Interoperability thinking improves care at Walton Centre NHS Trust

Interoperability has become a much-used and meaningful word in healthcare in recent years, in particular in the UK, even if there have been some outrageous claims made for it. But it is the case that digitization of the publicly-funded NHS has been an ongoing agenda item.

With the announcement of Sustainable and Transformation Partnerships (STP) in 2016, the UK found itself once again bringing NHS trusts, local government and social services together, connected by access to information and technology. The 44 STPs bring these organizations together to jointly decide on the future of health and care systems to be used in their region under a five-year plan reaching 2025.

The British Medical Association (BMA) backed the introduction of STPs by the Conservative government, but with reservations on the "enormous pressure on STPs to deliver savings...plans were focused on finances, not care."  

As Head of IM&T at The Walton Centre Foundation NHS Trust in Liverpool since 2001, Justin Griffiths has been through the full gamut of NHS technology-led policies, but as a highly specialist care provider, interoperability has been at the centre of Griffiths' strategy, as it is the STPs. Underpinned by a Patient Administration System (PAS), the Walton Centre has focused on interoperability since the early years of the century.

It's not brain surgery, but of course it is.

The Walton Centre is the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management - brain surgery as the CIO puts it. Nearly 3000 elective operations take place a year, and 2000 emergency operations, serving patients all across the North West of the UK as well as the Isle of Man and Wales.  

It is the largest concentration of specialists outside of London, and everyone is very proud to work here. The trust treats people with neurology issues such as multiple sclerosis and motor neuron disease.

Pandemic proof

The Coronavirus pandemic has, if it was needed, proved the point of interoperability as health and social care providers had to adapt to the national lockdowns and still treat patients. For healthcare CIOs and their counterpart Clinical Chief Information Officers (CCIO) the benefits of interoperability have been demonstrated clearly.

I spoke about interoperability five years ago, and it was almost frowned upon, but luckily we have an executive team here that believed in what we were doing towards this.

Griffiths has had the freedom to think differently at Walton Centre, in part, he admits due to the specialist nature and size of the trust. Walton Centre has developed what the CIO calls a presentation layer on top of its PAS to deliver that all-important interoperability.

Our role is to make sure the consultants can do their day-to-day job and have all the information at their fingertips to do that.

Griffiths describes the renewed focus on interoperability as healthcare going full circle.

A lot of the large admin systems are not, in fact, a single system, so they are no different to adopting and integrating best-of-breed technologies as we have done. 

He adds that just as interoperability is back in vogue, so too is joining up the different agencies that care for those most in need in society:

An STP is like being back with regional health authorities. But now really is the best time to get health data moving around so that everyone will benefit.

Regional Health Authorities were disbanded by the then UK UK Prime Minister John Major in 1996, but in the 2020s, the pressures on health and social care mean this decision is being reversed, but with an increased technological focus.  

Despite how the limbs of political power have moved, the Walton Centre has always kept its head and focused on being patient-centric, which leads to interoperability.

Concentrating on the presentation layer means that we can move data around really effectively. Consultants don't care how you get the data there, as long as it is in a uniform state. So the logic was that data had to move from system to system. Rather than a single system, we concentrated on a best-of-breed approach.

For the last 17 years, the trust has used the PAS from Silverlink Software. That relationship has recently been extended for another five years. Walton Centre technologists have then developed APIs and the presentation layer on top of the Silverlink PAS. Griffiths describes the PAS as the architectural foundation for this approach, adding that the freedom and ability to develop on top of the PAS has saved the trust millions, a freedom a PAS from a global giant would not have afforded to them.

On the clinical side, we do some modular development in open source. For example, we developed a time in theatre module that is incredibly flexible as most theatre scenarios overrun. 

Griffiths' team of four developers created the theatre system having developed a risk assessment package when Walton Centre found it could not find a package that met their requirements. The electronic patient record (EPR) is also self-developed by the trust, and the CIO says the development time was equal to that of migrating to an EPR from a major provider.  

APIs quite often go against the commercial model of most PAS providers.

Griffiths says Walton Centre has developed a two-way relationship with Silverlink Software that sees the developments his team make fed back into the software provider and their product.  

With a big vendor, there are too many layers for change control. The PAS is used for clinical appointments and has a master patient index, so it is our core for the patient record too.

Future thinking

Griffiths has developed a strong relationship with the local universities in Liverpool, which gives the Walton Centre access to regular sandwich year students, the students gain real experience of developing healthcare technology, and the CIO says the trust gains access to the talent the city is producing, and many return once their studies are completed.  Next on the CIO's agenda is to produce some TED Talk style presentations to tell the story of technology in healthcare and continue to build that trust. He adds that this will be vital as the digital health agenda continues to grow. The Walton Centre is looking to become a level seven trust in terms of digital maturity - a standard set by the Healthcare Information and Management Systems Society (HIMMS).

Like a number of his peers, Griffiths is excited by the opportunities the next generation of technologies will provide to healthcare.

I really do believe that assisted and Artificial Intelligence (AI) is incredibly exciting. The most important thing is always the use cases.

He believes that Low Emissions Bluetooth could be just one example of a technology that may not get the hype of AI and machine learning, but could really make a difference to healthcare. Placed in the homes of patients, Low Emissions Bluetooth could trigger the action of providing all of patients records to a visiting clinician when they enter the home - a clear case of interoperability thinking.