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Leaving isolation behind – why interoperability is vital to health and social care

Keith Naylor, head of implementation – transfer of care at the Health and Social Care Information Centre (HSCIC), discusses the interoperability challenges in the health and social care sector.

Welcome to ‘Isolation International’, where beyond the check-in desk a flight beckons to sunnier climes. But there’s a problem. You booked with a travel company whose IT systems only connect with certain airports – and this isn’t one of them. So you hand over your debit card, but you can’t type in your pin because the keypad works with a limited set of characters. They don’t include yours. You head for the cash machine, operated by an organisation you don’t bank with, and it can’t process your transaction. Time to phone for a taxi home. But your mobile can’t connect to this particular network and, even if it did, the operator doesn’t speak your language. 

Welcome to glorious Isolation where – in electronic terms at least – you don’t exist. 

This scenario may seem entirely fictitious but in many respects this is the stark reality of health and social care interoperability. The idea of a wealth of information being electronically at the fingertips of clinicians and patients in a variety of care settings, across the length and breadth of the land, is currently more flight of fancy than fact. 

The Health and Social Care Information Centre (HSCIC) is working in collaboration with NHS England to change this.

NHS leaders have set out a vision to change the way the NHS operates by 2020. Central to this is an ambition to radically improve the connectivity and accessibility of health and social care systems for patients and clinicians, to improve direct care and empower patient choice. 

To do this, we must develop a way to best connect the variety of primary, secondary and social care systems that operate within the confines of relatively parochial boundaries, and work to standardise the information that flows through these connections so that it can be universally understood. 

While a patient’s salient medical details, from test results and medications to referrals and family history, will usually be available at the point of origin (such as a GP practice), the likelihood of this information being available electronically if required at another care setting – such as a hospital 50 miles away, let alone further afield – is more remote. Add into the mix the idea of a medical record transferring between a myriad of care settings using exactly the same descriptors and definitions, even within a relatively small geography, and the odds become longer still. 

I vividly recall a comment from one clinician who said:  “It is hard to imagine the paucity of data with which hospital clinicians sometimes have to work. In extreme circumstances:  no notes, no old letters, no blood results, no list of medications – just a patient who says ‘I’m not sure why I’m here.’” 

We are not starting from scratch 

There are a number of existing systems and data flows that demonstrate the power of interoperability and of underpinning standards. 

The NHS Spine, run in-house by the HSCIC, is effectively the electronic engine room of the health service, powering 24/7 connectivity across the whole country. Handling more than 400 million electronic messages a month, it securely connects more than 20,000 care organisations, from large urban hospitals to small rural GP surgeries, with national systems and services. 

One such service is the Summary Care Record (SCR), a copy of key clinical information from a patient’s GP record to support their direct care.  Managed by the HSCIC, the SCR can be securely accessed by authorised health professionals in settings like GP surgeries and hospitals. This means if my GP is in Leeds but I had an accident in Liverpool and end up in A&E, the doctors on the other side of the Pennines can access my SCR and note, for example, I am allergic to Penicillin. 

Every 10 seconds, a health professional somewhere in the country will use the Spine to access a SCR to care for a patient. This is a powerful example of how interoperability can make an enormous difference to an individual’s care and indeed to the clinician, who can save precious time by accessing the information they need in a recognisable, consistent format at the click of a button. 

But the enormity of the health and care sector, the breadth of systems and the sheer scale of information, much of it paper-based, means there is much more to do. Equally, this is a massive opportunity to support improved use of time and money. 

The HSCIC is taking forward a number of interoperability projects that will have a large and sustained impact, with the electronic 24-hour discharge summary being one of them. All trusts in England are in the process of implementing electronic discharge summaries, which are sent from the acute team to the GP within 24 hours of a patient being discharged. 

Statistics published by the HSCIC tell us that in England every year, hospitals create more than 16 million discharge summaries for patients in receipt of NHS treatment. Many of these summaries, which are destined for a patient’s GP practice to support their ongoing care, are paper-based and dispatched by post. They do not typically follow a set format, which means the way a medical condition and required care are articulated in print can vary not only between one hospital and another, but between clinical departments in the same building. 

The impact of this cannot be underestimated. A five-minute reduction in the manual handling of each discharge summary means the NHS could potentially save £50m every year. 

To further this work, HSCIC is consulting with organisations to understand the impact of adopting the recommended Academy of Medical Royal Colleges headings within their discharge summaries.  

This is only the beginning 

If you consider that discharge summaries represent just 15% of the documents produced by hospitals, GPs and in social care, the opportunity to build towards further efficiency is clear. 

HSCIC is also supporting the NHS to adopt one universal method of clinical coding by 2020. Two systems currently exist, which means a marked inconsistency in the way a clinical condition or treatment is recorded (coded) by a clinician.

For instance, a hip operation might be coded on one GP system as X, but on the other as Y. The issue of easy interpretation in another care setting is obvious. We are providing support to primary care providers so that by the end of 2016 they are all using one system – known as SNOMED Clinical Terms. Similarly, we are supporting all secondary care providers to make the move by 2020. 

Information and technology is not just a minor player in the efforts to improve care and save the health and care sector precious resource. It has a lead role. With simple changes, from the way a humble blood test is recorded by clinics nationwide to how a major system is configured by every single trust, we can remove the blockers to electronic information becoming a powerful force universally. 

Although there is still much to do to achieve this ambition, we are certainly on the journey away from glorious Isolation.

Every 10 seconds, a health professional somewhere in the country will use the Spine to access a SCR to care for a patient. This is a powerful example of how interoperability can make an enormous difference to an individual’s care and indeed to the clinician, who can save precious time by accessing the information they need in a recognisable, consistent format at the click of a button. 

But the enormity of the health and care sector, the breadth of systems and the sheer scale of information, much of it paper-based, means there is much more to do. Equally, this is a massive opportunity to support improved use of time and money. 

The HSCIC is taking forward a number of interoperability projects that will have a large and sustained impact, with the electronic 24-hour discharge summary being one of them. All trusts in England are in the process of implementing electronic discharge summaries, which are sent from the acute team to the GP within 24 hours of a patient being discharged. 

Statistics published by the HSCIC tell us that in England every year, hospitals create more than 16 million discharge summaries for patients in receipt of NHS treatment. Many of these summaries, which are destined for a patient’s GP practice to support their ongoing care, are paper-based and dispatched by post. They do not typically follow a set format, which means the way a medical condition and required care are articulated in print can vary not only between one hospital and another, but between clinical departments in the same building. 

The impact of this cannot be underestimated. A five-minute reduction in the manual handling of each discharge summary means the NHS could potentially save £50m every year. 

To further this work, HSCIC is consulting with organisations to understand the impact of adopting the recommended Academy of Medical Royal Colleges headings within their discharge summaries.  

This is only the beginning 

If you consider that discharge summaries represent just 15% of the documents produced by hospitals, GPs and in social care, the opportunity to build towards further efficiency is clear. 

HSCIC is also supporting the NHS to adopt one universal method of clinical coding by 2020. Two systems currently exist, which means a marked inconsistency in the way a clinical condition or treatment is recorded (coded) by a clinician.

For instance, a hip operation might be coded on one GP system as X, but on the other as Y. The issue of easy interpretation in another care setting is obvious. We are providing support to primary care providers so that by the end of 2016 they are all using one system – known as SNOMED Clinical Terms. Similarly, we are supporting all secondary care providers to make the move by 2020. 

Information and technology is not just a minor player in the efforts to improve care and save the health and care sector precious resource. It has a lead role. With simple changes, from the way a humble blood test is recorded by clinics nationwide to how a major system is configured by every single trust, we can remove the blockers to electronic information becoming a powerful force universally. 

Although there is still much to do to achieve this ambition, we are certainly on the journey away from glorious Isolation.

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