NHSX, the central digital unit for the National Healthcare Service, has outlined its plans for governing standards and interoperability across healthcare organizations. The move is a positive one, given that past top-down efforts to standardize systems and processes across the NHS have proven very expensive and have ultimately failed.
The previous National Programme for IT, which wasted billions of pounds of taxpayer money and resulted in very little, highlights why standards and interoperability are a smarter approach for the NHS - where dictating technology use to a diverse and complex organization, with varying needs, simply does not work.
NHSX is hoping that if it can set strong guidelines for standards from the center, then this will result in greater interoperability across the NHS and ultimately lead to better care for patients.
In a blog post, NHSX notes that the challenge of interoperability for the NHS isn't a new one and that there is still a long way to go before it sees success. In fact the Wachter Report in 2016 and the NHS Long Term Plan in 2019 both highlighted the need for the approach.
However, NHSX hopes that its new plan will mark the necessary changes needed. Irina Bolychevsky, Director of Standards and Interoperability at NHSX, notes:
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.
The only way that tech can work in a complex health and care system is for clear, open standards to be set, effectively incentivised and enforced where appropriate. Local providers can then make their own choices, and as long as what they do and buy is compliant with the standards then everything will slot together and systems will be able to communicate with one another.
NHSX notes that the potential benefits of delivering an interoperable health and care system are great, including: improved patient safety through reduced errors; more integrated care by making the right information available at the right time and at the right place; allowing people to access their own information and supporting the use of data for population health, policy making and research.
NHSX is aiming to develop and improve the governance, framework and processes to support standards, which it hopes will get widely adopted across the system. Bolychevsky states:
The process for standards development and compliance will be streamlined through a robust model for standards development and implementation. This will be supported with clarity on what exists, what is required and which suppliers and systems are conformant.
NHSX will lead the work to establish fit-for-purpose interoperability standards, working closely with NHS Digital, the wider NHS, the social care sector, standards bodies and the vendor community.
The team has created a five point plan to drive adoption. These are:
A new end-to-end process and governance model for standards - NHSX believes that this will result in new standards that are fit for purpose and will be co-developed with key users and relevant communities. An end-to-end model will outline clear accountabilities, responsibilities and handoffs for adoption, maintenance and depreciation of standards.
Standards and interoperability strategy - the new strategy will outline NHSX's vision for a health and care service where interoperable systems are ubiquitous and the benefits of adoption are understood by clinicians and technical staff alike. It will provide the framework for overall objectives, guidance and guardrails for addressing key challenges.
Open source playbook - the playbook will provide "tangible guidance" and advice to providers and commissioners looking to adopt and implement open source solutions.
Long-term roadmap - a long-term roadmap for standards and interoperability will set out a pipeline for new standards and priorities for the implementation of existing standards. It will include a timeline for moving from one version to another and will assist vendors, providers and commissioners with planning and development.
A standards portal - this new service will include a registry of standards across health and care. It will bring together tankards by use-case, provide clarity on which standards are applicable, and will enable vendors, providers and commissioners to search for and easily locate the artefacts needed for implementing a standard.
It's good to see action being taken on this front by NHSX. We've seen the benefit that introducing common standards can have across government, when GDS did something similar a number of years back. Hopefully similar benefits can be introduced to the healthcare system - as it is much needed. Users of the NHS often note how poorly different parts of the system speak to each other, something which can be rectified through the adoption of common, open standards. However, the NHS is a huge, vastly diverse organization and this certainly will not be a quick fix. What's not yet entirely clear yet from NHSX is how much ‘stick' and how much ‘carrot' will be used to drive adoption. We will be watching progress on this closely, but the initial steps are very welcome and could drive real change.