Professor Peter Bannister, Executive Chair of the IET’s Healthcare sector explores the need for interoperable health records to ensure a digital future for healthcare
Interoperability is a term that has been widely associated with healthcare for several years and for many people it brings to mind the challenges we all experience as users of health and care services. For example, seeing nurses having to refer to physical binders of notes, which cannot exist at the GP practice and the specialist clinic at the same time, or the diagnostic odyssey that befalls those with rare diseases: having to tell the same story – previously extensively documented by other healthcare professionals – over and over again in the hope of someone being able to piece together the data to form a diagnosis.
However, like all buzzwords, it is essential that we dig deeper and understand what is really meant by interoperability in the eyes of those who need it most: patients and the people who deliver their care. It is clear from decades of trying that there is no quick fix to the disjointed architecture of healthcare systems, which in turn hinders innovators from realising the potential of personalised healthcare based on a comprehensive understanding of an individual’s many encounters with clinical professionals. The world will not converge on a single supplier of electronic patient records, were it that easy – in fact it has become increasingly well known that the concept of “paperless” in even the most advanced healthcare systems is a pipe dream.
Finding a united way to share data
So, if the common factor is not a communication standard, or a top-down mandate for a common data format, what does interoperability need to stand for? In short it entails a common understanding of the real-world constraints present in today’s healthcare systems combined with a balanced appreciation for the role that technology and data could play in enhancing it. Healthcare systems will always be extremely heterogenous in terms of their many components, both physical and digital, and therefore it is essential that we are able to empower those closest to the problems with the knowledge and skills to lead the development of effective solutions, while supporting them with policy that encourages good behaviour and with more detailed guidance that fertilizes success.
Key to achieving this is a robust understanding of how to deploy technology within real-world settings, while remaining cognisant of the requirements for clinical accuracy, data protection and cost-effective health economic delivery. Specifically, established engineering practices such as Agile and design thinking approaches can ensure we engage the patients and clinical professionals (who best understand the environment they operate in) early and often thereby accelerating the development of effective solutions.
In that case what specific role can we play at the intersection between policy, technology and skills? Consider that interoperability should not only address current inefficiencies in today’s reactive healthcare delivery but aspire to facilitating a preventative model of healthcare in the near future, one where people, technology, data and the physical environment are aligned to promote sustained good health and trigger early, effective interventions.
The continuing impact of COVID-19
As a result of the COVID-19 pandemic, the digitisation of the UK’s health and care services has been hastened in various ways. An example of how persistent barriers, such as poor interoperability, privacy concerns, and difficulties getting data to flow in real time, have continued to restrict the ability of the UK to use Healthcare Information Technology to support policy and planning is the development of mobile applications to support contact tracing.
It will be possible to improve healthcare quality, safety, and efficiency by leveraging lessons learned from the COVID-19 pandemic. This will be an exciting decade for healthcare information systems. However, as it stands many NHS staff within the system find it extremely difficult to adapt to changes in the healthcare system.
Interoperable health records are key to a digital future
We have a need that we can’t meet unless we change our processes and become more effective and efficient. Therefore, having the digital advantage in this domain allows us to move from being a reactive health service to one that is much more focused on preventative health as we drive innovation at scale, where it can improve care, and this will allow citizens to do more for themselves in a constructive, helpful, and beneficial way.
A number of issues need to be addressed, including enhancing the usability and compatibility of healthcare information technologies and systems, increasing data processing and analysis capabilities and safeguarding personal information, as well as increasing financial support and promoting digital inclusion. Healthcare information systems are complicated interventions that need to be adapted to local circumstances, and the UK should learn from its past mistakes as well as from global exemplars. An ideal balance between bottom-up and top-down implementation will be necessary for this process to succeed, which should lead to tangible benefits.
In conclusion, interoperability is not a standard or a protocol: it is a far more holistic mindset and a methodology which can facilitate cross-sector collaboration. At the IET, we look forward to championing this technology- agnostic approach starting with the recommendations presented in our Digital Advantage report.
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© 2019. This work is licensed under CC-BY-NC-ND.