Connecting up healthcare - interoperability shows vital signs of improvement

Mark Chillingworth Profile picture for user Mark Chillingworth March 18, 2022 Audio mode
Digital healthcare needs to be well connected, and patient-centred say CIOs and industry leaders

Medic using healthcare technology on tablet © metamorworks - shutterstock
(© metamorworks - shutterstock)

The rapid adoption of new healthcare technologies during the pandemic lockdowns has brought the need for improved interoperability between health systems into focus. In common with all sectors, healthcare intends to keep the pace of digitization high, but for digital healthcare to succeed, interoperability between the vast array of applications and medical devices in use by health services has to improve. Failure to do so will impact the patient, slow the adoption of the next wave of technologies and disappoint the tech-literate clinicians entering the sector.

Interoperability is when different devices and applications exchange data with one another, as well as other applications, this data exchange must also be able to take place across organizational boundaries.

It is a decades-old challenge and a long-time priority.

Wrote Irina Bolychevsky, Director of Standards and Interoperability at NHSX (which has recently been folded into NHS England), a National Health Service (NHS) technology body. In September 2021, Bolychevsky and NHSX began increasing the focus on interoperability with the formation of the Standards and Interoperability team. She added:

While important progress has been made, the interoperability agenda has further to go.

Ananda Kanneganti, CTO for Healthcare Consulting (Northern Europe) at systems integrator Atos adds:

New medical equipment has become more commonplace, so interoperability has become more important, and you need interoperability to make sense of the data.

The interoperability challenge

A health services technology estate is as complex as the human body. Take Calderdale and Huddersfield NHS Foundation Trust, which spoke to diginomica in the weeks before the pandemic hit the UK. This Yorkshire Trust provides emergency, maternity, gynaecology, critical care and children's medicine. Between 2018 and 2019 clinical care was delivered to 119,000 people, 440,000 outpatients, 150,000 were accident and emergency admittance and 5000 babies were delivered. Just as the maternity ward's clinical needs are very different from the outpatient department, so too, often, are the technologies in use. 

However, a patient is likely to deal with several different departments - especially in a country like the UK with a rapidly ageing population who will have a number of different illnesses at any one time. Data sharing becomes even more important to improve care and operational efficiency. Bolychevsky points out:

The NHS and care sectors are too diverse for a one-size-fits-all single IT system to be the answer. Equally, letting a "thousand flowers bloom" can lead to thousands of different systems that do not speak to each other.

Kate Walker, Digital Programme Director for Suffolk & North East Essex integrated care service, who has been a CIO for major NHS trusts, adds that technology leaders must be aware of the patient and their needs:

Interoperability has been a challenge in many areas. COVID-19 has accelerated so much digitization that we can make the more vulnerable and seldom heard even less heard. To better serve the people in our communities we need to be able to put the person at the centre of their care.

Kannegant says the adoption of Fast Healthcare Interoperability Resources (FHIR) - a global open-source standard for healthcare data - is a step in the right direction, but he has concerns about the monolithic systems many large health services have in place.

They have good breadth, but not depth; take oncology, you need specialist oncology systems and then a need for integration. As health moves to greater APIs, FHIR will make things easier, but the challenge will be the legacy systems that cannot support FHIR.

Mat Rule, Founder and CEO of Toca.IO, a technology provider that has introduced Low Code to health, agrees and says large scale investment in electronic health record (EHR) systems prevent innovation.

Interoperability opportunity

Unless health service organizations prioritise interoperability, there is a concern that this will impact patients. Digital healthcare consultant Kevin McDonnell says getting the entire organization to understand and appreciate the value of interoperability is a big hurdle. Walker says interoperability is key to good care:

As we recover, it is critical that the information is wrapped around the patient's needs. Traditional healthcare involved going to a place for care. Now there are many different organizations providing care, so we need to make sure that people are not repeating their story time and time again. Their needs must be forefront in a clinician's mind.

Former clinician Dr James Somauroo says of his previous life:

When I was a clinician, there were not the same expectations for everything to be seamless. Now the idea of writing blood test results in one place and then another and then communicating them to someone, and they then write down the results again, that complexity was normal. You were annoyed by it, and you knew there were efficiencies to be had.

Dr Somauroo, now a healthtech advisor and CEO, goes on to add that clinicians entering healthcare today have had their interoperability expectations shaped by their technology experience outside of the ward.

"Everything is done on the supercomputer in your pocket."

Despite the complexity of the health sector, Agile and rapid deployment of technology can be done. Rule at says:

We built a cancer pathway system, it took six months to get the needs; building the system took four days to go live.

Ultimately the real opportunity is to benefit the patient, as Bolychevsky of NHSX, now part of the NHS Transformation Directorate says:

The benefits of successfully delivering an interoperable health and care system are huge: improved patient safety through reduced errors; more integrated care by making the right information available at the right time and at the right place; a thriving and innovative health tech sector with usable apps and products; people able to access their own information and supporting the use of data for population health, policymaking and research.

By ensuring interoperability across systems, we avoid delays in diagnosis, prevent tests from being repeated unnecessarily, and speed up the process of starting people on the correct treatment and care.

Care also takes place outside of the hospital or GP surgery, and there has been a belated realization in the UK that social workers and local government need to be integrated more efficiently with the NHS. The good news is that this is already coming together in some communities. Norfolk County Council CIO Geoff Connell explains:

We developed a vulnerability hub, a database that we set up in a day for multiple agencies. So if there is a household that is vulnerable, you can have a view of that as the County Council, District Council, NHS or even some voluntary bodies, so you can all coordinate care.

European focus

Interoperability is a high priority for the new European Health Data Space, a major investment programme to increase data sharing - within the realm of GDPR across Europe. The European Health Data Space aims to improve healthcare delivery, medical research and innovation across the continent, and health policy amongst the 27 member states. Interoperability is one the pillars of the European Health Data Space, and the European Commission states:

To fully exploit the potential of exchanging health data, it is essential to ensure health data quality and that the various sources of health data are able to "talk" to each other. This requires technical and semantic interoperability between the different infrastructures and IT systems.

EMEA CIO Francesco Buonarroti, for pharmaceutical firm Johnson & Johnson told the Masters of Digital Conference:

We need an ambitious European policy, and we see best practice that has momentum in France and Germany. The process of research to beat the biggest disease is international, not national. 

It's in the data

Consultants don't care how you get the data there, as long as it is in a uniform state.

Says Justin Griffiths, Head of IM&T at The Walton Centre Foundation NHS Trust, who has long been an advocate of interoperability. Kanneganti at Atos agrees but says data quality is a big issue.

The context is really key; 10 kilograms, for example, is that the weight? Or is the clinician asking the patient to reduce their weight by this? Semantics is really important.

CIO Walker adds that data silos reduce the ability of clinicians and health services to provide care.

We can carve out time to care, and that is really key.

Data quality issues will be even more important as healthcare organizations look to adopt the next wave of data technologies, including artificial intelligence (AI) and machine learning (ML). McDonnell at Datalla Group adds:

Everyone is interested in AI, but 80% of the cost of AI is getting the data cleaned before you can deploy the algorithms.

A grey colored placeholder image