Integrated healthcare requires a more open approach to Health IT
Tony Shannon, the clinical lead for Ripple, discusses the thinking behind building an integrated digital care record platform, underpinned by an open architecture
If there is one certainty about the successful integration future of health and social care, it is that it will never meaningfully happen until we are able to seamlessly share and use digital care records.
We have known this for a long time and the ambition of having an IT system to enable this is what motivated NHS Connecting for Health to try to connect 30,000+ GPs with the 150+ hospitals in England.
The benefit of time and hindsight has shown the flaws in this approach to providing shareable care records.
Most obviously, it is clear that mega-projects like this are simply too big to be deliverable. They are certainly too big to be manageable – just witness the resources consumed for so little gain.
More pertinently, it is clear now that although we were working towards the right goal we were failing to address the underlying issue which would always stymie information sharing: that is the ongoing proliferation of bespoke or proprietary IT which will never be efficiently interoperable.
So here we find ourselves over a decade later, some distance from achieving the connectivity we need across NHS England.
An Android for the health IT market
A recent change in emphasis to investment in and provision of solutions which deliver integration at local not national level is now allowing us to make some progress towards the goal of enabling shared access to health and care records.
Certainly, this devolved approach is what allowed us to launch the Leeds Care Record in 2013. This provides a single overview of the care provided to individuals across the 105 GP surgeries in Leeds. It’s been a successful initiative with immediate and tangible benefits for healthcare professionals and patients. As a result Leeds City Council have supported the development of the related Ripple platform, which is now being explored in the context of a city Person Held Record, with other organisations and authorities exploring the reuse of this open source platform outside of Leeds.
The approach to this project gives some clear hints as to how we need to approach some of the bigger challenges we face.
The first lies in the scope of the project where the ambition was to start small and try to improve from the bottom up – hence the name Ripple – rather than enforce change from the top down.
Allied to this is the fact that it is clinically-led – focused meeting on the common needs of health and social care organisations – the primary objective isn’t to improve technology but to improve the integration of care.
When it comes to using technology our view is that in the same way that the open Android de facto standard paved the way for disruption and change in the smartphone market – (the last time I looked this open platform now powers more than three quarters of the world’s smartphones and all the apps that sit on them) – it is open source and open standards that will disrupt and liberate NHS IT.
For this reason, open IT principles which aim to address the challenge of integrated care are consistent right across our work.
So when it came to creating shareable electronic health records we focused on using OpenEHR, a de facto international standard which had already developed from within University College London. To enable better integration with the wider range of systems within the NHS we are focusing on the use of open APIs as a way of leveraging information held in bespoke or proprietary systems. We have also created open governance documents which set standards for information sharing and information governance.
A final lesson we can learn from Ripple is that after years of NHS workshops on technical architecture and stand-offs with vendors which have delivered little in the way of a scalable health IT platform, getting on with building and delivering something which solves a problem is the most powerful way of moving forward.
So that is how I believe we must move forward: putting open source and open standards at the heart of our work, collaborating to solve clinical problems and being disruptive. If we can jointly commit to doing that, solving problems from the bottom up, we’ll be in a far better place to tackle bigger challenges down the line.
Dr. Tony Shannon is the clinical lead for Ripple - a team working to build an integrated digital care record platform, underpinned by open architecture. Dr. Shannon background is as an emergency physician, who work now involves information technology in healthcare. He has a masters in IT management.
He is a contributor to Eduserv’s Executive Briefing Programme report on health and social care integration, Part II, The potential of digital