Evergreen Life, established by former clinical pharmacist, Stephen Critchlow, aims to put people in control of their health and wellbeing to get the care they want. Through the acquisition and solution integration, the tools will be able to share clinical data between the patient, secondary care and primary care, for areas such as supporting self-care, clinical risk stratification, remote monitoring and population health.

The company’s vaccination platform Vaccess is the first product to benefit from the partnership – with clinical system integration for the primary and secondary care management system now available.

Its bespoke vaccination management system, both patient and clinician facing, automates eligibility checks for influenza as well as COVID-19 boosters, and allows patients to book, cancel, or reschedule their own vaccination appointment.

The company said to HTN: “Our fully customisable solution maintains patient anonymity and data security, whilst also helping to streamline the end-to-end vaccination process and therefore significantly reduce demand on GP phone lines during the busy winter period.”

Cievert, a company established in 2011 by former NHS radiographer, Chris Kennelly, has a history in focusing on the efficiency of complex clinical pathways in NHS hospitals across the UK. Their first software application is now used widely by cancer services across the country.

Mark Hindle, COO of Evergreen Life, commented: “We believe that people should be empowered to get the wellbeing and health that they want and be supported to get the care that they need. Cievert has a track record of using technology to help the NHS to improve access to care; managing referrals for cancer and other specialist treatments, managing thousands of vaccination bookings for sites across the UK and helping patients to be followed up remotely in the community with patient reported outcomes and assessments. By working together in this way, we can join up more parts of the health and care system around the person as part of our mission to deliver People Powered Health.

“Refreshingly, Chris and the team at Cievert have always focussed on patients as people and we have a shared ethos around connecting health and wellbeing data so that it both benefits the individual, the NHS, and the wider community.”

Chris Kennelly, CEO of Cievert, added: “We realised that Cievert and Evergreen Life shared a range of research interests, and we could deliver greater services to our customers, and ultimately patients, by being a single organisation.

“Our mission is to make routine healthcare a thing of the past, and by integrating with Evergreen technology we will be able to share clinical data between the patient, secondary care and primary care.”

For more information about Evergreen Life visit: https://evergreen-life.co.uk

To find out more about how Vaccess can help your organisation please visit: https://cievert.co.uk/vaccess-primary-care-vaccination-platform

The Northern Territory Government (NTG) is using InterSystems TrakCare® for its Core Clinical Systems Renewal Program (CCSRP), following an open, competitive tender that was managed by the NTG Department of Corporate and Information Services.

The Northern Territory will become the first Australian state or territory with a single system for all of its public healthcare sites. CCSRP is the “largest ever” IT reform in the Territory, according to health minister Natasha Fyles, and is designed to improve health outcomes for all Territorians by promoting efficiency, effectiveness and integration throughout the public healthcare system.

InterSystems TrakCare unified clinical information system will connect every point of care across all public health facilities, including the five existing public hospitals, the new Palmerston Regional Hospital, 54 remote health centres and all community-based health services, including the most remote locations of the 1.3-million-sq-km territory.

InterSystems will deploy TrakCare on its HealthShare platform, and clinicians at remote locations—even if they have intermittent Internet access–will be able to use TrakCare to manage a cohort of patients on disconnected devices and upload changes when they regain connectivity.

The Northern Territory Department of Health, or NT Health, aims to deliver better overall experiences for every Territorian through a single, end-to-end patient information system to coordinate care.

The availability of a single record, with all relevant information provided to authorised users and clients, both at the point of care and for the planning and review of client care, is critical to consistent, high-quality care.

“InterSystems was selected as the preferred provider, among highly competitive international vendors, through a robust procurement process which was supported by a wider group of frontline NT Heath Staff,” said Associate Professor Nadarajah Kangaharan, Clinical Sponsor for the CCSRP.  “As Australia’s first end-to-end fully integrated ICT solution, once implemented, it is expected to support a highly efficient, safe and quality healthcare delivery to Territorians with ability to monitor clinical outcomes.”

Watch the video here.

– Feature by InterSystems

Of course, the COVID-19 pandemic continues – but with some reason for optimism on that front, we asked our experts to delve deeper than that with their observations, as well as their predictions.

Here’s what we found out from their feedback…

Mental health to take centre stage

Mental health management cropped up plenty of times among our respondents, hinting that – unsurprisingly – it will require much of the industry focus in the aftermath of the pandemic and related social restrictions.

Ross Harper, CEO and Co-founder of Limbic, told us that while the past 12 months has largely been “focused on preparing healthcare workers for the predicted influx of patient referrals…psychological services such as talk therapy fundamentally rely on human relationships.”

Ross’s learnings included that “innovation in mental healthcare must focus on augmentation, not automation – that is, empowering clinicians so that they have the tools to support patients at scale, rather than seek to offer digital substitutes. Specifically, we uncovered a need for better information sharing between patients and clinicians.”

Dr Lloyd Humphreys, Head of Europe, at SilverCloud Health, added his thoughts too, emphasising the need for digital solutions to deliver blended care at scale.

“The challenge for the public sector and supporting service providers is meeting the escalating demand for mental health support by devising new, effective ways of delivering blended care at scale that draws more for instance on digitally delivered therapy, when face to face contact is restricted,” he told us.

“There is a lot of discussion about the extent of mental health issues from the pandemic but not enough clear action, and this includes the need to strongly support frontline health workers who are suffering stress, anxiety and burn out.”

A world of interoperability, integrated care and data sharing

Many of our commentators highlighted the undisputed speed of digital adoption over the past 12 months. But Jonathan Bingham, CEO of Janeiro Digital felt that despite that, “there is one core part of the NHS that has seen little change – collection, interoperability and sharing of patient data.”

He added: “Information relating to individual patients is not captured and stored in a consistent way. Even within the same hospital walls, there are often multiple patient record systems being used at any one time, each capturing, recording and storing information in different ways. This makes transferring accurate and timely patient data hugely challenging.

“As a result, creating a universal patient record, which has remained elusive so far, may well be the final chasm to cross. With discussion of new initiatives such as the vaccine passport and the growing need to provide an integrated approach to health and care provision, it is now more critical than ever to find a solution.”

David Newell, Managing Partner of Gemserv Health also highlighted that the “range of issues to be addressed” include “the need for joint working and collaborative action across both health and social care.”

David also turned his attention to ICSs, telling us that “to form fully functioning ICSs will require all stakeholders to align to a common vision.”

Key issues he felt included: governance and information sharing, and a “cohesive technological philosophy to form the basis of a digital transformation programme.”

Glen Hodgson, Head of Healthcare, GS1 UK, also got in touch to tell us of his “headline learnings” too.  These included the “critical need for structured data” and “the importance of traceability.”

The “two go hand in hand,” he said, “this is the precursor to actually being able to deliver full traceability in a clinical setting.

“Irrespective of what the future has in store for healthcare, the priority should be on standardising data so that it can be shared seamlessly between systems and organisations. With the growing focus on integrated care, this quickly becomes a crucial patient safety requirement.”

Keeping up, keeping up

Among our snapshot of industry feeling, it also appeared as though there was a need to underline that, although great progress had been made, the pressure to improve and move forward needs to remain.

Martin Bell, Director of the Martin Bell Partnership summed this up with his thoughts that, “Continuing to invest in [digital health] during 2021, to not lose what has been gained, will be key.”

He also chose to remind us of the inequalities that still remain, perhaps more prominent than ever, and underpin the challenges facing healthcare. “With the disparities that exist in the UK and [that] have been exposed and indeed, increased during the pandemic,” he continued, “the ability for all organisations in a community to service not only the clinical, but the social needs of people will be even stronger.

“Technology is not always the answer, but it is most definitely one of the answers to many of the questions faced by health and care providers, commissioners and the people who use those services. Digital health is here to stay – we now need to make it work for everyone.”

Alan Lowe, CEO at Visionable, spoke along similar lines, highlighting: “The challenge for the NHS will come in sustaining a digital journey which has been largely propelled by the crisis we have been faced with and the consequent, necessary drive to find new solutions.”

Alan added that over the course of the next year, he anticipated that “appointments are going to be increasingly based on patient choice,” and “we expect that there will be also be an appetite from healthcare professionals for this blended approach to healthcare delivery. Importantly, patients and staff will not want things to simply return to how they used to be.”

Stephen Mackenney, Chief Executive Officer, C2-Ai, also underlined that “retaining the flexibility to manage COVID-19 patients while establishing efficient systems for dealing with other urgent or elective surgery and treatments will be key throughout the rest of the year.”

Looking a little further ahead, Stephen spoke about the challenge of “creating resilience and releasing capacity to ‘future-proof’ our healthcare.”

“Capitalising on the improvements possible from integrating and networking healthcare providers is one key facet,” he concluded.

Primary care in the limelight

Of course, it can be easy to focus on secondary care when talking about challenges. So, we reached out to tech industry experts in primary care too, to gauge their thoughts on the hurdles ahead.

Juliet Bauer, UK Managing Director at Livi, said: “The COVID-19 pandemic has confronted the healthcare sector with extraordinary challenges. Practices had to rapidly adapt to new patient demands and harness technology to administer high-quality care remotely. This digital first approach of reaching patients has eased pressure on the NHS and provided patients with access to healthcare more quickly and conveniently.

“This way of working will certainly continue post-lockdown,” Juliet continued, “digital platforms will accelerate better population health outcomes and transform the delivery of services to ensure patients can access the right care, in the right place, at the right time.”

Paul Bensley, CEO of X-on also spoke of primary care’s evolution, adding that he expects there to be “fundamental issues relating to technology that require attention to effectively support practices and GP homeworking”. For example, he highlighted, “the cost of calls as a result of practice communication being much more practice-to-patient than previously will also need to be addressed.”

“Joining up the IT is going to be a significant challenge,” he explained, “impacting on ability to share data and at the mercy of bandwidth and telephony quality. This needs to be centrally monitored to avoid regional disparity in delivery of general practice.

“The same applies for GP homeworking, as that becomes part of modern, pragmatic general practice, with effectiveness governed by quality of home networks.”

And the solution? “Innovations in the app space will be able to address escalating practice call and SMS costs,” Paul considered, “but commissioners and practices need to form clear and fair cost reduction strategies.”

Waiting lists and community diagnostic centres

Tom Scott of  Alcidion, meanwhile, discussed waiting times.

“As we are seeing, the number of patients on waiting lists or waiting for preventative treatment in areas such as oncology are on the rise and will increase pressure on healthcare providers in the months to come,” he stated.

“Under the surface though,” Tom continued, “there are other challenges at play. The pandemic has shown that NHS organisations need to be able to procure easily and robustly from IT suppliers while maintaining value for money and accountability, yet also cut red-tape. Technology solutions that orchestrate care across a region but also allow the flexibility to deal with regional nuances and changes in healthcare delivery are a must.”

Jane Rendall, Managing Director at Sectra, for the UK and Ireland, also shared what she thought were priorities.

“Keeping as many well people out of hospital as possible has become an urgent priority as the NHS seeks to deal with an unprecedented backlog of elective surgery,” she told us, before explaining that, “one idea some trusts are exploring to help address the challenge is to create diagnostic centres in the community.”

Discussing how “the NHS has reached out to the community on a huge scale around testing and vaccine delivery for COVID-19, and in an extremely short time frame,” Jane wondered whether the same infrastructure and change in thinking could be used elsewhere.

“We might now ask how we can re-use that ground-work to allow hospitals to focus on the people who need them the most, and to allow community based diagnostic centres to carry out many more diagnostic functions that alleviate pressures on pathology, radiology and other ologies in acute settings,” she said.

“Doing this would require the right technology to be in place. We also need to think about using technology in ways that create low barriers of entry, and that could enable volunteers in the community to complete appropriate diagnostic functions without the need to use unfamiliar and highly specialist systems.

“This also raises the opportunity to advance the prevention agenda, with the potential to use such remote diagnostic centres in combination with population health analytics for targeted screening of at-risk patients, tailored to the specific challenges faced in different parts of the country.”

If you’d like to share your stories, case studies or challenges in healthcare, get in touch with us by emailing press@htn.co.uk.

We discuss what factors are important to consider when bringing an innovation to market, how to foster innovation and how to expose opportunities.

HTN asked Oliver a few questions…

Could you take me through some innovations that you are currently working on?

Our innovations focus on a simple philosophy of ‘giving time back to patient care’.

We recognised five years ago that clinical staff were using pen and paper to conduct quality audits and safety inspections; this process was cumbersome and limited with delayed collation in trying to build a picture of quality. Ultimately, audits and inspections take time away from patient care.

Our work has focused on innovating in this area, reducing the amount of time required in conducting audits and making sure we are simplifying the process, whilst making it more engaging. However, we recognised it means our customers can have quality information in real time so they can focus on issues in the present and not those issues that have already occurred in the past.

Fundamentally, the purpose of our product is to enable healthcare organisations to perform quality audits and inspections of areas, functions, and processes within the organisation; and doing this on mobile or handheld devices.

Customers can then analyse how they are performing in certain areas so they can subsequently adjust a process in order to continually improve. For example, this could be in areas such as patient hydration, cleaning, medication, infection prevention and control, falls, medicines management, maternity care and so on.

Exposing real-time opportunities for improvement

We want to bring digital healthcare quality improvement to market and find where people are doing things right. There are issues to uncover, problems to solve but there is also value to recognising expertise and brilliance. When I think about where we want to be five years from now, the identification of excellence is really important.

We also want to deliver insight; when data is inputted into our system, we can bring meaning to that information – we want to make information really understandable and useable by everyone, from junior healthcare assistants to the CEO, and this is one of our mantras – ‘insight at our fingertips’.

Something that we are working on now is tying inspections more closely into improvement plans; creating handoffs and workflows in the system that takes users through the process of identifying issues and making realistic lasting improvements. Another core focus right now is extending our web portal so that information is available at the user’s fingertips wherever they are.

Also, at the beginning of the first lockdown, we created a COVID-specific inspection and that took off hugely; there were many organisations who decided to use it and we released this free of charge. We released the product to state that this is the type of innovation that really drives us – it is identifying a problem we can solve, and solving it quickly and easily in a targeted way.

How do you involve those who may not be as digitally literate through this innovation of moving away from pen and paper inspections?

For a system such as ours, we need to make it simple to use and this is a big focus for us; there is a certain discipline required in achieving simple usability which I do think we have got right. Simplicity and usability are key, as well as ensuring co-design principles and that there is a feedback loop in place. Taking this approach means the adoption of Perfect Ward becomes much easier.  One of our most recent customers implemented phase one in just eight weeks and it was during the pandemic. Return rates for audits have risen dramatically to 97% from 25% prior to the mobile system being introduced.

How do you foster innovation as a business?

There are three key ingredients: firstly, open lines of communication with our users – we need the insight they give to understand the problems they face.

Secondly, open lines of communication within the company – this is often what I see companies get wrong – essentially all teams within a company need to get the information from and to customers flowing.

Thirdly, exploration and experimentation; trying things out – you cannot innovate without failing. That of course brings with it a certain cost, where experimentation inevitably does become expensive, and so if you’re going to fail, fail fast and cheaply; build upon the good ideas and move on from the not so good ones.

We are soon launching an Innovation Lab and our plan is to have a group which is dedicated to that programme, experimenting and building prototypes and asking customers what does and doesn’t work before we go ahead into the cutting code phase.

To foster innovation, you need to give staff ownership of things. This doesn’t mean as leaders we stand back and watch, staff still need direction, but we want our staff to pour their passion and skill into projects and we as leaders need to provide them the tools to do it.

What’s important to consider when bringing an innovation to market?

Communication is an important aspect – be open to suggestion and not too defensive of the product you’ve created, embrace opportunity to improve and provide a better solution. You can’t be too proud of what you’ve created as chances are there will be flaws somewhere. Communication is twofold: firstly, it is about research prior to release in order to understand what is required – this is where the Innovation Lab comes in.

Secondly, it is about not making the mistake of trying to focus on making something perfect right from the start – in the real world, we know that perfection does not exist – it is the process of getting there that makes a difference. When we bring new products to market, we build a slick, simple, easy to use, contained function and we expect and encourage feedback.

It is about developing a product and then optimising it through gathering feedback. We recognise that for many this maybe their first step into the digital world, so we work on the basis of evolution not revolution.

What’s coming up next for Perfect Ward?

We really want to continue the journey that was started five years ago, and the next step is fundamentally turning data into insight and putting that data and insight at the fingertips of our users. At every stage of the process, we want our users to have access to the information that helps them understand the environment they are working within. Information, knowledge and understanding is intrinsically empowering.

In terms of technology, we want to focus on an infrastructure independent deployment model to launch new ideas smoothly and quickly, which also enables us to be more agile when it comes to shifting regulations.

In terms of the team, we are always looking to recruit exceptional individuals into Perfect Ward. It is fundamental for our product innovation to attract the best talent right across our Product and Engineering teams; it ensures that we remain at the forefront of technology. In fact, we are actively recruiting right now for various roles across this whole workstream – product management, UI/UX, backend, mobile and web development, QA and are very interested in hearing from talented people who would like to be part of creating excellence.

As far as intensity goes, this has been one of the most extreme and challenging months in history for the healthcare sector. As a I write this, we are simultaneously experiencing one of the most transformative periods in healthcare, while systems in the UK and across the globe continue to struggle in delivering urgent and routine services.

The volumes of patients waiting for high, medium and low risk procedures or care continue to grow at an accelerated rate, backlogs of cancer cases already exceeding 104 days with over 6,100 patients this month, compared to 3,000 last year. Within the rapidly growing national surgical waiting list, there are approximately 103,491 patients requiring treatment within four weeks in the face of a significant risk of deterioration.

Professor Neil Mortensen, president of England’s Royal College of Surgeons, said the growing backlogs were “very worrying”, adding: “My focus at the start of 2021 has been trying to support surgeons to find ways to keep urgent surgery going through these challenging times.”

Our advanced analytics, powered by Draper & Dash’s health Data Science Platform (DSP), highlights a 2.5m gap (shown below) which needs to be closed for elective patients alone. Despite these challenging times, clinical and leadership teams are taking the opportunity to accelerate new ways of working as they plan for a tight window of recovery before the next wave of Covid-19, flu and other disruptive viruses over the coming year.

As we approach an anticipated easing of lockdown measures and head into the spring, our modelling and predictive analytics emphasise the need for frontline clinical teams to take well deserved breaks. While absolutely essential, this will in turn potentially temporarily slow down the backlog recovery effort. When compounded with the harsh reality that the real barriers to recovery aren’t purely the number of Covid-19 cases, but a more deeply ingrained set of issues – namely a shortage of 58% within the healthcare workforce, 44% in bed capacity and 28% in operating room capacity – I believe that this is something we can all relate to, as capacity has now become a real issue for many.

Once again reflecting on the words of Professor Neil Mortensen, the truth is that many “NHS staff are burnt out” from the experience of working without a break through Christmas and the New Year, right on the back of a hellish year where many were unable to deliver the standards of care to their patients that they first entered into their professions to provide. There is no point to politicians talking about operating 24/7 in order to get the NHS back on track when many anaesthetists, theatre staff and surgeons will need time to recuperate come Spring. There are now national plans being discussed for some sort of break for NHS staff, and although the precise shape this will take is not yet decided, it will surely be very welcome.

To learn more about the current elective landscape, insights for recovery, and predictive analytics for the NHS’s upcoming demand surges, download our detailed report here.

We have been working with a number of providers and systems, both nationally and internationally, to support with leveraging advanced predictive machine learning and data science for the modelling of targeted scenarios. These support areas including:

• New elective pathway mapping and new ways of working.
• Profiling the waiting list and patent risk stratification at both a local and system level.
• New ways of addressing the capacity gap.
• Supporting workforce shortages by optimising new models of care.
• Modelling patient complexity and admission criteria.
• Predicting the Summer demand and Autumn/Winter surges, with stand-up and stand down models.

Partner with us for your recovery. To learn more, contact us here at info@draperanddash.com

We asked Mark and Gary a few questions about their work in this area, some of the challenges and what’s coming up next…

Can you tell me about your current roles at Healthcare Gateway?

Mark:  As strategic partner and alliances manager, I build on existing partnerships, engaging with our 80 plus partner systems that are accredited for the Medical Interoperability Gateway (MIG). I seek new opportunities with health and care systems to provide them with interoperability solutions to enhance their system offering, as we provide our partner systems with a range of health and social care data in a HTML or a structured format.  For the past four years I’ve collaborated with our partners and delivered exciting projects, facilitating new product development with partners such as Liquid logic and the creation of an adult social care dataset.

Gary: My team is responsible for commercial account management, ensuring our new and existing customers are utilising MIG services to their maximum potential, undertaking benefits realisation analysis and identifying data gaps to join up patient care, ultimately enhancing the patient experience and improving outcomes.

What have been working on in the area of interoperability?

Gary: During 2020 our focus was supporting the NHS response to Covid.  At the onset our customers ranging from health and social care organisations to transformational boards, at local and regional scale reached out to us, primarily due to our ability to quickly mobilise connections of patient data. For example MIG data was implemented at Nightingale Hospital at Excel London, meaning clinicians would have access to medical records of patients from the whole of London and its surrounding areas, a huge footprint.

We supported One London Local Health & Care Record Exemplar (LHCRE) programme which involves a multitude of health and care organisations who came to us and told us the existing data needed to flow into the data poor areas; we successfully turned that around in just over a week, where usual deployments can take anything between 10 and 12 weeks. To turn this around in such a short space of time was an incredible achievement for us and our partners but more so, immensely important to patients who required urgent care.

There was also requirements for cross-border sharing of patient data, helping clinicians treating out of area patients to have real-time information about the patients they’re caring for.

Alongside this work, we have also seen an increase in projects relating to local and shared care records and deploying data into health information exchange (HIE) portals supporting the national level up of shared care records agenda.

Mark: Interoperability is massively important to shared care records and as specialists in this field we’ve worked together with our partners and customers to successfully feed patient data into many HIE/ community portals across the country.

Health and care organisations in Kent as an example, have a new care portal (Graphnet). For this programme we have helped mobilise data into that system quickly and at scale; Kent already have organisation to organisation or point to point data connections with us but alongside that the demand was to establish a holistic view into the shared care record. We are not just entering into these global viewers, but also small specialist systems where collated views are not available such as the systems used in ambulance trusts (Cleric) supporting critical emergency care.

What have been the main challenges of implementing these systems?

Gary: We have challenged the normal process and re-written the rules. It’s proven that people can collaborate quickly to achieve goals; usually in the health technology space, there can be a roadmap for delivery that takes up weeks, months or even years whereas we’ve managed to mobilise data into systems in much less time than that.

Not being able to hold face-to-face discussions was initially a challenge, but again we’ve adapted to remote working and now support customer strategies and plans virtually. Personally, I like to use a whiteboard to map plans out in front of people, however online collaborative tools available today work just as well. To support end users once we’ve deployed services it is important to be present (usually in person) – what we call ‘floor walking’ and support via our MIG awareness sessions. Although we’re unable to be on site at the moment, we’re currently running adoption sessions remotely which is important for end users to gain most out of the data presented to them. This has been challenging but not insurmountable.

Historically I spent a lot of time ‘on the floor’ with our users, for example in Hertfordshire floor walking; Watford General Hospital took on our Shared Record Viewer (SRV) solution, but to really get users engaged, it was important to have that two-way communication and demonstrate and realise the benefits. To physically stand in A&E you realise how important patient data is to our users and I miss the chance to do that in person.

Mark: That is definitely key; you can give someone a tour but unless you walk them through it you rely on a user to find the full potential of the services presented in the clinical system. The growth in the usage of MIG has been fantastic and we’ll continue to support our customer in a remote capacity providing our fully managed service, which sets us apart – often it’s seen as the reason for our success.

What would you say are the biggest challenges to the implementation of interoperable systems across healthcare in general?

Mark: Across healthcare there are challenges with developing to the same standards, systems being open and then having the development resource to integrate at pace. MIG has over 80 partner systems that we have integrations with that provide patient data to and from, in the absence of national standards MIG was widely seen as the ‘de facto’ standard for GP sharing. As we all develop to national standards to complement what we already have the challenge is getting them adopted quickly. There have however been massive strides; and it has taken healthcare one year to achieve what would usually take years which is a huge positive and shows how it can be done.

Gary: That challenge puts Healthcare Gateway in a niche space currently; there is demand, but given organisations are not at the same digital maturity level. We have found that we can support by providing the flexibility to adapt to systems at various stages of development. This is something we are very proud of, and in 2020 we can hand-on-heart say we’ve supported the Covid effort across the country. 

What’s coming up this year for Healthcare Gateway?

Mark: Plans for 2021 are based on developing MIGs technical products and services that will enable our customers to meet nationally mandated services where available; to ensure patient experience is optimised. We will continue to innovate and provide data streams that are unavailable today. Programmes of work regionally including the levelling up and continued roll out of shared care records, supporting our HIE partners is important to help our mutual customers meet  their shared care plans.

Gary: In addition, shared care records are one element of what we do, whilst we support that agenda, our focus for us is mobilising more health and social care data for example social care data out of Liquidlogic into the MIG estate of 4500 consuming systems. We provide GP, Community, Mental Health, Acute and Social Care information, increasingly our available datasets to best support the demands of our customers today, and in the future. This builds on our managed service, we will continue to support our customer’s full end to end interoperability projects, from information governance, full project management, technical support and ongoing customer service.

Are there any learnings you would like to share?

Gary: As we deliver health and care connectivity, we do not need to reinvent the wheel to deliver a rip and replace programme to support ICS strategy; there are very successful connected systems across the country and a ‘lift and shift’ approach to reconnect into a different systems/settings may be the cost effective but also best for the patient.

We’re breaking down the barriers; where patient data sits in silos allowing that data to flow, when and where it is needed the most is key. In some cases where MIG solutions already exist, our customers recognise that the available feeds can be reused in any system or setting for little or even no cost in some spaces. For those being drafted in to look at connectivity, look to see what we can do to maximise return on existing investments before moving to a replace agenda.

I think it’s about making sure there’s a full analysis of what they already have before they go out and buy a new system.

Mark: We are all patients of the NHS and as patients we all want the healthcare professional who is looking after us to know our current and accurate medical information in order to provide us with the best possible care. What I’ve learned from this past year is that we need to get the basics right and support the users of our clinical systems better. We all have a right to be looked after by clinicians armed with the most up to date information held on us regardless of where that information is recorded.

Get in touch with Healthcare Gateway to learn how you can access real-time patient data via the Medical Interoperability Gateway (MIG).

To get a birds-eye view of the bigger picture as well as technical detail on the nuts and bolts of digital transformation in the public healthcare sector, we spoke to both Director and Founder, Tony Corkett and Chief Development Officer, Neil Taber.

Find out about their challenges, learnings and predictions for 2021, below…

What are your backgrounds and your roles within Cloud21?

Tony: We started Cloud21 in 2010 – 2011 on the basis of [the idea] ‘how can we help the NHS improve?’

My clinical background was in radiology, some 20 plus years ago. We had PACS (Picture Archiving and Communication Systems) – basically how you digitise radiology – similar to how we went from film to digital camera. We [realised we] had the digital image in hospital A, so how do we get that to hospital B?

The early work I did in the 2000s was coming up with the concept of how you moved imaging around, across regions. That was what formed the national programme [and] we brought PACS to the entire country in a matter of years.

From the work I did in my clinical role to digitise radiology, I realised that through getting technology and strategy aligned we could actually do a lot more. We could actually help a broader set of patients.

And that’s been the ethos behind a lot of what we try to do, ‘how can we bring innovative technology to health and care organisations and actually make a difference with it?’ It’s what certainly motivates me as the Founder and Director of Cloud21.

Cloud21’s ethos has always been to answer the ‘so what?’ question. Technology alone isn’t the answer. We have four divisions: consultancy, IT services, enterprise solutions and Neil’s division, interoperability.

Neil: I’m the Chief Development Officer for Cloud21. I’ve been working either for, or with, healthcare since 2000.

For the last 16 years I’ve been working with code and tools to help computer systems understand each other. We work with everything from simple data transfers to information understanding, and use integration engines, ETL tools, and process automation (RPA) suites to deliver the solutions. We’re helping to support the business changes required to make more efficiencies and to support an ever-increasing demand on the existing workforces.

As Tony said, the reason I’m with Cloud21 is that we see technology is an enabler to the challenges that are out there in the NHS and across the services they provide. And that’s not just limited to the acute sector. We understand that healthcare interoperability spans primary care and GPs, emergency services, health and social care but also includes local authorities and government.

It really is a vision to try and help these organisations better interact with each other. Aiming for true interoperability – sharing utilisation of the information that’s so often held in these silos.

What are some of the challenges around digitally-enabled care?

Tony: As your audience will know, the NHS isn’t a single system. The NHS is a complex set of institutional organisations, often competing against each other for resources, for funding and for services.

And in that complex dynamism is [the question] ‘how does a patient – and it should always be about the patient – navigate their way through that? How does the information that would help the professionals flow through the system?’

That challenge has been there since day one but now, with the adoption of digital technology, the public assume that this problem no longer exists.

Patient’s flow through a complex myriad of different points of care. ‘How does their data flow with them, so that everybody knows exactly what they need to know at any point in time?’ That’s challenge one.

Challenge two then is, ‘what can we do with that data?’ How can we take that data and begin to use it not just to improve care for that patient, but actually to improve the care for the population as a whole? And that takes us into areas like AI, machine learning, predictive analytics, population health and risk management.

I spent a couple of years with Google DeepMind – probably one of the leading, if not the leading, AI company in the world, looking globally at how we can use health data. And some other parts of the globe are progressing really well, collating data from multiple sources and re-purposing and reusing it to actually treat a condition or symptom before it gets to the point where a patient is presenting in an acute setting.

That’s another challenge we have: ‘how do we stop people walking in the front door of hospitals? How can we interact and intervene with them earlier?’

Neil: And I have experienced a further three challenges;

The legal [one]: what are you actually allowed to share, and who makes that decision – patient, staff, organisation? [Then] how do you make sure the receiving organisation will capture and process in the right way at the right time? Information that could have been shared may end up being archived or discarded, reducing the effectiveness of the outcome.

We [also] then have the political view of the information that’s available. For a long time, information captured was processed on the premise of ownership of that patient. The immediate delivery of the care needs are always first and foremost, however when the patient moved on, not all of their data did at the same time, if at all. Relinquishing that control has, and still is, a challenge to any interoperability programme.

Finally, the usability and understanding of what can be done with the information. You, whether as an organisation or an individual staff member, may not be aware of what could be provided from other teams or systems; Other information providers may not know you would be interested in the other information they hold. It’s important for organisations to understand the usefulness of their information outside of their direct context and also ensure that data maintains context outside of their core applications.

Knowing the breadth of information you have available, and how it can be presented, is key to the sharing of content and coverage of the data so that it becomes useful in an interoperability sense.

Do you have any real-world examples of those challenges?

Tony: Political decisions are being made, most recently the move to a concept of ICSs has been accelerated.

It’s recognised that care has got to be delivered across the entire continuum. The ICS world will change the political landscape at local levels, it’s going to change roles and responsibilities. It’s going to move some of the powerbase around.

Interestingly enough, legally, the NHS structure isn’t aligned to that currently; we’ve got to get laws through Parliament to enable ICSs to be formed in the correct construct, away from the existing CCG (clinical commissioning group) structure.

Politics and legal movements are there, at a macro level, but Neil has got a really good example of what that actually means on the ground.

Neil: Our role in a 15-organisation-strong collaborative – comprised of acute hospitals, health and social care, local authorities and government agencies – was to bring together a centralised record for a person inside a demographic area.

Our engagement supported the discovery and pre-enablement phase, where we assisted the organisations in better understanding the information that they had available.

This phase was important for two reasons; firstly, to uplift the hidden information that they do have available. Secondly, it highlighted the challenges of information alignment between the different organisations. This enabled the project to undertake an early assessment of the semantics of the information to help to ensure information shared would be ‘usefully usable’.

This is a term that should be in the forefront of peoples’ minds because the ability to make good use of information is a key message in the NHS 10-year forward plan. Just passing someone information is one thing, but that receiver being able to use it in a way that supports their organisation in providing a better healthcare experience for the patient is key.

Part of our role with the programme was to develop a framework that would allow the organisations to document and better understand the silos of data they individually had, and to allow the development of common information alignment and not just a data mapping exercise. The ability to work with, and document, the semantics and lexicon to align meaning was a really important step to having a strong information alignment.

When the project is complete, combinations of the data will be used by advanced data analytics tools. The information that has been shared between the organisations can then be utilised in different ways – to look at modelling, and to look to predict service utilisation across many areas.

Services for our patients can be improved upon by interoperability – sharing information and reducing the repetitive nature of data collection to minimise the chances for errors to creep in.

What are the wider implications when moving towards interoperability? What should organisations be aware of?

Tony: One area we’ve been talking about for years – and I feel we’re slowly getting there – is open standards; the ability to establish and agree a set of standards that makes things easier to be shared.

Secondly, as an industry, we have the silos inside the organisations. But we also have silos from a supplier and vendor perspective, who quite rightly look to protect their own systems and platforms.

And it’s trying to encourage those vendors to be more open and realise that actually – through a sharing of data – everybody wins. That’s started to progress over a number of years and some barriers have been knocked down slowly.

Finally, I think for me, the capabilities of the technology that’s emerging from the fourth industrial revolution – AI, machine learning, nanotechnology – is dependent on the availability of raw data.

We have a huge source of data in the NHS that has a significant value proposition and if the NHS can achieve interoperability it will make a fundamental difference to patients and the health of our populations.

Neil: The NHS’s Open API policy and involvement with the INTEROPen group demonstrate that the NHS are dedicated to having an interoperable service delivery. A current challenge in the adoption of this approach is that that frameworks are still in a building phase.

Although they have been published for some time…they are regularly going through improvements, so there is always a bit of a moving target for the suppliers seeking to adopt the standards. It’s a lot of work for third parties to transfer to a new data standard after spending years aligning their solution to ITK HL7. We are starting to see new versions of software released that are more supportive of new data transfer capabilities but this is not across the board, and heavily impacts smaller dedicated and boutique solution providers.

When a good level of adoption has been gained, we’ll almost be looking at [more of a] ‘plug and play’ architecture, where the information can be directly shared with other organisations very simply, using the aligned data structures and information workflows that would be provided by the solution’s out-of-the-box capabilities. The shared business processes will, hopefully, be much more able to adjust and benefit from the more readily available information provided by the technology layer.

What’s your vision for interoperability going forward?

Tony: We’re only at the beginning of this journey. Interoperability can often get put into the bucket of technology [e.g] “oh that’s just an IT problem”. But actually, interoperability starts at the very top level – strategically [thinking] ‘what are we trying to achieve here? What’s the outcome we want?’ Then it moves into, ‘how do we deliver that service change?’

And when you get down to a technology level, it is just a tool that’s helping you achieve a strategy. If we haven’t got a strategic vision, if we haven’t overcome and removed the power bases [and] political barriers, the ‘not in my backyard syndrome’ – if we don’t tackle those, just giving technology to someone will make no difference at all. In fact, it will probably cause more problems.

We have to answer the ‘so what?’ question; we have a new bit of technology…what difference does that make? It only makes a difference when you go back and think: ‘have I got the strategy right? Have I taken the people with me? Have I got the processes right? And is the technology implemented in a way that achieves the goal?’

Neil: The tech part is the enabler, yes. And if we use the resources carefully, use staff wisely, and share a lot more data, there will be a lot less repetition of input, a lot less rushing around looking for information across multiple systems. There are ways of providing everything that a clinician, doctor, or a social care worker needs on their device at one time.

The mission is to support organisations in assessing their challenges, in understanding how their processes may need to change or be streamlined. During the discovery and planning phases, we can introduce the benefits offered by process mining, integration suites, and RPA (robotic process automation) that can help realise the benefits required.

Is there anything else that organisations need to consider?

Tony: We’ve got to move away from the [idea] that technology, data and digital is a little department that sits there and makes sure your email works. We’ve got to get to the point where organisations realise that technology is now the bread and butter of how healthcare operates.

In trying to get that message across it covers a whole plethora of areas. So, at a very macro-level, ‘have you got a CIO (chief information officer)? Are they sitting at the board? Do the board truly understand what technology can and can’t do? And the impact if you do it badly – the risks, [e.g] cyber security?

At a strategic level, recognising the importance, getting the right skills and investments and the long-term view of what you want, enables the right decisions to be made, the right processes to be made and [then], finally, getting the right technology to deliver. 

What’s coming up for you over the next year?

Tony: The progression into the ICS model will open up opportunities to do more of what Neil described in meeting the interoperability goals.

Our team is ready to support – from helping people at a strategic level…and then coming down through the layers to support them at the technology stage with the architecture and the design, all the way through the procurement and the implementation to the benefits and realisations.

The excitement of being able to sit down and look at that from the top downwards and cover all those elements, from a ‘helicopter view’ right down to being able to ‘put the wires together’ and connect them is what I want Cloud21 to focus on.

To find out more about the company’s projects and aims, visit Cloud21.net. And discover more industry interviews in our dedicated section. 

The recent publication of the NHS report ‘Delivering a Net Zero National Health Service’ highlights that 62% of carbon emission sources in the NHS are generated by ‘medicines, medical equipment and other supply chain’: medicines (20%), medical equipment (10%), non-medical equipment (8%) and other supply chain (24%).

Mark Hitchman, Managing Director of Canon Medical Systems UK, said: “The NHS net-zero report highlights the interrelationship between the NHS (compounded by the COVID-19 global pandemic) and the fragile state of our environment. It reinforces the need to have global eyes to minimise impact on the natural world and prepare for climate change.”

“The world around us has a profound effect on our local health systems as the pandemic has served to illustrate recently. Future changes in climate, such as extreme weather and poor air quality, will further increase pressures on UK healthcare, such as asthma or respiratory issues. 2019 alone saw 900 more deaths from the summer heatwave.”

“The health system in England is responsible for 4% of the UK’s carbon footprint so has a moral obligation to look after the wider health of the planet. As a key imaging equipment provider to the NHS, and the only OEM with net-carbon credentials already, we will do all we can to support UK radiology with a focus on green and sustainable management of the imaging departments.”

“The recent announcement to create Diagnostic Community Hubs will keep patients closer to home and thus reduce travel related carbon emissions. But a rapid ramp up of medical equipment inside the ‘one-stop-shops’ to recover and renew UK diagnostics needs careful consideration – a green NHS needs sustainably focused equipment innovators.”

The company recently worked with NHS England to deploy fifteen relocatable Canon Medical CT scanners, as part of NHS England’s COVID-19 recovery plan to help with the patient imaging backlog and winter COVID-19 preparations. These systems had zero carbon tonnes of emission for the NHS.

Paul Chiplen, Director at CO2balance, a specialist provider of innovative carbon management and offset solutions to UK industry, added: “Supply chains that include independently verified carbon neutral players are incredibly important in verifying the strength of sustainability credentials. Our work with Canon Medical for over 6 years assures its customers and partners that its carbon statements and data are independently verified and validated. The NHS net-carbon targets alongside that of wider UK Government are positive steps forward to protecting the health of our precious planet.”

NHSX CEO Matthew Gould recently announced that all 42 Sustainability and Transformation Partnerships/Integrated Care Systems (STP/ICS) organisations must have a Minimum Viable Solution (MVS) shared record in place by September 2021. There are nine months left to achieve this goal.

Shared Care Record procurement and deployment has generally taken much longer in those areas that have one. Is there an approach that meets these timescales? We take a look.

The requirements of a ‘basic’ shared care record – the MVS

Like many technology projects, the programme team’s first query is: what are the intended requirements and deliverables? In November HTN reported that NHSX wanted a ‘basic’ level of record-sharing in place as set out by the Professional Record Standard Body in their Core Information Standard.

As well as general demographic information, this includes appointments, medications, care plans and more. The Core Information List includes over 1,500 data fields which might exist across hundreds of different IT systems. With NHSX wanting further interoperability of records to include NHS trusts, GPs and social care, organisations coming out to tender are shaping their own interpretation of what constitutes the MVS.

Integrated Care Systems and STPs are complex. Your ‘basic’ level of record sharing and your requirements, i.e. your MVS, will undoubtedly be different from another ICS/STP. How do you make sure you can design and deliver this interoperability for your teams’ requirements by September 2021?

Prioritise the objectives of your MVS

Keeping clear objectives at the forefront makes it easier to identify the indispensable critical elements needed for your shared care record.

What are your clinical priorities?

• Is GP data shared in the hospitals within your STP/ICS, especially in ICU?
• Do you need to manage repeat testing by sharing lab data across the community?
• Does the wider system have visibility of allergies and alerts?
• Do you need better transitions of care?

Flexibility: Start small and build incremental programmes

It is essential to manage scope and appreciate the interoperability capabilities within your organisation.  Start with the basics, add datasets incrementally and work at the pace your clinical teams can manage, between now and the end of Sept 2021.

Encourage clinical champions to support their communities through the change programme and adopt a common language to create a clear understanding of the proposed solution.

A measure of success will be the level of buy-in from your clinician teams; if they don’t believe it in, how can they endorse it?

What’s the end goal?

A shared care record enables any user across any care setting to view the same information about a patient in real-time.

Shared care records will pave the way to population health management, analytics and machine learning.

The fundamental requirements for your MVS shared record and any procurement are:

• A detailed health and care record – view everything in one place, including documents, medications, appointments, results, scans and care plans.
• Real-time data flow across care settings – update information once and share immediately.
• Role-based access – ensure users only see the information they need for their care setting and role.
• Integration across all health and care settings – build with Open Technology for complete interoperability with existing sources whilst allowing for future changes.
• Read and write capability – allow users from all care settings to collaborate seamlessly. 
• Single sign on authentication –enable users from all organisations to log in to the record using their existing credentials.
• Caseload lists – created by users and shared across care settings to promote collaborative working.
• An intuitive user interface – for users to quickly view patient information and activity from any care settings without the need for dedicated training.
• Cross-organisation search – allow users to find patients no matter which system they are registered with.

These fundamental requirements will give you the platform to enhance data sharing in the future and pursue a sustainable healthcare delivery model; as health services transform and patient participation increases.

A partnership approach to shared care records

When your supplier understands your needs and can design a shared care record with your users, with their workflows and patients in mind, it results in an interactive consultation. This improves collaboration and innovation and when professional needs are listened to efficiencies can be realised.

The discovery phase should not just be a technical audit, but an opportunity to understand each partner organisation’s local needs and their readiness to meet the project goals. Flexibility is key. The flexibility of the shared care record functionality must deliver a solution that meets the ICS objectives, tailored for each organisation to support a mixed pace and approach to local adoption. Only then can early benefits across all settings be recognised.

Suppose you and your shared care record supplier have an up-to-date view of the systems’ technical state and the clinical priorities. With this mutual understanding, you can plan and manage in a way that considers competing priorities and differences in system maturity, even where those priorities appear to conflict.

What technology do you need for shared care records?

Ask your supplier what type of technology they use to build, host and manage your shared care record. How will they integrate, and how will you have access to the care record? Will there be any dependencies on your local infrastructure? Will your supplier be able to add or remove user components, functionality and features without any downtime?

We at ReStart believe our interoperability solution, the IMX Clinical Record, is the answer. It is not a constraining, pre-defined product but instead is designed with your input specifically for your region and to address your immediate concerns. STP/ICSs can build their own MVS or ‘basic’ care records according to their users’ needs and current working practices.

IMX-CR can provide the MVS shared care record in as little as 12 weeks. The care record doesn’t require a large data repository and is developed using a modular approach to save a considerable amount of time. The incremental programme approach makes it very cost-effective as you never pay for functionality you haven’t asked for and don’t need. IMX-CR is fully interoperable and can integrate any system or embed within it.

We’re here to break down your silos of data from legacy or current systems. We work with clinicians to present a single source of real-time information, that enables better-informed decisions about patient care and a view of data you want, right from the start.

IMX-CR is hosted in the AWS (Amazon Web Services) cloud, and offered as a fully managed service with built-in data replication. Barring some access to, and integration with, local trust integration platforms, there are no dependencies on trust infrastructure. IMX-CR has micro-service architecture so we can update the system safely, without downtime, which is essential for a 24/7 NHS. Find out more in our latest blog ‘Why microservices are the answer for shared care records’.

Get the ball rolling today

The NHS has confirmed funding will be available to help STP/ICSs meet the 2021 target. We recommend getting the project underway as soon as you can before suppliers are fully booked, and you are at the end of the queue.

With IMX we challenge the 2021 naysayers and Mr Gould himself, “I do not want to put a timescale on deeper interoperability and getting away from the legacy estate and extraordinarily patchwork system that we start with, because it is complex and hard to pin down as a job.”

We don’t need to get away from existing technology at all. It is far more efficient for shared care records to embrace the complex patchwork already existing and capture it for re-presenting in a user-friendly way. We believe it’s the most effective method to deliver flexible shared records necessary for the regional NHS landscape. With the IMX Clinical Record, you can think big, start small, scale fast and deliver your MVS by September 2021.

Find out more

For more information, view the following:

• IMX Clinical Record product overview video
  Four-minute product overview to see a glimpse of the powerful functionality of IMX-CR.
• IMX Clinical Record booklet
  Downloadable PDF showcasing testimonials from our current customer base.
• Bedfordshire NHS Foundation Trust Interoperability case study
  Case study on how Bedford Hospital uses IMX to gain immediate access to patient information.
• IMX-CR website overview page
  Webpage for an overview of IMX-CR, including user testimonials and where healthcare organisations use our interoperable clinical record.

To discover more about how IMX can solve your shared care record challenge talk to an expert on 01392 363888 or email hello@restartconsulting.com.