Collaboration, collaboration, collaboration: How to deliver a digital NHS | Shaun O’Hanlon

Dr Shaun O’Hanlon

We need to break down the old barriers to deliver new digital services, writes health tech chief medical officer Shaun O’Hanlon.

2016 will go down as the year that STPs – sustainability and transformation plans (STPs) – were everywhere, even making front page tabloid news as the media interrogated the bold plans to transform health and social care.

At the heart of the STP process is the need to deliver ‘place-based’ planning of services – taking a big picture view across the whole of health and social care, and across large local populations. This requires a level of collaboration not seen before, as service planners and providers in the NHS and local authorities come together to predict and respond to local needs.

There’s a similar revolution happening in the healthcare technology community. Digital services are a key part of the new care models that are needed to take the NHS into the future; they will play a central role in a more integrated infrastructure of care. 

And just as with the STPs themselves, these new digital services require very different ways of working and a far more collaborative approach.

The watchword for technology is interoperability – joining up information and systems to support truly integrated care. 

In November, NHS Digital director of digital transformation, Beverly Bryant, sent a shot across the bows of the healthcare IT community. Progress in joining up systems had been too slow, she said, in particular the delivery of Open APIs (open application programme interfaces), a mechanism for connecting third party software to established systems. 

As a representative of the healthcare supplier community, I’d like to respond to that – and in so doing to highlight both the opportunities and the challenges that this new era of collaborative working holds for NHS IT.

Open standards will encourage innovation
Firstly, I think it’s important to say that there is a great deal of excitement among suppliers and our customers about the move towards shared standards within NHS IT. 

The Department of Health’s commitment to Open APIs as a central plank of its technology strategy is a game-changer. By removing the barriers to information-sharing, it will encourage innovation in every quarter, from start-ups to established suppliers and indeed clinical teams. Adopting shared standards will also mean clever ideas can be implemented more quickly and easily – delivering quicker benefits for patients and making the NHS more efficient.

A great deal of good work is already happening on the ground.  

In September last year, the industry body Tech UK launched its Interoperability Charter – a public statement of commitment to collaborative and open working from the supplier community. More than 100 organisations have now signed the charter, including my own company. 

Another key initiative is the INTEROpen collaborative – a group of individuals, organisations and health and care providers who have put commercial interests aside to work together to make open standards a success.  Its focus is very much on the practicalities of delivering joined-up care – running conferences, workshops and projects that encourage collaborative problem-solving and practical solutions. 

Individual suppliers are also progressing their own initiatives – including direct data-sharing with competitors and opening up their core systems to shared standards. 

More than record-sharing
This is strong evidence that the new era of collaborative working is well underway. 

But it’s important to realise that interoperability is about more than simply sharing patient records. It’s about serving up the right information to the right person as they are seeing a patient, and then enabling them to pass on the right information to ensure a seamless handover of care to the next professional on the patient’s journey.  

For example, how does an out-of-hours service alert a district nurse that a patient who was seen last night needs their blood pressure to be taken this morning? This is about more than simply sending a technical message from A to B. What’s needed is a meaningful flow of information – embedding it in the clinician’s workflow so it becomes a natural part of how they do their job, not an unnecessary add-on (for example, a text or an email that may be lost or ignored).

For me, this is the real challenge of delivering integrated care, and it requires a very different approach to how technology is designed and used.

New ways of collaborating
In this new era of place-based planning, developing the right information systems is no single organisation’s responsibility. The NHS and local authority teams, the third sector, existing and new suppliers, and managers all need to collaborate and to share the baton. 

Users also have a critical role to play; the best and the most successful systems will be those that simply ‘do the job’ for the user, and are easy and intuitive to use. Involving users from the start, and developing and shaping systems with them as we go along will be crucial for all suppliers.

A great example of this new way of collaborating is the groundbreaking work that is currently underway in east London to improve the health and care of a population that has some of the lowest life expectancy rates in England as part of the discovery project.

Here, the east London commissioners are working with two major IT suppliers and a third sector healthcare technology platform to gain greater insight into local population health and improve preventative care. 

The ambitious project will bring together data from primary, community and secondary care systems into a central hub which is then used to create a ‘learning health system’ that is focused on improving population outcomes as well as providing high quality care to the individual. 

For it to succeed, the disparate partners have had to forget what makes them different and instead maintain a laser-sharp focus on the common goal – improving the health of the local population. It’s about making it happen, not commercial agreements.

Looking ahead
For me, it is clear that these types of partnerships are the future for NHS digital services. Partners from across the spectrum of health and social care – and the private and third sectors – will need to come together to deliver innovation and change. While it will certainly bring challenges, it is invigorating and exciting. 

In 16 years of working at EMIS Health (my company), I have witnessed the unravelling of numerous large-scale IT projects that clinicians warned would fail, because patients and their complex, human needs as they moved through the care system were not considered at the planning stage. 

If STPs are to achieve anything, the technology has to fit round the patients as East London is showing – and we really cannot afford to get it wrong this time. 

Dr Shaun O’Hanlon is chief medical officer at EMIS Group. Follow him and the organisation on Twitter @drshaun @EMISGroup

EMIS Group is an NHS Confederation associate. Find out more about our associates programme and how you can get involved.

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