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NHS Interoperability 2018

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

Authored by: Jeremy Goff and Jon Christensen May 16, 2018 | Read Time: 5  minutes

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NHS England’s Five-Year Forward View and the National Information Board’s response have thrust interoperable systems into the national spotlight in England, including the development of a Local Health and Care Record Exemplar programme. This report represents KLAS’ first look at interoperability within the NHS. The report examines how well organisations (i.e., primary, secondary, mental health, community, and social care organisations) are able to receive outside patient data, and it will serve as a baseline for future research. What types of electronic data sharing are taking place today, how frequently, and with what benefit? What technologies are relied on most? How are suppliers perceived by customers relative to the suppliers’ role in facilitating interoperability? 

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KEY DEFINITIONS


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).


MARKET INSIGHTS

Interoperability within the NHS

Today, a substantial amount of patient data is being shared within the NHS, mostly via 61 local shared records across England. However, much of this sharing is limited in breadth and cumbersome in nature since it falls outside of the clinician workflow. These factors prevent ideal interoperability—defined here as consistent access to needed outside patient information in an easily located and viewable place within the care record/EPR. Just over one-quarter (26%) of organisations report having no means in place to electronically receive outside patient data (with the exception of faxing and core NHS Spine services); acute trusts—which have a significant need for shared data—account for most of this gap in sharing.

current interoperability methods
care records eprs in use

PARTICIPATION SUMMARY

participation summary

MARKET INSIGHTS

Interoperable Methods and Data Being Accessed

Eliminating extra steps for clinicians, nearly one-third of organisations (30%) display patient data from other health or care providers within the care record’s fields or on a separate tab. Another third (35%) use portals to display data from other care providers; this represents the broadest type of data sharing going on today. However, portals don’t fully meet clinicians’ desire to have patient data integrated into their normal workflow. Even those organisations with full integration don’t meet all clinician needs since their use cases are limited to ingesting results or transferring data from one GP to another who uses the same supplier (e.g., EMIS-EMIS, Microtest-Microtest, or TPP-TPP). There are instances of structured information being shared across care settings between disparate suppliers, though such sharing is limited to date.

methods for viewing exchanged patient data
what exchanged data is being accessed

how often does exchanged patient data benefit care

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).


garbage in garbage out and top shortcomings of exchanged patient data

most significant barriers to interoperability

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..


SUPPLIER INSIGHTS

Local Care Records Facilitated by HIEs Like InterSystems and Cerner Having Meaningful Impact


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.

supplemental interoperability product ratings

EMIS Health Making Interoperability Progress; TPP Digging in Heels

Secondary Care Suppliers Not Driving Interoperability Vision


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.

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.


care record epr interoperability ratings
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2020 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.