Fixing the plumbing is only half the story of getting information flowing across health and care 

For too long we have assumed that if we just get the right kit in the NHS and social care our problems of getting one computer to talk to another would be solved.

Unfortunately the interoperability solution that has evaded health and care for so long isn’t simply a matter of plumbing in the tech and pressing the on button. Job done. It’s partly about the tech, but it’s also about the funding, the people, the cultures in health and care and how we fix all the moving parts with the engine running.

NHS England in collaboration with the Faculty of Clinical Informatics, is consulting on a Standards and Interoperability Strategy for health and care, which promises to provide a framework and guidance for standards implementation that addresses challenges to interoperability.

PRSB supports this work and I want to encourage colleagues in the digital health and care space to take part. Having a clear, sensible roadmap to deliver interoperability based on standards is exactly the right thing to do and PRSB is fully behind this strategy.  

PRSB’s views have been shared with NHS England and the Faculty and we felt a public summary of our feedback would be useful for members and supporters to view. Our conclusions are based on themes and ongoing discussions with our members and stakeholders over the last several years and include.

Social Care

We cannot achieve interoperability until health and social care systems share information about the people in their care. If we are to deliver the aim of ‘integrated care’ through interoperability, social care must be prioritised in the same way as health when setting out our vision for the future.  The needs and priorities of social care need to be front and centre to engage social care stakeholders and better reflect our collective objective of an integrated, digital transformation.

System suppliers and vendor conformance

System suppliers offer a valuable perspective and the system would benefit from more consideration of their views, particularly in relation to the life-cycle experience for system suppliers in contributing to development and adoption of standards. Our Partners  describe challenging, time consuming and disjointed approaches that makes it harder than necessary for them to contribute, and by including their perspective, it will help to overcome these challenges at the beginning of the interoperability journey.

The Standards Partnership Scheme is already having a significant impact in conformance. It is welcomed that the system is considering conformance as a key tool for measuring and assessing standards’ implementation, but it would benefit from a clearer analysis of how this is already being done and therefore, what can be done to strengthen existing processes for conformance.

The inherent value of information record standards and relationship to interoperability

Health and care are rightly focused on interoperability as a goal, however, this focus fails to recognise the value of precisely defining information content standards in their own right – i.e defining good practice and optimum information needs for a given use care. This content is a pre-requisite for interoperable sharing of the data and neglecting this for just the technical structure runs the risk of creating a beautiful piping system delivering the wrong water. By recognising this, it will be easier to engage the professions and people we represent.

High impact changes – alignment of regulators

Safety, care quality and efficiency would be improved by aligning standards for interoperability with regulation of health and care. PRSB believes that the inclusion of standards in regulatory regimes such as the Care Quality Commission’s inspection regime would deliver significant benefits. Our members and vendor partners tell us this would have a major positive impact on advancing the use of standards and this should be a stronger stated direction for national policy.

A robust and sustainable infrastructure for curation and evolution of standards

There should be an acknowledgement of the importance of supporting, maintaining, and evolving the standards in a structured way with strong feedback loops from all stakeholders to improve and strengthen the standards as they mature. Developing a process for adoption of local standards is good but there has to be recognition of rigorous guidance and assurance so that clinical buy-in and support for a common maintainable model is assured.

Building on what is working well

It’s important to look at what is working well currently and where the biggest issues are so that the resulting plans are based on evidence and actions can be prioritised according to the greatest needs. For example, the existence of the PRSB, its burgeoning membership, the level of buy in and commitment to the standards from nearly 80 professional bodies provides a foundation of support from the users of standards never previously achieved. The suggestion that the system needs to be ‘based on open standards that are developed and maintained by a collaborative and consensus driven process’ – that is a good description of what PRSB do today and is well supported and trusted by our members. It is important to acknowledge the work already existing in this space to ensure that we do not risk repeats and restarts that our members tell us damages confidence and enthusiasm in the standards and interoperability mission.

These are just some of the core components of our feedback to NHS/EI, which we hope will be incorporated into the final iteration of the Standards and Interoperability strategy, to ensure it is as beneficial to as many working in and using the system as possible. We would strongly encourage everyone to take part in the consultation and share their views by going clicking here.

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