Solving the NHS's interoperability problem

The UK government's policy commitments to digitalise the NHS as part of a wider initiative to improve patient services was an ambitious undertaking that, so far, appears not to have met its desired objectives.

In February this year, an independent panel of experts sitting on the House of Commons Health and Social Care Committee concluded that "the Government is making inadequate progress on vital commitments to digitise the NHS".

Specific failings included lack of support for the improvement of digital capabilities, insufficient funding and a lack of essential digital skills.

The policy commitments assessed by the panel concerned:

• The care of patients and people in receipt of social care;
• The health of the population;
• The cost and efficiency of care; and
• Workforce literacy and the digital workforce. 

The benefits of meeting these commitments include:

• The ability for patients to move effortlessly between NHS organisations and locations; and
• Providing the UK's healthcare system with valuable datasets for research, development, and innovation. 

The panel also highlighted a lack of interoperability – i.e., the ability of different IT systems to exchange and make use of information – as a particular obstacle for the NHS.

While for the NHS's legacy IT systems, interoperability remains an almost alien concept, it is a familiar design feature for IT service providers as they (and their customers) contend with data portability rights under the GDPR.

The need for interoperability across the NHS provides an opportunity for IT service providers to share their expertise and experience and to be at the forefront of digital change within the health service.

Why the focus on Interoperability?

Areas of inadequate progress highlighted by the Select Committee panel included:

• The roll out of a central integrated health and care record system; and
• The de-identification and re-use of data collected from GP practices. 

The process of moving data between systems and ensuring each of those systems can understand the information received is fundamental to technology solutions achieving their potential.

In other words, success requires the alignment of data formats according to agreed models and schema, and a common terminology.

Interoperability within the NHS would allow for innovation of practices and treatments by leveraging the vast amount of data the service holds and processes on a daily basis.

However, it relies on the structure and quality of the IT systems embedded across all health and care providers within the network. This presents a particular obstacle, largely because levels of digital maturity across NHS organisations vary, with a lack of harmonisation across the many technical systems and interfaces used.

From a practical perspective, while the NHS has embedded new technology in many areas, the lack of consistency is hindering the technology from performing as effectively as it could do.

What are the potential implications for IT service providers?

The Select Committee's findings may refocus NHS organisations' attention on overcoming barriers to digitalisation, and particularly interoperability.

To achieve this, they will need support from IT providers who can collaborate with front line staff to understand the required areas for development, and implement the necessary changes successfully.

By gaining valuable knowledge and building a relationship with health and care staff, IT providers may be able to use their insights to position themselves to deliver integrated solutions for NHS organisations across the country. This could also help avoid lengthy integration phases, which is a typical pain point.

While some suppliers may continue to procure directly with an NHS organisation, there are increasingly other routes available, such as tendering for a slot on the new NHS Digital Buying Catalogue through new or upcoming frameworks, including the GP IT Futures programme.

The introduction of the NHS Digital Buying Catalogue provides a clear and structured method for any health care provider to procure IT systems and an opportunity for IT suppliers to raise awareness of their IT systems for NHS consideration.

However the NHS procurement process can remain challenging for some suppliers. NHS organisations are expected to implement contractual controls to meet existing and evolving policy aims and guidance, which may lead to tougher negotiation environments.

IT providers may expect to be required to sign the TechUK Interoperability Charter, which involves a commitment to sharing and cooperation with other NHS suppliers with respect to technical specifications, as well as adopting international recognised standards.

Further, there may be a focused effort in continuing the development of software solutions in the open, for greater transparency and efficiency across NHS organisations.

In November 2022, we wrote an article on Open-source software (OSS) for software developers; while some NHS contracts may insist on OSS, developing software in the open can assist the interoperability process, building a collaborative environment between IT suppliers and healthcare providers.

Unsurprisingly, and in addition to interoperability, suppliers will need to place greater emphasis on privacy by design, technical security and other trust-building mechanisms.

The existing UK policy framework focuses on the flow and use of health data across public sector health providers, similar questions of interoperability are prevalent in the EU community as it seeks to implement its European Health Data Space (EHDS) regime.

The EHDS rules could see IT suppliers having to comply with mandatory interoperability criteria to respond to compulsory licence requests from 'data users', which is planned to include both the public and private sectors.

Conclusions

The lack of interoperability within the NHS remains problematic for the NHS and IT suppliers; however, there are a number of measures suppliers can implement to mitigate associated risks.

The opportunity remains for suppliers to participate successfully in the NHS's digital transformation and aid the movement towards interoperability.

It is becoming increasingly evident that IT service providers in the health and care sector have an opportunity to differentiate themselves in the marketplace; however this is somewhat reliant on the government delivering on its policy commitments and providing the necessary funding and focus to establish interoperability.

This article was authored by Chris Eastham and Olivia Woolston Morgan, Technology Partners at Fieldfisher.