'How standards will provide interoperability support'

FDB’s Ian Arrowsmith shares his thoughts on the new draft document from NHS England/Improvement Transformation Directorate

In April 2022, the Faculty of Clinical Informatics (FCI) published a new draft strategy ‘How standards will support interoperability.’ Commissioned by the Transformation Directorate at NHS England and NHS Improvement, the draft strategy was put out for comment and input from the digital healthcare sector. We talk to Ian Arrowsmith, Head of Clinical Operations at FDB, about the new guidelines and how this is going to shape interoperability support and standards across the digital healthcare space.  

Hi Ian, could you tell us about this new strategy, please?  
This is a new strategy which is intended to provide the framework by which the sector is able to move forward with interoperability, bringing into focus the latest conventions and technologies.  It dives into the infrastructure that NHSD and others are looking to provide and how vendors and others operate – and should be prepared to operate more collaboratively in the future. It really resonates with the team at FDB because of the work we do here and is very closely aligned with our ongoing strategy. 

What are the new guidelines proposing? 
Essentially, the guidelines are looking at interoperability across the entire care sector, something that FDB and its solutions already support and are ready to work within. It’s an emergent model which updates previous strategies and provides key standards for the care digital ecosystem. 
The vision is: ‘A health and social care system that enables all relevant care information to be accessible by those who have a legitimate right to do so, at the point of need, no matter where it is held.’
The strategy talks about achieving interoperability thus: ‘allows people involved in the provision and receipt of care to seamlessly exchange and access the data they need to inform care decisions across a whole pathway, using the tools that work best for them.’
The report talks about the impact on clinical safety of current systems not 'talking to each other' and advocate the following: 'The only way that technology can work in a mature health and social care system is for it to be based on open standards that are developed and maintained by a collaborative and consensus driven process. ' 

What are the challenges facing interoperability support? 
Among the many issues that need to be addressed is the key challenge: ‘Health and care providers are solving interoperability challenges alone or in silos leading to inconsistencies, duplication and wasted resources. This is something that we’ve all seen in the past, and NHSD are cognisant of the impact of silo solutions on interoperability – hence why they are tackling this head on. Despite Wachter, Topol and others, there remains a strong tendency to look at standards and interoperability as a technology change rather than an adaptive cultural and transformational change - the evidence is that we will not succeed unless this balance is redressed.’  
Importantly, whilst the objectives of the strategy are very obviously laudable, the action plan that must accompany this (following a hopefully successful consultation) is probably the most important thing we all need. Stakeholders, particularly in the commercial world, need more motivation than it being a good idea – there need to be sticks and carrots to ensure commercial concerns move at the pace required. There is a section in the strategy on aligning drivers and incentives, but it is inevitably speculative at this stage.

What does the draft strategy suggest doing? 

1. Define a model care record. 
For health and care practitioners to integrate their working practice they will need to maintain care records fit to share with other practitioners, carers and the people receiving their care.  While each IT system maintains its own physical data store, there must be increasing consistency of how medical records are maintained which will ultimately provide more confidence in the data being transferred from one system to another.  Organisations including National Institute for Health and Care Excellence (NICE), Professional Records Standards Body (PRSB) and Royal Colleges have come together to describe business requirements for medical records.

2. A common understanding of the meaning contained in health records.
We need to create reusable, commonly understood formats and codes in these models (data definitions and terminologies). To achieve the vision, the strategy focusses on key standards that will work together to allow information to flow through the system:

  • ICD-11 
  • A procedure-based classification (PBC) 
  • Unified Test List (UTL) 
  • dm+d 
  • HL7 FHIR 

3. Make implementation easier.
The strategy proposes to create a number of artefacts and services which should make the interoperability support standards easier to adopt like a standards directory, standard FHIR profiles and SNOMED value sets.

What’s the ‘healthcare digital ecosystem?’

The ‘healthcare digital ecosystem’ is a term that’s been used quite widely in the US healthcare space. It’s all about online healthcare services, for instance, prompts to the patient at home or in a different care setting to monitor blood pressure and enabling ease of access by the patient or other clinicians caring for the patient.  Access to instantly updated available data. To me it sounds like we are moving in a similar direction in the UK. As a UK-based and founded, but US owned digital healthcare company- we’ve got a lot of backing from our FDB team in the United States – so it’s really interesting to see some of the parallels going on there and how we can take learning from our US colleagues to develop here in the UK.

The objectives of the strategy and the mechanisms by which they are expected to be achieved are worthy, however, this is not the first such interoperability support strategy to be produced and the timing of any initiative as well as the motivation (financial or otherwise) are vital as to whether it will succeed in achieving the main objective of delivering a truly joined up digital care ecosystem.
Some of the dates are not too far away (like dm+d adoption expected by April 2023) so it will become clear soon what trajectory the strategy is on. Typically, most of the objectives will happen but not necessarily at the desired rate. The strategy at the very least gives all stakeholders a direction of travel.