Features: December 16th, 2016

Content management specialist SynApps Solutions’ Gary Britnell discusses the biggest problem NHS IT leaders have right now: getting computers to talk to each other.

“If I had any one piece of advice for the NHS around going digital, it’s to get interoperability right from the start. We have hospitals in the US that have great computers, but where 95% of the systems can’t talk to each other.”

The speaker is US digital health guru Robert Wachter, who Jeremy Hunt brought in to advise the Department of Health on how to better utilise digital technologies, and whose landmark review was published in September [https://www.gov.uk/government/publications/using-information-technology-to-improve-the-nhs/making-it-work-harnessing-the-power-of-health-information-technology-to-improve-care-in-england].

If there is one sentence that sums up the interoperability challenge the NHS faces as it tries to become fully digital, Dr Bob has said it there. Hospitals want to share patient data internally, as the paper chase chokes productivity. They also know that they’ll want to share that data with other providers as we move to break down the barriers between health and social care.

Many practitioners believe the best way of doing that at local level is something called the Integrated Digital Care Record, the IDCR. The challenge: unlike in the days of the National Programme for IT, there’s no central, top-down procurement route to get an IDCR: Trusts are going to have to build their own.

What will an IDCR have to look like? Information is the foundation stone of the IDCR, as it’s what will keep the structure up. But the engine that will make IDCR happen is data interchange. Trusts are going to need a safe, reliable and highly open but secure way of moving data around.

That foundation is also going to have to be data-format agnostic. A hospital Trust will be familiar with DICOM data, while a GP’s surgery may have never heard of the term. We are going to have all sorts of medical and social care data, from Excel to HTML to other formats, to manage here.

The role of CDA and MESH

There are two answers emerging (and being framed as such by stakeholders like NHS Digital), CDA and MESH. CDA is an HL7-controlled standard for working with Clinical Document Architecture (think things like discharge summaries and progress notes), so is a great way to put your output into a useful XML-based format, while MESH (message exchange service for health), which is replacing the older NHS DTS standard, is a new way to exchange health information and data.

So these seem to be great formats for producing and sending content. However, there is a lot of needed information still falling between the gaps. For example, hospitals can generate a PDF for a discharge note, for example, but then end up printing it off and posting it to a GP. That’s not really the desired result.

The heart of the matter is that not enough NHS stakeholders have appreciated the difference between coded and non-coded documents. Put simply, non-coded documents are less useful than coded (though a lot more useful than paper). With coded documents, you can add in information that health systems at the other end can pick up automatically, which gives the recipient a lot more context and useful information about the patient and the case.

What we want to do to get to the IDCR stage is to provide a way for NHS practitioners to a) more easily start using coded electronic documents that best exploit the power of the CDA standard, and b) allow them to start using the power of MESH to safely route and share such digital assets.

The potential of interoperable systems make the work worth it

The key to doing that is realising that hospitals have lots of different types of documents and data, e.g. DICOM and non-DICOM. We have to work with all these data formats to get to the kind of interoperable future NHS Digital wants us to be moving to.

What we need to offer is a way to check in all those different sorts of documents and formats into a safe place that means they can get routed out again in packages that conform to the CDA and MESH protocols. We need to be able to work with coded documents, but based on what the early IDCR pioneers are finding out, non-coded is the stepping stone we have to work with to get there.

It’s not going to be easy, and in many ways it would be a lot easier if there was one National Programme we could simply get an IDCR from. But the good news is that once we have this in place, smart documents can do all sort of great things in the NHS, such as route information without any need for re-keying or asking the patient the same questions 20 times, allow collation of data for better analysis of the bigger trends, programmatic search, and so on.

So Dr Bob is correct, we have to get interoperability right. The IDCR is the way to do that, if we approach its design at Trust and local health and social care levels in the right way. Let’s make IDCR the way NHS and its social care partners share data as soon as we can, and get the system ready for tomorrow at the same time.

The author is Head of the Healthcare Practice at synApps Solutions (/), a pioneer in the delivery of advanced content management solutions to the NHS.