Flight from Ireland

The UK Interoperability Problem

Over the last two years we have created stories about health care as a liquid, a hospital without walls, a hospital in a box and the delivery of a digital fabric. Health care focuses on physical places and, perhaps wrongly, digital healthcare is often following this paradigm.

What if we removed the traditional four ‘places’ of healthcare delivery; the Acute, the GP, the Mental Health service and Social Care environments are no longer what the patient expects. What if digital could place the patient at the complete centre of everything: the integration of systems, of data, of the user experience. That’s the only way we can do this with a legacy of infrastructure that isn’t always going to allow for interoperability to be the answer.  

Earlier this year, I went to visit my parents. It was a short flight away from what was then a very sunny Ireland to the Scottish borders, always an exciting trip. Let us look at how the logistics of this journey could be transcribed into a digital health system. 

Firstly, because I accept that I want my service provider to have access to my data they know the type of flight I like, the time, the day and even where, roughly on the aeroplane I would tend to sit, so just by putting I want to leave on a Thursday afternoon it is already suggesting these things ready for me to accept.

Then, the data is integrated, the systems interoperate to such a degree it knows I would normally park a car and roughly where I would normally do that and offers this to me as well. The system can also see how much I hate to queue and that nine times out of ten priority boarding is the way I roll, so that is added to my checkout basket.

For the first time on this trip I have decided rather than drag my parents all the way to Newcastle airport I am going to hire a car, even though it’s the first time I have done this the systems data integration makes it easy to do, and because I trust the system integrity I am happy to let the system do the movement of information that allows me to pay for the car hire and even do the insurance checks. How does this make me feel though? Happy and reassured that the airline knows how to look after me and confident that if the service they offer is so professional, joined up and focused on me then, in all likelihood, the flight will be too.

The object of healthcare is not just considering but making interoperability work, to create the same feeling in our patients, in no way am I suggesting that the health systems of the world adopt a bargain airlines culture, but maybe those of us looking at digital integration could consider this as the outcome we all want to achieve and use it as a model for making this work.   

There is another consideration here too, how does the air stewardess feel about me flying this way? The travel team know I have been given all the information I could possibly need, I have been told what bags I can take, what ID I need with me, what time I need to get there. An app on my phone informs of the departure time, the gate and any changes to the departure. This gives them the ability to do the job they have trained to do; care for their customers and handle the unexpected, rather than the repeatable and standardised things.  

If we could offer this service, this kind of assuredness for our clinicians then imagine the impact on the clinical relationship with the patient. Recently a clinician described to us that an out-patient appointment without a digital infrastructure was like going on a first date every time they saw the same patient.

Literally having to go through ‘discovery’ every time the patient comes and sits in front of you, getting to know them again and re-building the relationship, not delivering an assured nature of knowledge and information. Integrated solutions that share information and ensure that information collected once can be appropriately shared where appropriate are the reason why we need this to be top of our agenda.

Integration and interoperability are now required to be the fourth utility in health, heating, water, electricity and the ability to share information should be at the absolute forefront of what we are here to do.

I’m looking forward to watching as my colleagues at the NHS in the UK undergo the effort to measure the state of their interoperability at present. It’s a daunting task to look at such a complicated effort, and try to make sense of the progress being made. I trust, however, that the research process is in good hands, as our friends at KLAS will facilitate the research and, as they’ve done in the United States, help bring clarity to a cloudy scene. 

I would hope that those who work within the healthcare community of the UK will take this opportunity to help the NHS in this effort by participating in the research.