FDB in conversation with Ann Slee: FHIR and the vision for interoperability

We talk to Ann Slee, NHSX Associate Chief Clinical Information Officer, about her mission to transform the healthcare landscape through medicines interoperability.

Hi Ann – can you tell us a bit about yourself and your role at NHSX? 
I lead the digital medicines team across NHSX and NHS Digital. Our collective aim is to introduce and define interoperability standards in the NHS and support adoption. Our goal is to enable medicines information to move safely between care settings across the NHS and Social Care, reducing the risk of medication errors and ultimately optimising patients’ treatments, thereby improving patient outcomes.

What are the main aims of NHSX’s strategy for data and ePrescribing?
Our vision is to support safer, more joined up care through the seamless, digital flow of patient medicines information across health and care: improving patient experience, reducing burden for health and care staff as well as increasing opportunities for research. Our goal is for consistent, accurate information about a patient’s medication treatment to be available - whether it is the patient who holds this information or the NHS. 

In your opinion, what role does FHIR play in this broader ePrescribing strategy?
UK Core FHIR and the related implementation guidance, will enable consistent information to flow across organisations, which in turn will improve health and care outcomes. FHIR is the messaging standard we use to move information around and across organisations and their electronic systems – it is the structure and standard for information transfer that the NHS is adopting.1 
If we’re going to achieve medicines interoperability, we need to define standards for the data/content within the messages, so that we can be confident it will support all the common use cases. Making sure we have both the messaging specification and data standards right is key.

Could you please tell us a bit more about the work going on with the Vendor and NHS Communities in using and developing services that utilise FHIR and provide interoperability? 
We are working with both vendors and clinicians (not forgetting patients) - whether they are experts or novices - to ensure we get this right. We must ensure that the standards, specifications and associated implementation guidance are clear and comprehensive. Timely engagement and involvement with multiple stakeholders is critical otherwise, we would come up with something that will just sit on the shelf, and it would be a missed opportunity.

Engagement, such as running stakeholder workshops and hackathons - is hugely beneficial. The live and dynamic feedback that we get from working with vendors and Trusts on the information and guidance helps us to understand what we’ve got right, and just as importantly what we’ve got wrong… and why. This feedback is also vital as it also helps everyone understand how and why they should implement. It’s about sharing and learning. It doesn’t matter if you’re from company ‘A’ or company ‘B’, and if you are normally competitors. It’s all about learning, sharing, and collaborating. Interoperability only works if all parts of the equation can share and understand the information. The hackathons are important to enable sharing and get input, creating something that everyone owns. This all feeds into our ultimate goal, which is improving care for patients, giving the best care that we can, and optimising medicines treatment for individuals. 

As described in the recent report on overprescribing ‘Good for you, good for us, good for everybody. A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions',2 one of the key challenges we have is that clinicians and patients don’t have the access they need to key information when they need it. Interoperability is the way we can achieve this. From my perspective, I want to give a massive thanks to all the people who have given time to support the work – the open and honest feedback and input they have provided. We have published information standards for medicines interoperability, and we wouldn’t be here without that collaboration.

How does the interoperability agenda fit national data and healthcare strategy?  
With regards to national policy, the Wachter report3  identified that interoperability has to be ‘baked in’ from the start. The NHS Long-term Plan puts access to information and data available through interoperability as fundamental. The Secretary of State’s policy paper, ‘The future of healthcare: our vision for digital, data and technology in health and care in 2018 also had interoperability at its core. Most recently, the overprescribing review again highlighted the need for medicines interoperability, showing a common theme which has been running over a number of years. Now that we have the standard for medicines information, the next step is to work with industry partners and the NHS to support uptake, which is why collaboration is vital. 

Do you see the pace that the industry is adopting this approach as encouraging? 
As UK Core FHIR for medicines interoperability is now a standard (recently published ISN DAPB4013), it means that the NHS needs to adopt its protocols by March 2023, i.e. in 18 months. We have sites that are using FHIR already, and we are working with vendors to broaden this. 

How is the healthtech industry and NHS sites doing in terms of uptake of FHIR? 
We are working with early adopter sites who are well on the way to developing systems using FHIR, while others are at the beginning of their journey. We are making sure that the medicines piece can be consistently used in a number of different scenarios and across all programs that involve medicines. We now understand where the gaps are and what the trajectory needs to be: we want to try to do this once and once only. With continued collaboration as described above, the tools can be developed to support care providers to achieve full interoperability, and it is clear where our priorities lie.  

Why do you think vendors need to be responsive to the interoperability agenda?
The direction of travel is to blur boundaries of care, and the traditional boundaries between organisations will change over time. Sharing information is going to be a fundamental part of care delivery - reducing medication errors, improving patient outcomes is something that we all want to support from whichever sector. We are all likely to be patients at some point…

Can you tell us about what is being done in the journey towards digitally joined up care?   
We are working with a number of ICSs around the country as well as the shared care programme to deliver shared medicines solutions - be it a common shared record or supporting messaging between sectors. This early work has already proven beneficial as it has informed the interoperable standards development and more importantly will deliver early solutions that can be used at a local level. In listening to those that we are working with, we have delivered tools that we believe will accelerate supplier development and aid adoption of the interoperable medication standards, allowing benefits to be realised more quickly. These are complex systems we’re working in, and as such we need to be cognisant of the fact that this will take time. We are working hard with suppliers and service to support adoption, and with the wider NHS and Social Care to convey the need for and benefits of putting the standards in place.

The potential for innovation is ever more visible as these common standards are being rolled out, and the opportunity to improve patient care is becoming a reality. 



For more information, visit: 






1 https://digital.nhs.uk/services/fhir-uk-core 

2 https://www.gov.uk/government/publications/national-overprescribing-review-report