How interoperability will be vital across ICSs

The aim of integrated care systems (ICSs) is to bring together the healthcare operations within an area to consolidate and improve the patient experience and outcomes. This, clearly, is a major undertaking, bringing disparate facets of the healthcare industry together in order to improve services. The aim is a simple one; achieving it will require a lot of hard work and common understanding. This blog takes a closer look at how interoperability – of systems, staff and functions – will support ICSs in achieving their intended aims.

The NHS Long Term Plan states that, “ICSs bring together local organisations in a pragmatic and practical way to deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care. They will have a key role in working with Local Authorities at ‘place’ level, and through ICSs, commissioners will make shared decisions with providers on population health, service redesign and Long Term Plan implementation.”

In order for ICSs to achieve this, the use of technology within them needs to be well thought out. Whilst it’s not essential that every facet of an ICS is using the same technology provider, it will be essential that the technology they each use is capable of being interoperable with the other systems deployed across the ICS.

What is interoperability?

Starting with the basic question, this is something that NHS England has outlined in its vision of creating more efficient and effective healthcare solutions: “With new models of care emerging and evolving, there is a clear need for more effective information sharing between care settings, organisations and geographies, as well as between professionals and citizens, to optimise patient outcomes and quality of care. This is reliant on the ability of IT systems across health and care to be interoperable with one another and is key to the delivery of the future vision of care in England.”

How can interoperability be achieved?

This is reliant upon the technology ecosystem within an ICS. It is not reliant upon everyone using the same system, rather that everyone is using a system that can be integrated with the other systems being used across an ICS. Most modern systems operate with an application programming interface (API), meaning that they can be configured to send and receive data from other systems according to the specific rules required around data sharing. A basic of example of this is being able to use your Facebook login details to login to other services – your data is shared between Facebook and the other service, meaning that you don’t have to spend time registering and inputting details.

Data can either be sent to a central data repository, to then be appropriately managed by other facets of the ICS, or direct system-to-system integrations can be established. The former provides a central view of all activities, whereas the latter establishes real-time data sharing between two or more entities directly.

It sounds simple in theory, but interoperability is only as good as the technology supporting it.

Siloed data

ICSs aim to break down data siloes. For example, if a patient has visited their GP and the GP surgery has no means of sharing this data with any other point of healthcare provision that the patient might interact with, then that data is useful to that GP surgery and that GP surgery only.

This works to the detriment of the patient’s healthcare experience, since they will have to duplicate their effort in explaining any problems to the next service, whilst that service will have no oversight of the issues faced by the patient. This is an extreme example and doesn’t exist in practice, thankfully, but serves to highlight the issues with data becoming siloed within specific sections of the healthcare service.

Away from frontline NHS services such as GPs and hospitals, however, there are significant hurdles to interoperability across all ICS activities. The National Care Forum (NCF) notes that, “The government aims to have shared care records in place for everyone by 2024. Only 40% of social care providers have fully digitised records and there is no detailed plan to bridge that gap.”

How can the 60% of social care providers that are reliant upon pen, paper and filing cabinets for recording patient activities share this information with other facets of the ICS within which they operate?

Interoperability is only as good as the technology supporting it

This presents a significant issue in achieving interoperability across an ICS. Manual records cannot be shared into a data repository nor directly with another provider. The data in these social care providers is siloed and inaccessible outside of the individual organisation. It is, therefore, unknown to other healthcare providers and hampers progress towards achieving the goals of ICSs.

It’s not all bad news, though. There is an opportunity for social care providers to be guided as to how best to implement technology for both themselves and the wider ICS. It is also possible for them to leverage the technological investment of others.

Budgets are always a hot topic of conversation. With an impending cost of living crisis looming, soaring energy bills and no clear direction coming from government, it is unlikely that social care providers currently operating without technology systems to record patient care and activities will suddenly find the cash down the back of the sofa to fund it.

It’s also unlikely that this will be top of their priority list, especially as “there is no detailed plan to bridge that gap.”

The ability to open up technology systems internally will help. If licences from a system already invested in within an ICS can be made available elsewhere, this will help to not only implement the requisite interoperability, but also to manage costs more efficiently and effectively.

This will then help those facets of an ICS such as social care providers who are not currently utilising technology, and are therefore holding siloed data, to open their data up to the benefit of the ICS. It will also help them in realising efficiencies across their own processes – removing the reliance on manual methods of recording data will facilitate staff being able to focus more of their time on patient care.

Conclusion

Interoperability will open the door to delivering the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care. It will be the bedrock of the interaction between them, enabling data to be shared seamlessly for the benefit of the health service and its patients.

There are many health specific technology solutions available to the market, so working with providers that support interoperability is crucial for each facet of an ICS. Understanding how your data can be shared and working with your provider(s) on this will help in meeting the central aims of an ICS.

Most modern solutions will support interoperability, but it’s crucial that they can work and integrate with multiple solutions. It’s inconceivable that every facet of an ICS would be using the same technology solution, so this point is paramount. Working with the technology that’s the best fit for your area of the ICS, whilst at the same time making the data that you generate available to the other areas of the ICS that need it to enhance their services, is the fundamental aim.

We explore the subject of interoperability, as well as a number of other areas where technology will play a fundamental role in the success of ICSs in our recent white paper, Integrated care systems and the role of technology to support patients across the UK. You can download your free copy here.