologies – Medicines – Genomics – Medical devices – New techniques and procedures Greater citizen expectations – Quality – Convenience

Woodcote Consulting The Challenge How do we to we apply technology to mobilise knowledge and information to help us meet the growing demand for healthcare with little growth in the resources available to do so?

Woodcote Consulting The Landscape Information about service availability and quality Information about patients and carers Knowledge about treatments and interventions Care Plan Informal Care NetworkFormal Care Network Care Pathways

Woodcote Consulting The Vision To engage patients and their informal care networks in their own care alongside side formal care networks to enable them to make appropriate choices taking greater responsibility for their own care To provide secure and timely access to all those concerned with the delivery of health and social care to an individual to relevant parts of that individual’s care records where and when needed irrespective of organisational boundaries. To provide workflow management and decision support tools to manage the patient’s journey along the most appropriate clinical pathway within and across organisational boundaries in a way that delivers quality care, convenient service and makes the best use of NHS resources.

Woodcote Consulting The need for Information Understanding health needs and setting priorities Prevention and public health Designing treatments, services and care pathways Targeting interventions Supporting the care process Engaging patients and informal care networks Evaluating outcomes to drive up quality All of these uses require interoperability

Woodcote Consulting Levels of interoperability Transport – Systems can reliably exchange an undefined payload that can be viewed by a human recipient (e.g. ) Semi-structured – Information has defined structure and metadata that can help get the right information to the right person at the right time in an eye-readable form (e.g HL7 CDA level 2) Semantically interoperable – Information fully structured and coded to enable reliable automated interpretation and processing (e.g OpenEHR archetypes, HL7 CDA level 3)

Woodcote Consulting Where are we now? IT an Information systems have been critical to the functioning of significant parts of the NHS for 30 years, but it has yet to result in transformational change. Health is a devolved matter so significant variation between home countries. NHS NPfIT in England has been a distraction that has delivered little that would not have happened faster and cheaper without it. UK GPs have been 99% computerised for at least 10 years with highly structured and coded records and most are now “paper- light” Hospital and community services lag behind with most having no electronic patient records, but substantial use of IT for administration and diagnostics

Woodcote Consulting Where are we now? Broadband networks in place in all home countries. England has a national Spine and a range of national services (PDS, C&B, EPS, GP2GP, SCR) Scotland has a range of national services (ECS SCI Gateway SCI Outpatients SCI Store SCI Discharge, CMS, AMS) Wales has a range of national services (IHR, Welsh Clinical Portal, Canisc) There are numerous local initiatives sharing data in local health communities (GraphNet, EMIS Web, TPP SystmOne)

Woodcote Consulting Where are we now? Patient access to GP records increasingly available Various initiatives involving Patient Portals Monolithic enterprise-wide solutions have been discredited but not entirely abandoned. Finally the hardware and technology are not material barriers Solutions based on SoA, allowing interoperability between heterogeneous systems are emerging and we have some of the infrastructure but the ecosystem is not yet sufficiently mature for rapid growth.

Woodcote Consulting Closing Thoughts Sharing information is not the same as effective communication We need to focus on the application of Health Informatics to supporting clinical processes and enabling new and better clinical processes NOT building ExRs We need to address the information and clinical governance issued exposed by greater information sharing

Woodcote Consulting Key Initiatives International – SNOMED - – HL7/HL7 CDA – OpenEHR (CEN13606www.openehr.orgwww.openehr.org – CEN 251 and ISO – IHE Home countries – ITK – Healthcare Gateway/MIG – RCP Headings Project

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Woodcote Consulting

BCS Themes Preparing for information being mission- critical to the NHS Integration and interoperability through opening up systems Patient engagement and self service