Interoperability is a peculiar word. It sounds like something that is expensive and complicated that demands advanced IT skills to put in place. In fact, it describes the biggest advantage of modern digital healthcare systems. Every healthcare service provider should embrace it. But what is it, and why do you need it?
What is interoperability?
Interoperable systems can exchange data with each other. In primary care this means one GP can share information about a patient with another GP or with other health and social care providers. They can add information about the care they provide and make this available to the registered GP.
Every clinician and carer can treat patients using the same up-to-date information. This is safer, more efficient for the NHS and improves the patient experience.
Debunking the myths
There is a lot of misinformation about interoperable systems. Here are some of the biggest misunderstandings.
1. Everyone has to be using the same system
Saying that all GP practices in an area must use the same system before they can share information is a mistruth. It comes from a web of misinformation that system suppliers spun several years ago. It suited them at the time because their systems could not interoperate.
Stop to think for a moment. The core principle of interoperability is to have existing systems sharing data. Using the same system across an area will only allow those people using that system to view each other's records. But the nature of the NHS is that there will always be many teams that need their own specialist systems. The new models of care described in the NHS 5 Year Forward View involve collaboration across the NHS. It is not possible for health and social care in its entirety to use one system. Interoperable systems are vital and the only option.
2. Patients don't want to share their records
There is a misconception that people don't want other clinicians to see their GP's medical notes. It is only the extreme minority that refuse consent once they understand the benefits. In London, the Richmond GP Alliance (RGPA) run an extended hours appointment service. In its first year only 1 patient out of 45,000 refused consent for a different GP to view their medical notes.
3. You can't control who sees patient data
NHS England says "The law allows personal data to be shared between those offering care directly to patients". How can interoperable systems make patient notes available anytime without compromising security? The answer is to use sharing agreements. The local healthcare team agrees:
- who can access shared medical records
- which patients' records are available
- what aspects of the record are available for a given service
- specific data elements or Read codes to exclude
We transfer these rules into electronic sharing agreements. They restrict sharing to authorised clinicians and the agreed data. This approach allows services to run in parallel, sharing particular data with different people for each service. An audit trail shows who accessed shared records along with the time and reason for access.
4. It's too expensive
It's true that you can spend a lot of money implementing interoperable systems. But it doesn't have to be like that. One thing is for certain, it is much cheaper than forcing GP system changes for many practices (see point 1 above).
The benefits created by interoperable systems outweigh the costs. These benefits vary depending between services, but include:
- more appropriate use of resource
- fewer hospital admissions and unnecessary A&E attendances
- improved outcomes
5. It doesn't work
Using data from existing GP systems was one of the challenges the RGPA faced when planning their extended hours appointment service. The federation consists of 22 GP practices using Vision and 6 using EMIS Web. For their service to be workable the patient records from all these practices had to be available to GPs working in the evenings and weekends. They had to have end-to-end interoperability between Vision and EMIS systems.
Vision supplied a solution that achieved this. Any patient registered with a Richmond GP can use the service. The clinicians have access to full medical records, and they are only viewed with agreement from patients.
RGPA board member Dr. Neil Jackson has recorded a webinar describing their experience. Right at the end he is asked if the end-to-end interoperability between systems works. Watch the webinar and listen to his answer.