As the vision for the NHS National Plan for IT (NPfIT) evolves and budgetary cuts come into effect across the UK’s public sector, the direction of the NHS IT is shifting from the current philosophy of “Replace All” to that of “Connect All”. To successfully accomplish this vision, comprehensive and widespread deployment of healthcare interoperability technology in the NHS will be key.
The term “interoperability” is subject to many interpretations and misuse, with few companies having true and proven experience in this field. This is especially true in the comprehensive vertical integration of healthcare systems such as the NHS where the current and future need is to provide a comprehensive local patient record. One that is available on the basis of tiered-access to healthcare providers throughout the continuum of care - primary, community and tertiary – and fully subject to defined security and access policies relating to both caregivers and patients.
dbMotion, a proven and recognised leader in the development and delivery of vertical integrated interoperability healthcare IT solutions, has been implementing large-scale cross-enterprise health information exchanges since 2001.
dbMotion’s technology and systems are soundly based on clinician needs for patient-centric care within their existing workflows and operational environment. They have for example been in operation in Israel for nearly a decade effectively providing a virtual patient record to the tens of thousands of caregivers at Clalit Health Services, and two large governmental medical centres – Rambam and Sheba – providing a national-scale health information exchange covering over 70% of the country’s population (for more information see www.dbmotion.com/Clalit Health Services). dbMotion has further successfully deployed, or is in the process of deploying, its technology and systems in Belgium, the US and Canada. Its flagship US implementation at the University of Pittsburgh Medical Centre (UPMC) has been operational since 2008 aggregating and integrating data from more than 25 major clinical systems throughout its broad network of 20 hospitals and 400 clinics; providing access to over 25,000 caregivers with a virtual patient record from primary, community and tertiary care points. More information on UPMC can be found at www.upmc.com and on this specific implementation at www.dbmotion.com/UPMC
dbMotion’s proven international experience and excellence in the development and delivery of interoperability technology provides the NHS with an opportunity to leverage dbMotion’s technical and large-scale implementation expertise to fulfil its vision for a comprehensive, vertically integrated system at all levels of care.
Today’s Challenges Facing NHS IT
In the NHS, the increased financial pressure of diminishing central funding is pushing trusts to find savings and efficiencies in their IT systems at all levels - from procurement, support and license fees; to one of NHS' biggest headaches, the lack of interoperability within and between systems and care levels. The winners in the race to meet this new financial and operational reality will be those who innovate and go the route of interoperability.
Local Service Provider (LSP)’s contracts are likely to be revisited and optimised for greater efficiency. The wholesale adoption of all-encompassing electronic medical records systems with their rip-and-replace strategy will no longer be feasible or strategically prevalent going forward – with interoperability’s ability to “Connect All” picking up the mantle.
dbMotion’s technology creates a truly integrated health record system available to all eligible entities.
Interoperability and QIPP
According to Johan Hjord, Director of EMEA Sales at health interoperability solutions provider, dbMotion, “Central to the successful modernisation of the NHS across all levels of care is the NHS’s own Quality, Innovation, Prevention and Performance (QIPP) programme. This programme is not just related to IT, but acknowledges that properly integrated comprehensive IT systems are increasingly critical to supporting these quality and performance objectives.”
Hjord explains, “Local movement towards interoperability in Connecting for Health (CfH) in and between the all levels of care providers is a key enabler for the quality, innovation, prevention and performance aspirations of the QIPP agenda across the entire NHS. And by leveraging comprehensive integrated IT to deliver on this agenda, huge clinical benefits can be achieved for clinicians and patients alike.”
Integrated delivery networks for EHRs
Business intelligence and clinical data integration at the point of care are emerging as pivotal application areas at the local health community level. To effectively leverage this trend, NHS Trusts will increasingly need to invest in solutions that enable them to share critical data both within the walls of their own organisations as well as between GP, community and acute-care organisations.
According to Hjord, “Reduced central funding for NPfIT systems and correspondingly increased emphasis on local responsibility and choice means there is a huge opportunity for Trusts to invest now in electronic health record (EHR) systems to take advantage of technology to integrate local systems and/or the local care delivery networks. In doing so, Trusts are free to choose systems that can meet their administrative, financial, and clinical needs, while still generating the high-quality integrated information for healthcare professionals ultimately required to help them adapt to the increased interoperability and interconnectedness of our society.”
dbMotion’s technology is minimally invasive in deployment and fits smoothly and efficiently into existing workflows. It is easy to use, easy to learn (hours) and produces immediate and recognisable clinical benefits - all resulting in improved outcomes and increased clinician, and patient, satisfaction.
Low cost solution
Despite what many think, successful interoperability adoption does not need to entail large-scale costly rip and replace approaches. Hjord explains, “Interoperability and the integration of delivery networks do not have to entail a substantial increase to total cost of ownership. As Trusts search for ways to overcome the current IT challenges, and deliver solutions that will provide immediate and much-needed clinical impact, cost savings, and improvements in quality of patient care, a less disruptive approach based on leveraging existing investments and gradual rollout of EHR technology is a wise avenue to explore. At dbMotion, we have developed software that can integrate with legacy systems and addresses all areas of the QIPP programme. The technology is cost-effective - considerably less costly than a large-scale EMR deployment - and brings multiple benefits all of which contribute to an improved bottom line, performance and short-term pay-back, an excellent investment indeed.”
dbMotion’s technology is an affordable solution which produces proven and substantial operational savings.
Silos of information put patient safety at risk
Once in place, interoperability platforms help providers overcome the barriers between today’s ‘silos of information’ that compromise performance. Nowadays, patients see a variety of specialists, physicians and healthcare professionals in clinics, group practices, long-term care facilities and hospitals. As a patient moves from one link in the chain to the next, it is an ongoing and significant challenge for a healthcare professional in one care setting to easily access and understand what providers in other settings have done; an unacceptable situation for care providers and their patients.
Information about hospitalisations, prior office visits, medications, allergies and other data that enables healthcare professionals to make well-informed decisions and provide the best quality care, is often elusive, or, in some cases, completely unavailable.
According to Hjord, “Successful models of healthcare across the world address this fragmentation of data as a priority and this is what the NHS needs to address now across all levels of care (legacy or future).”
dbMotion’s technology drives / supports / enables new clinical workflows that facilitate necessary and beneficial change management.
Bringing patient information to the point of care
In healthcare environments, people and equipment are constantly in motion but, too often, the information needed for high-quality patient care moves less easily. dbMotion’s technology seamlessly brings comprehensive patient information to the point of care and provides ubiquitous access to structurally and semantically integrated information.
dbMotion’s technology is patient-centric and complementary to transaction-based systems, easing their adoption and selective deployment e.g. NPfIT, or its successor.
dbMotion’s Proven Experience Scaling Systems Development and Delivery
Hjord explains, “Existing dbMotion networks support millions of patient records and thousands of clinical users on a daily basis. dbMotion is not about finding the lowest cost solution to electronic medical record problems, it is a whole new paradigm for the delivery of patient-centric information integration and system and record interoperability. The technology can, for example, enable current systems and records within a Trust to be effectively interlinked without changing the access interface or the local clinical records solution(s).” The information that feeds dbMotion originates from disparate sources, and access to the integrated patient record is granted on a graded peer access basis, so ensuring the necessary confidentiality and privacy regulations are fully met. It also connects to information sources both in the acute/tertiary and primary care environments, thereby creating a very detailed and accessible local/regional care record. Hjord adds, “We have proven large-scale interoperability deployments in some of the world’s most challenging environments. Our implementations at Clalit Health Services in Israel and UPMC in the US are both large-scale, cross-enterprise health information exchanges (HIEs) that are considered to be among the largest and most advanced in the world. We are also involved in smaller, more locally oriented projects, in organisations comparable in size to a single NHS Trust.”
dbMotion technology draws from all existing systems, enabling integration synergy with “no rip and replace”, no new interfaces.
SOA: Maintaining autonomy while working for the common good
As the NHS begins building interoperability platforms, according to Hjord, “It would be well-advised to consider approaches that are built within a service-oriented architecture (SOA) framework.”
Although providers may not recognise it as such, they are undoubtedly familiar with the attributes of SOA. For example, it is this framework that enables them to access an independent rental car or hotel reservation system from the airline’s flight reservation system. From a technical standpoint, SOA is defined as an approach to building applications with distinct units – also known as services – that can be distributed over a network, reused and combined to create new applications.
For a Trust, this means a SOA-based platform facilitates interoperability among existing clinical or administrative systems, workflows and processes. Varying applications can consume data from each other, because functionality is agnostic to originating system architecture, format and structure. This is vital, since each of the many applications a healthcare provider typically deploys in a Trust will have been developed by a different vendor and has its own structure, developmental tools and underlying logic.
The benefits of operating within a healthcare-enabled SOA framework are wide-ranging. Services are written only once and reused by any and all applications. Information is shared on an as-needed basis, negating the need for costly data-migration exercises and data-ownership headaches. Ultimately, different applications can make use of a common set of services for potentially very different purposes.
Hjord explains, “Each entity can leverage their own system and maintain their autonomy. Yet, they can all work together for the increased wellness of the patient.”
Minimised disruption and enhanced physician decision-making
Providing healthcare professionals with an efficient way to access integrated patient data, both locally generated information well as that from other connected providers; with minimal workflow disruption is key to increased physician satisfaction. This coupled with enabling Trusts continued pursuit of a best-of-breed approach when choosing and deploying IT-solutions, all lead to greatly improved ROI on existing technology.
Healthcare professionals using an integrated health information exchange (HIE) system reap the benefits on many levels, foremost of those being enhanced decision making and avoidance of error.
dbMotion’s technology further facilitates and reduces unnecessary hospital admissions, avoids repeat admissions, assists in early discharge, improves and extends provision and extent of care at primary and community levels - all of which leads to improved efficiency and cost savings.
Patient Satisfaction
Patients are afforded a more efficient care process and improved care when their healthcare professionals have access to an integrated patient record. For example, a patient is admitted to hospital on a Thursday and scheduled for a cardiac catheterisation on the following Monday. For the catheterisation to take place as scheduled, clinical and demographic information is required from the patient’s GP before the weekend. Often a great deal of time is spent by healthcare professionals hunting for and gathering information – in this case a cardiology nurse had requested that the information be faxed to her. By late on Friday, the nurse had not yet received the necessary material which would have normally caused a postponement of the procedure. However, by accessing dbMotion, all of the required data was retrieved and the schedule was maintained.
dbMotion’s technology enriches clinician knowledge; facilitates well-informed diagnosis and treatment planning; improved patient care and patient safety - all while maintaining strict standards of patient privacy and confidentiality.
Not just integrated, but semantically harmonized data
Interoperability, and especially semantic interoperability, overlay medically oriented business-logic to the maze of complex monolithic systems currently in place across the NHS. It does so seamlessly in the background, without the healthcare professional needing to be an IT expert. Information is semantically organised by unifying the various nomenclatures and rendering data from disparate systems truly usable in a ubiquitous and meaningful form.
Once the system is in place, the healthcare professional simply sees an easy-to-use web interface where, at the click of an icon, they can immediately see that a patient requires a specific sort of care that they would otherwise not have been aware of.
Security and compliance
As interoperability is the path to sustainability is there a compromise to security? Hjord explains, “Our mature solutions offer sophisticated security, privacy, and confidentiality management tools that have proven their relevance and capabilities in complex care settings around the world. With a choice of distributed or centralized data storage and access models, dbMotion also provides an answer for care settings that involve sharing of data with different underlying information ownership. Finally, dbMotion fully supports and often surpasses the standards imposed by the NHS and is well-aligned with the requirements for integration with national standards and systems, such as the Spine or the forthcoming “ITK” (Interoperability Toolkit)
It would be imprudent to suggest that sustainability for the NHS Trusts will be an easy road to navigate but adopting SOA-enabled interoperability and integrated delivery networks for EHRs are proven vehicles to reach that destination.
dbMotion in Action
Early discharge programmes adopted in the Israeli healthcare system, getting people out of hospital beds and into community care at the earliest possible time – helps reduce bed blocking and delivers care in a more cost-effective way. This is made possible because of the shared medical record contributing to better coordination of care between the different providers (hospitals and GPs together with appropriate social services for example).
In the US, significant reduction in the time spent on preparing patients for surgery. A focused study at the University Pittsburgh Medical Centre (UPMC one of the US’s largest academic health systems of 20 hospitals, 50,000 employees and US$7 Billion in revenues) realised an 82% reduction in the time required to prepare a patient for surgery, as well as a 50% improvement in the state of readiness of patients for surgery on the scheduled day, thus greatly improving theatre use efficiency as one of many results of implementing dbMotion.
Reduction in single-day admissions: Clalit (Israel’s leading healthcare provider) has observed a significant (15-30%) reduction in the amount of patients hospitalized following a visit to A&E, after making the shared medical record available at the point of triage. A better understanding of the patient’s medical history allows A&E physicians to send more people home with confidence, rather than hospitalise for a night of observation (single-day admissions are among the most costly hospital nights, so any reduction here will lead to lower operating costs, and will also help combat bed blocking).
Reduction in duplication of lab tests and other diagnostic procedures because of access to better and more complete patient information at the point of care - previously unavailable or impossible to attain within the needed timeframe for effective care.