Code4Health Interoperability Community Board are seeking views from the BCS membership community on the following interoperability topic
- Interoperability Measurement
Interoperability between the different computer systems that support health and care is a key requirement in NHS Digital Strategy. In 2015 the Interoperability Handbook was published. This set out the need to integrate services across care settings through technology. This strategic context is set out in the Five Year Forward View and Personalised Health and Care 2020 .
Interoperability is not new; indeed nearly 20 years ago Information for Health published in 1998 gave two of its five commitments as,
• round-the-clock on-line access to patient records and information about best clinical practice, for all NHS clinicians
• genuinely seamless care for patients through GPs, hospitals and community services sharing information across the NHS information highway
There are many examples of inter and intra organisational success in interoperability; order communications and results reporting, use of national DTS/MESH services to support electronic messaging from the secondary sector into primary care systems, local health economy wide shared views of patients, GP to GP records transfer, prescription messaging and indeed access to the SCR widely across the care system. In addition many initiatives are in development for example the pan London document exchange. We should also consider the evolving work emerging from the ability to use such data to compare and improve health for individuals and populations.
Whilst interoperability has in many ways been an add on to existing systems, there is a clear welcome change in tone from NHSE, local health partners and industry alike that shifts the requirement to be a mainstream core requirement for any system. It is increasingly likely therefore that those systems without interoperability and open data will not be procured going forward.
Over recent years there has been a ground swell of local opinion formers and influencers that has sought to take interoperability into the mainstream, such as the
• Newcastle Declaration which arose during the 2015 CCIO Summer School and which set out five general interoperability principles and the
• TechUK Interoperability Charter in 2015 which sets out key principles for the IT industry, NHS and Local Government to commit to, in order to enable the change needed to deliver better integrated health and social care.
In the last year the Code4Health Interoperability Community Board has been established and is bringing suppliers, providers, NHS England, NHS Digital, Social Care and commissioners together in a network of networks to support the development of interoperability using the FHIR standard. A first tranche of FHIR APIs have been set out and have now started the process of validation through the PRSB.
Health and Care suppliers have organised themselves from a broad base in TechUK into a group called INTEROPen with the aim of accelerating the formation and validation of standardised approaches to interoperability. So far about 60 suppliers have joined.
NHSE through the GPSoC Programme is in the process agreeing three standard APIs using the FHIR standard for reciprocal use in primary care and other sectors.
So there is much underway and the expectation is high that we will collectively deliver interoperability as set out in recent policy requirements and perhaps deliver on 1998 commitments set out by Frank Burns.
However we do not deliver interoperability for its own sake, it has to be for the benefit of patients and those delivering care. How then are we going to measure these benefits? The purpose of this discussion document is to lead a conversation on measurement so that the broader community of people and organisations involved in this work can settle on an approach to measurement.
Approaches to measurement
In North America ONC HIT has set out an initial response to consultation on measurement recently. This has suggested four overriding principles and set out two measures,
• Burden: Do not create significant additional reporting burdens for clinicians and other healthcare providers.
• Scope: Broaden the scope of measurement to include individuals and providers that are not eligible for the Medicare and Medicaid EHR Incentive Programs.
• Outcomes: Identify measures that go beyond exchange of health information. Although measuring the flow of information is important, it is also critical to examine the usage and usefulness of the information that is exchanged as well as the impact of exchange on health outcomes.
• Complexity: Recognize the complexity of measuring interoperability. Multiple data sources and more discussions are needed to measure interoperability fully.
• Measure #1: Proportion of health and care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.
• Measure #2: Proportion of health and care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making
In the context of the work in England the Interoperability Handbook cited a number of measurable outcomes which take us beyond these two simple measures Patient/citizen satisfaction (tell story once, increased confidence in level of care being received, personalised care)
• Efficiency (e.g. reduction in letters, phone calls & faxes, carrying out triage and analyses, reduced referrals, reduced assessments, reduced tests and orders)
• Improved efficiency in the care pathway (e.g. admissions and re-admissions, discharge planning and care planning)
• Quality of care (patient wishes including end of life)
• Safety – safe transfers of care, medicines reconciliation
• Cost of legacy infrastructure and systems
• Data quality-One version of truth
• Decision support, ie the ability to make information from one system available to another, or an algorithm
Process efficiencies are fairly straightforward to measure. Patient impacts are another matter. We are not good at applying health economics to health informatics. Given that we spend money that could be used elsewhere in health, perhaps we should take a more rigorous view of the opportunity costs of our investments?
This is potentially a complex area. There clearly is a need to demonstrate the benefit, indeed will be an expected byproduct of any investment. Current schemes tend to only report the number of views and anecdotal stories. However in general we are expecting significant patient, clinical and efficiency gains.
You are invited to have an open discussion to help shape the C4H CIB approach to interoperability measurement.
Personalised Health and Care 2020
Information for Health
TechUK Interoperability Charter