Thursday, November 18, 2010

A Very Interesting Move Forward in UK Health IT Standards.

The following article appeared a few days ago

If I had a hammer...

When the interoperability toolkit was launched 18 months ago, there was excited talk about it being the new way forward for healthcare IT in England. The project has just delivered its first tools. But it is far from clear whether they will be used to crack big problems or small ones. Daloni Carlisle reports.

A few years ago, teenage boys used their thumbs for flicking Subbuteo figures. SMS texting had just got going; and you could text only to someone on the same network.

Then shared standards came along. Teenagers’ thumbs found a new use as users started to text network-to-network; and some people made a lot of money.

According to Sean Riddell, chief executive of EMIS, NHS IT is on the brink of a similar breakthrough. The widespread adoption of interoperability standards, developed through the Department of Health’s interoperability toolkit, could take it into the equivalent of the texting era by enabling systems to share information in real time, he says.

A new way forward

Mike Fuller, European marketing director of InterSystems, also thinks that ITK is a fundamental technical shift.

“It’s a configuration service, a way of using standards for governance and technical web services,” he says. “It’s more sustainable because you take each new use and pass it on. It’s like moving to a situation where everyone has 13 amp plugs.”

This is the sort of green shoots vision that might appeal to Paul Jones, head of the Department of Health’s Technology Office.

In a recent interview with E-Health Insider, he said that 20 ITK services have now been tested and work is underway on several more.

The idea is to create a library of standard interfaces, each relating to specific business processes or service; such as sending a discharge summary or installing a patient check-in kiosk. Each will be accredited by the DH and available for re-use by any NHS trust.

Jones was upbeat about suppliers’ willingness to get involved despite a business model that, at first sight, limits their revenues.

Rather than demanding £70,000 a pop for a bespoke integration solution for at trust, they would be able to command four-figure sums for accredited services that are used on a repeat basis, he said.

Questions about money

But who is paying for this? At the moment it appears to be suppliers – and, in particular, some of the smaller suppliers that were frozen out of the National Programme for IT in the NHS in its early days.

Adam Towler, director of Bluewire Technologies, describes some of the early meetings between NHS Connecting for Health and suppliers that were hosted by Intellect when ITK was announced in April 2009.

“These workshops were the first time that CfH had really engaged with small suppliers,” he says. “It was very fiery, with people saying they had been trying to do this for ages but had not been able to.

“One of the fundamental questions asked – and dodged – was where the money was coming from. Would they allow any of the [local service provider] contract money to come to smaller suppliers for these developments? This still has not really been answered.”

Nevertheless, Bluewire Technologies and its partner SRC have invested in developing services that are now ITK accredited. For example, they have worked on e-discharge summary solutions, and are on the brink of rolling them out into live situations.

It’s a similar story for EMIS and INPS, which together provide 75% of primary care IT systems. This summer they set up Healthcare Gateway Ltd to develop and market a medical interoperability gateway – or MIG – to facilitate sharing of information between healthcare providers.

The MIG had been on the cards for some time, but was spurred on by the ITK. It can be used to view care records, including chronic disease records, medication records and child health information, and to exchange clinical documents such as discharge summaries.

It is already ITK accredited and is now being implemented on the ground. Current projects include transmitting discharge summaries, allowing hospital clinicians to request detailed medication histories from GP practices and allowing out of hours primary care providers to access patients’ GP electronic record.

Peter Anderson, commercial director at Healthcare Gateway Ltd, believes the business case at trust level for demanding ITK-accredited services extends to more than just the saving in licenses.

“We are working with one trust that currently generates about one million clinical documents a year at an average cost of 50p per document – and that does not include the costs at the GP surgery of scanning letters and managing them,” he says.

“If we can deliver something that captures information and files it directly into the GP workflow system, then we have a business case.”

But, says Riddell, not everybody is on board. “Unfortunately, in the healthcare industry there are still commercial organisations who believe that it is commercially advantageous not to share information but to lock it down. I won’t say who; everybody knows who they are.”

More is found here:

The initial plan for the ITK was discussed in an earlier article.

Interoperability Tookit update

The NHS has been promised an interoperability toolkit to get good, local ideas working with existing and national programme systems. Daloni Carlisle gets an update on its progress.

In April last year, Christine Connelly, the NHS’ director general of informatics, promised that an ‘app store’ style toolkit would be developed for the health service.

Connelly said that while the “core aims” of the National Programme for IT in the NHS would be retained, the toolkit was needed to “allow new products to be developed locally, accredited centrally and linked to existing deployments of information systems such as Cerner and Lorenzo.”

In other words, the toolkit was to provide more local flexibility, and to encourage trusts to learn from and spread innovation between each other.

From app store to toolkit

CfH has since been working on the Interoperability Toolkit, developing a set of standards and frameworks for interoperability covering transactional and analytical services.

Paul Jones, chief technology officer, says: “The intention of this toolkit is to release the data stored in many of our applications so it can be used in new ways and combined with other data items. The possibilities that this provides are very wide and our initial pilots are about proving the concept – it will be staff working on the frontline who will generate the best ideas for using this data and supporting patient care.”

The early applications to prove the ideas include:

  • The simple integration of text message appointment reminders to help reduce 'did not attend’ rates into a system that does not provide this function as standard;
  • A simple and standardised integration of self-service kiosks into a patient administration system;
  • An electronic whiteboard integrated into patient administration systems to allow vital information to be recorded in a clinically intuitive way (by writing on a board), but then captured and sent to the PAS.

Jones adds: “The range of future applications is almost unlimited and this is where the real value of the toolkit emerges. The toolkit is a technological innovation that will enable further innovation to flourish.

“Although there is no shortage of innovative technological solutions to real clinical and administrative problems, without the standards and frameworks to ensure their interoperability, these solutions risk either not being taken up in service, or becoming prohibitively expensive because they require bespoke interfaces for deployment within the existing NHS estate.”

The is more information from this article here:

You can read press releases from two major players here:

and here:

The Intersystem release summarises nicely just what all this is about.

“The Toolkit specification, created by the Technology Office, is a set of technical and governance standards and frameworks for interoperability. It covers transactional and analytical services aimed at accelerating the pace of delivery and is in line with the Department of Health’s strategy to ‘connect all’ rather than ‘replace all’, as outlined in the recent White Paper, ‘Equity & Excellence: Liberating the NHS’.”

There is more official documentation available here.

With all the work and progress seemingly being had in the UK I find it odd that the most recent NEHTA document on interoperability is over 16 months old and the fact sheet - presumably current - dates from 2006.

Here we have the UK NHS proceeding with using HL7 V2.4 to enhance interoperability and information flows and NEHTA is wittering on about the HL7 Congress in January 2011. It seems to me the interoperability team have - at the very least - been keeping their work a bit of a secret.

Given HL7, Intersystems and Orion are all major players in Australia why have we not see more from NEHTA explaining what they are learning from the UK and from these parties and how it might maybe assist here.

I suppose it just another case of “hiding their light under a bushel” It is worth noting the most recent Interoperability Framework (V2) is dated September 2007, so clearly not a frequently updated area - or maybe it was already perfect?

I have to say I am conceptually keen on the idea of ‘connect all’ rather than ‘replace all’ and really would be keen to see that objective as a broad priority as I know it is with many other groups around the world (IHE for example who are working with NEHTA SMD to get some convergence - better late than never I guess).

Maybe the upcoming Summit could offer expert advice on how to move this area forward!


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