When arguably the largest digital health vendor in the world starts to consider how they move to a new terminology for what they deliver we need to prick up our ears and at least understand what the noise is about; a Community Health Record (CHR) is now the direction of travel for EPIC one of the worlds largest digital health care organisations. In the same period the Secretary of State for Health and Social Care has begun to add some flesh to the digital vision he published earlier in the year, particularly around the state of the GP System in the UK and the desperate need for interoperability of the systems, ie. enabling the creation of a CHR in the NHS on a national scale.
I remember a pre-NPfIT world where the NHS had a choice of GP Systems from a vibrant market, and even when you were with a single vendor there was often a plethora of systems with a multitude of functionality levels available to you; who remembers EMIS LV, GV, PCS and Web all being on the market at the same time. SeeTec, Microtest, TPP, InPS, Torex and iSOFT all with the ability to deliver new exciting functionality and at the same time support legacy and green screen solutions. The move that we all took as NPfIT to rationalise the market was meant to modernise what was available, was meant to support innovation and create a new market place one where a CHR would be delivered. It didn’t it created a duopoly that has stifled innovation removed any kind of ‘start-up’ culture within the market place and disempowered much of the ‘family business’ loyalty that existed between vendor and GP. The GP element of a CHR can now only be delivered by moving to a single supplier base across a region and even then only through the movement of information in ‘old technology ways’ in the most part. What were we thinking!
Matt Hancock Secretary of State said the week before Christmas,:
“Too often the IT used by GPs in the NHS – like other NHS technology – is out of date: it frustrates staff and patients alike, and doesn’t work well with other NHS systems. This must change.”
The move from the mega-vendors in this space to try to create systems that span acute, community and primary care will not alter this paradigm and we need to take care as a joined up health and social care system to not start to drink the cool-aid again. EPIC now ‘offering’ a CHR is not the solution to a GP market place that has shrunk in size and is currently slow to consider how interoperability can be achieved outside the walls of their own systems.
In the same week that the Secretary of State made these comments Sarah Wilkinson the Chief Executive Officer added,
“The next generation of IT services for primary care must give more patients easy access to all key aspects of their medical record and provide the highest quality technology for use by GPs. The suppliers must also comply with our technology standards to ensure that we can integrate patient records across primary care, secondary care and social care.”
The simple fact that our national body for digital followed up the Secretary of State’s comment with this is a good sign, an ask for vendors to integrate across the care setting that make up the NHS against an agreed and publicised set of standards is what NHS IT teams have been asking for since the demise of NPfIT. Enabling patient ‘easy access’ cannot be done at a national level, that has been proven when the centre’s attempt at Health Space and Microsoft’s cancelled Health Vault solution. What can be done though are elements of patient access; security layers, a unified front end and entry point, promotion of the solution, standardised sets of data and ways in which this is presented and access to national data sets and information; but access to local information is best managed at a local level!
The work done in Southampton and now in Leeds and now many other places is showing that elements of an open Person Held Record (openPHR) can be achieved with connectivity, standards and a reliance on the expected parts that are best done once nationally.
The EPIC Systems CEO Judy Faulkner told a meeting ahead of EPIC leaders just ahead of Christmas that
“If you want to keep patients well and you want to get paid, you’re going to have to have a comprehensive health record. You’ll need to use software as your central nervous system, and that’s how you standardise and manage your organisation.”
These words echo some of the content of the new direction published by the Secretary of State and his team.
As a digital leader I have always pushed back though on the statement that IT will help standardise the organisation. That needs to be a clinical pull for standard work not a technology led necessity. In Ireland in late 2014 the Department of Health pinned parts of the Electronic Health Record Case for Change on the standardisation that could be achieved through the implementation of technology. The CCIO community in Ireland understood what was meant here but still pushed back, they had built the understanding that clinical led change was the right way forward and insisted that change would come about only through collaboration and with digital as a foundation for standardisation. This is why it took two years from procurement of the Cerner Millennium system to go live in the first maternity hospital of the EHR system, the clinical team wanted to ensure that the standard work that the system helped them deliver was based on clinical best practice not how the software works.
Judy Faulkner told Healthcare IT News in December 2018,
“Because healthcare is now focusing on keeping people well rather than reacting to illness, we are focusing on factors outside the traditional walls.”
This makes sense, the delivery of Population Health is the new knowledge basis for what we as healthcare professionals (Note not digital leaders) need to focus upon, here in Leeds we need to deliver this as a city, as a citizen platform for good health and social care to exist. We need to protect our clinical, medical and healthcare professionals from a deluge of data and somehow find the right way to present the right data at the right time, not all the data some of the time. A move to ‘data is there for the asking, not the taking’ is what Ewan Davies chief executive of Inidus called out in his new year predictions recently, with permission and with the right tools the CEO of EPIC could be right, digital systems really could start to offer the delivery of healthcare the ability to consider how it can deliver healthcare ‘outside the traditional walls.
To kick off 2019 Simon Eccles, national CCIO for Health and Care revealed his predictions for 2019 to Digital Health;
“I believe we’ll see a renewed vigour in digital health technology and I hope an end to the acceptance of ‘not-good-enough’ tech in the NHS, with NHS Boards across the country taking action to support their staff with good technology. 2019 will see the launch of the first NHS Interoperability Standards, with clear timescales for their adoption, and we’ll see the NHS App being taken up which will start to show us the true potential of the empowered consumer in health.”
However Ewan Davis the chief executive of Inidus had a less positive slant to add on the direction needed in his predictions for 2019;
“Progress with interoperability will slow as vested interests and the sheer difficulty of making it work swamp efforts to get beyond the first few use cases and there will be growing recognition that we need a different approach to create the data fluidly we need.”
I believe the way to abort this gloomy direction will be moving to a learning from local approach, one where we come together as healthcare leaders and share what has been delivered and how, the Care Connect work in Bristol, GP Connect work in Leeds, Record Locator go live in various locations and an ask from One London to truly move forward with meaningful FIHR (Fast Healthcare Interoperability Resources) profiles all begin to truly ring a bell for interoperability to happen in earnest. Whether its new entrants into the GP market that deliver this or a renewed local relationship with the suppliers that exist now to my mind it doesn’t matter. What I do know though is that by working together the system can remove the frustration that our Secretary of State describes and offer a joined-up system that has digital at its foundation and data fluidity as its life force.
I am proud of being a digital leader but I think that in 2019, to truly deliver what EPIC have described as a CHR then we all need to become healthcare workers with digital expertise in the same way as a brain surgeon is a healthcare worker with surgical (and so much more) expertise!