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by Inderjit Singh
Published on February 5, 2018

In this post, we take a look at the interoperability initiatives at work in England’s National Health Service, a publicly funded organization dedicated to commissioning of health care services in England. This article originally appeared in Perspectives, a thought leadership publication dedicated to rising trends and issues in the health care and IT industry. For more information about Perspectives, go here.

The need for effective sharing of health and care information to support new and emerging models of care is a clear priority for the National Health Service (NHS), as more organizations in our industry are moving toward integrated care and realizing the need to manage total cost and quality of care for local populations.

Principles to achieve interoperability

Underlying the efforts in service integration, the NHS has been driving forward a collective approach to enable each part of the health and care system to digitally “speak” to other parts of the system. This approach is based on a number of key principles:

  • Break down the “interoperability” problem into key priorities for the service. Recognize that interoperability is not just a technical problem about standards but also a need for focus on service changes.
  • Alignment with the direction of the market in the development of common standards so that we move with, not against, the market.
  • Build in professional input in the development and validation of interoperability approaches to focus on the professional and clinical value that it enables.
  • Build a community that brings together professionals, vendors and national organizations in the co-development of interoperability solutions.
  • Encouragement of international collaboration across geographies in the development of and lessons learnt on interoperability.
  • Use of levers and incentives to drive adoption and uptake. 

Too often, we speak of interoperability strictly in technical terms. While adoption of a global, open API standard is important, if suppliers, clinicians and patients don’t see the benefits of personally investing in interoperability, we’re left with a theoretical platform but not the practical implementation of its true capabilities.

A strategy for interoperability

Often, the term “interoperability” can often mean different things for different people. NHS’s approach is to focus on several key priorities to provide benefit to professionals and patients and then build on this momentum to deliver future priorities. The initial focus has been key transitions of care, enabling transactional functionality (e.g. appointments booking, task/notifications across GP federations) and access to care record information across care settings.

By breaking the problem of interoperability into manageable, actionable chunks and focusing on key priorities for each organization, we can create solutions that demonstrate viable benefits and more people will “buy in.” Government and technology are two levers that have the greatest opportunity to change people’s lives at scale. The NHS is in a unique position at a national level to move those key levers and provide incentives to drive adoption of these standards.

Recent successes point to over 70 percent of acute hospitals now sharing the majority of their discharge summary electronically to primary care. Building on this, we have developed a set of professionally endorsed clinical content standards for discharges, A&E (accident and emergency) discharges and outpatient letters as well as transitions to social care so that this information can be shared consistently. In England, the Professional Records Standards Body has been established, which represents the Academy of Medical Royal Collages, so that we can build in professional input and validation into the content of key interoperability standards upfront.

Global moves toward FHIR and open API standards

In addition to building in a professional endorsement of the interoperability standards content, we’ve also proactively set the strategic direction at a technical level on the use of Fast Healthcare Interoperability Resources (FHIR) as a future dominant API standard. It’s important to recognize the move in the global market to FHIR and how FHIR enables innovation, especially in mobile apps, while also working in the direction of the market to speed up adoption. This takes account of lessons learned from previous initiatives that created UK-specific standards that needed bespoke investment from the market.

To drive the development of FHIR standards, the InterOpen community has been established to bring vendors, professionals and national organizations together to accelerate the development of open standards for interoperability.

This has already developed the “Care Connect” FHIR standards that focus on sharing key parts of the care record, bringing together CCIOs, CIOs and those implementing solutions. Who better to provide interoperability solutions than the people who witness the challenges every day?

Moreover, this development is based upon the Argonaut/DAF profiles and then validated for use in the NHS. By taking this international approach, key vendors operating on the global market are already actively involved. We will now be looking to these vendors and local organizations to drive through adoption of these key standards through initiatives that are driving the maturity of providers further faster. This development of FHIR APIs is part of an overall interoperability strategy that is underpinned by key national capabilities such as the National Record Locator Service. This will enable care records for a patient to be located as they move across organizations on their care journey.

The future of interoperability

It remains paramount that interoperability is not seen as technical issue to be solved. In addition to the standards and services being developed, it’s also important how we establish the leadership at a local level, improving knowledge on this through educational summits (such as the recent InterOpen Summit) as well as supporting local programs in being clear on the business case and benefits that can be realized. This is also reflected in the US-UK MOU, which is looking at common service transformation priorities, how we can collectively move the market and providing guidance on best practice to localities. 

The approach being taken is a fundamental shift in the way we are approaching interoperability, away from being nationally dictated and much closer to CCIOs and CIOs directly linking with suppliers and being able to deliver against those priorities. The tracks of health care technology are being laid, the train is going in the right direction. Now, we need everyone to come on board.

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