The Download: Unblocking the NHS’s digital plumbing

In January, a new NHS England committee met for the first time to discuss how to solve one of the biggest – yet low-profile – challenges facing the health service: how do you make information sharing easier in the NHS?

And, last month, an HSJ survey found that making information sharing easier topped the wish list for the majority of integrated care board leaders.

But making information sharing easier isn’t as straightforward as changing the rules around it. A key factor is making the technology enabling data flows more interoperable. 

To put it another way, if the digital plumbing isn’t in order, data can’t flow between different parts of the NHS. 

The problem, one which has dogged the NHS for years, is the pipes are often disorganised, out of date, and do not connect to each other. 

Until this interoperability issue is resolved, NHS chiefs will not have as much information as they want to make truly transformational decisions.

Unfortunately, there has been little focus, discussion and funding to address the interoperability failings in recent years. NHSE’s new Interoperability Advisory Group was set up earlier this year in a bid to change that.

Bleak picture

A presentation to the committee, obtained by The Download through a Freedom of Information Act request, noted interoperability was “possibly the greatest barrier to a high quality and excellent experience of patients who need to move through the system to get the most appropriate care possible”.

The stakes are high – but the reality is quite bleak.

The committee papers also referenced a 2022 NHSE survey which found only 15 per cent of NHS providers agreed they had contractual levers to get suppliers to prioritise and implement interoperability features.

A whopping 76 per cent indicated they didn’t have the required support from NHSE when negotiating contractual terms with suppliers, while only 22 per cent said they understood the costs that suppliers charge for interoperability features.

The result is several blockers that make full interoperability in the NHS a distant dream.

The NHSE committee categorised the main blockers as follows:

• Too many duplicated and redundant approaches to making information, using different technologies and standards;
• A lack of mature and consistent approach to managing standards through their lifecycle at NHSE; and
• A lack of effective management of providers and suppliers to drive adoption.

The plan

So, what is NHSE going to do about this? The committee papers identify four “key interventions”. 

The first is to “adopt a standard language for care harmonised to international standards so that data is constantly understood by systems and people”. This will largely be done by running an “iterative approach for developing data models that are based on OpenEHR and mapped to the well-used [Fast Healthcare Interoperability Resources] standard”.

Another intervention is a “composable architecture for interoperability so that implementation burden is reduced and new workflows possible”. This will need new governance, guidance, and API specification, along with the adoption of various data policies.

Thirdly, NHSE wants improved “end-to-end lifecycle management of interoperability standards so they are fit for purpose and have supplier confidence”.

Finally, NHSE wants to “manage adoption and align levers and incentives so providers and suppliers know what they have to do, and when, and are incentivised to do it”. This will mean more mandating of standards, a “strengthening of our statutory powers” and a new “compliance and conformance testing regime for IT suppliers and providers”.

It’s a big ask. It will need a concerted effort, and not just from the NHS tech community.

The papers call interoperability “more than an IT concern” requiring a “coherent agenda across all integrated care efforts”.

The Download has its doubts this message will be understood by integrated care boards, much less discussed at their board meetings. 

However, the papers do reference “large investment planned in the coming years”, which presumably is a nod to the investment in NHS tech spending announced in the spring budget. If funding is routed towards interoperability, then there is a chance some progress can be made.

But it needs to be made now. There’s no use in the NHS trying to embrace the emerging technology if the underlying plumbing is blocked.