NHS Interoperability 2018
Data-Sharing Efforts, Obstacles, and Progress in England

Care Record/Electronic Patient Record (EPR)—Patient record or case management system in use at a given organisation.

Data-Sharing Partner—An external health or social care provider from whom a given organisation wishes to receive patient or service user data (e.g., GP wanting a hospital discharge summary).

Clinicians are starving for data, and expectations for data presentation are rising. Respondents at organisations that pull outside information directly into the record (either fully integrated or on a separate tab) are about 20% more likely to say that their clinicians can access exchanged patient data “often” or “nearly always.” While there is room for improvement, 57% say exchanged data frequently benefits care (compared to 49% in the US for sharing between different EMRs).

Market barriers include insufficient technical and clinical standards, lack of patient education or willingness to share, lack of clarity on information governance, lack of understanding of disparate care settings among care providers (e.g., secondary care not understanding social care), etc.

Supplier barriers include unwillingness to enable data sharing, lack of supplier resources and/or expertise, poor quality or missing interoperability tools (e.g., inability to share structured data), pricing model, inability to accurately match patient records, etc.

Internal barriers include lack of strategy or interoperability road map, lack of resources/expertise, internal data-sharing difficulties, clinician unwillingness to adopt tools, unwillingness to share data, etc..

The most widespread sharing happening today within the NHS is through the 61 local care record (LCR) initiatives facilitated by health information exchange (HIE) technology—a bright spot in supplier offerings. Though still early, LCRs are aggregating data from numerous sources and presenting it to clinicians—usually via a separate portal. InterSystems and Cerner are the top performing HIEs thanks to the relative ease with which they can connect disparate data sources and their ability to share information between care settings. Although feedback is early, other solutions aren’t as highly regarded, yet most outpace nearly all patient record suppliers in terms of customer ratings for the suppliers’ support of interoperability. For example, Orion Health and Graphnet customers report more basic tools and implementation hiccups but also feel optimistic for the future. With the proliferation of HIE technology, respondents say that the MIG—one of the most common portals in use today (mostly for view-only access to GP data)—is becoming increasingly obsolete in light of the data-rich LCRs and the up-and-coming GP Connect programme.

EMIS Health Making Interoperability Progress; TPP Digging in Heels

Most respondents feel EMIS Health has been receptive to the interoperability discussion and has worked in recent years to make their system more interoperable. While delivery has been slower than customers had hoped, nearly all say EMIS Health outpaces TPP in regard to interoperability. Like other suppliers, TPP has enabled sharing among their own customer base, but exchanging between disparate systems is extremely challenging. Customers and non-customers often describe TPP as unwilling to facilitate outside data sharing. There are a few bright spots with GP suppliers Microtest (for Microtest-Microtest sharing in Cornwall) and INPS (for their flexibility), though both have small customer bases.

Secondary Care Suppliers Not Driving Interoperability Vision

According to customers, secondary care suppliers have been too willing to go with the flow rather than proactively drive cross-platform interoperability. For example, Cerner and System C (Medway) are open to discussions with customers, yet customers also say that Cerner’s approach is too focused on leveraging other Cerner products (HIE) and that System C can be closed off to certain products. DXC Technology (Lorenzo) has some gaps that prevent interoperability and has historically been reluctant to engage in interoperability discussions, though their new platform is promising for some. Without a paradigm shift among suppliers, change will continue to be driven by pressure from customers.