Tuesday 9 August 2016

Interoperability and the NHS: are they incompatible?

Interoperability and the NHS: are they incompatible?


Do you remember what Jeremy Hunt’s New Year’s resolution was? On 1 January, he pledged that by the end of 2016 every patient in England would have access to their medical records online. Quite a bold claim, given that some hospitals are still using fax machines.

Therein lies the nuance: the Health Secretary was only promising access for patients, not for medical professionals. While much of the general public embraces the advances in information technology from our app-filled smartphones to our fitness-monitoring wristwatches, the NHS trails behind – often frustratingly so. If we’re ready to access our care records whenever and wherever we are, is the NHS ready to do the same?

The NHS has been wrestling with IT challenges for years; billions were largely wasted on the IT plans of the early 2000s, in 2012 the coalition government outlined plans for a new digital strategy, and then in 2014 the Department of Health put forward an updated digital plandesigned to work alongside the NHS five year forward view. One of its key topics is interoperability – the ability of the disparate and almost innumerable IT systems and software applications in use in health and care to communicate, exchange and interpret data, and otherwise work efficiently together. Many aspects feed into this, from standardised data entry to improving the way information moves across locations and computer programs. The NHS hopes to achieve full interoperability by 2020, but all medical records should be digitally accessible by medical professionals in acute settings by 2018.

The entire health and care sector has the opportunity to implement some long-term, efficient changes that could shake up how care is delivered: improved interoperability would allow the integration of health and social care records, greater ease of use for clinicians and reduced admin. Some providers have already made moves towards integrated and interoperable care records. In Bradford and Airedale, for example, service users are able to benefit from an integrated care record that is accessible across a range of devices and situations by care professionals. Other areas such as Leeds have created similar systems, and efforts are under way in Lambeth and Southwark, Bristol and Hampshire to follow suit.

There are common themes in the work of these providers: they all had buy-in from their clinicians early in the process and involved them throughout; they all aimed to use digital tech as an integral part of wider transformation plans, and made a positive case for the benefits to both patients and staff. But despite some success stories, not all organisations are ready to make changes; the results from NHS England’s digital maturity assessment survey show that many trusts are being left behind. Out of the 148 acute trusts surveyed, more than half disagreed with the statement that other local health care providers could access the patient information held by the trust. When asked about social care services’ access to their information, the situation was even worse with more than 70 per cent of acute trusts disagreeing that local care organisations could access the patient information they needed. The survey results are not all bad news, however. Care providers were more positive than acute trusts when it came to the potential influence of sustainability and transformation plans in delivering the government’s current digital vision, and most mental health trusts were more positive about their information-sharing capabilities than their acute counterparts.

Considering the health and care sector as a whole, it is no wonder that so many providers have found it difficult to achieve interoperability of their systems. Working across health and care organisations is a complex and difficult proposition; from the cultural challenges of aligning different parties to the IT problems of bringing together data from normally incompatible sources and investing time, money and training into new computer programs and systems. Doing so at one of the most financially challenging and pressured periods in the history of the NHS may be a near-impossible task for many regions.

The Department of Health and NHS England are making funding available for digital projects, but there’s been uncertainty around exactly how much this will be and whether or not it will all be protected. Capital-to-revenue transfers were a huge boost to the Department of Health’s financial position last year, and there will be the temptation to do the same again. However, if trusts and commissioners feel able to protect that money from other pressures then the long-term benefits could be huge, not just financially but also for creating better care pathway planning and giving patients safer and higher-quality care. Additionally, it presents local health economies with the chance to prove they can work well together in ways they haven’t done before – something NHS England seems to value greatly.

The health and care sector – and the NHS in particular – needs to act now: if interoperability is not embraced in the same way it is by the public, then one day you might have to bring your mobile device along to your appointment just to let your doctor borrow your integrated care record.
Kings Fund

Pop-up glaucoma screening clinic to tour UK

Pop-up glaucoma screening clinic to tour UK

A glaucoma screening pop-up clinic will tour the UK as part of new research to better identify those at risk, according to a report in Optometry Today. 
NHS Networks

Dementia evidence toolkit

Dementia evidence toolkit

A comprehensive online database featuring the latest scientific evidence on what works in dementia care and treatment has been developed by the researchers at the Personal Social Services Research Unit, London School of Economics and Political Science (PSSRU at LSE).

Launched Wednesday 3 August, the toolkit devised by Adelina Comas-Herrera, David McDaid, Professor Martin Knapp and colleagues is the first of its kind globally. The Dementia Evidence Toolkit brings together more than 3,000 journal articles and 700 reviews of research studies in one place.

The Toolkit was developed as part of the MODEM (Modelling the Outcome and Cost Impacts of Interventions for Dementia) project, with additional funding from the Economic and Social Research Council (ESRC). The wider MODEM project is funded by both the ESRC and the NIHR as part of their Improving Dementia Care initiative.

The aim is to make all this information publicly available in a form that is clear and easy to understand for dementia patients, their families and unpaid carers as well as for staff working in health and social care. It will also benefit academics and those involved in decision-making both locally and nationally.

Dementia is the fastest growing major cause of health-related disability across the world, and the health, social and economic impacts are increasing because of an ageing population. There are around 850,000 people in the UK with the condition, a figure expected to rise to 2 million by 2051. There are currently no cures for dementia which is associated with ongoing cognitive decline such as memory loss, problems with judgement and often some behavioural issues. Instead, the focus for healthcare services is on slowing down dementia progression using different care approaches.

Professor Knapp, Director of the PSSRU at LSE, NIHR Senior Investigator and lead investigator for the MODEM project, says this new toolkit will help those involved in developing services and treatments for both people living with dementia and their carers. By searching the online database, they will be able to make informed decisions on which services and treatments are effective and how much they cost. It will enable them to check how strong the evidence is for a particular treatment or to identify how much more research is needed.

He said: "As the economic impact of dementia grows, it’s especially important to give commissioners and providers the information that helps them use public funds to the best effect. In that way we can perhaps improve the lives both of people with dementia and of their carers.

"Our toolkit draws evidence together in one place, showing which interventions work well and at what cost."

"There’s this perception that the cognitive decline associated with dementia is benign or even slightly humorous," says Professor Knapp. "The reality is people will often have behavioural issues and this impacts considerably on families - people talk of their loved one’s personality changing entirely. We hope the toolkit helps improve understanding of how people can continue to live well - and as well as possible - with dementia today."
NHS Evidence

Counting calories: how under-reporting can explain the apparent fall in calorie intake

Counting calories: how under-reporting can explain the apparent fall in calorie intake


In the UK, official statistics show a decline in calorie consumption over the past 40 years, yet the population has continued to gain weight over this period. BIT decided to look more closely at how the official statistics on calorie intake are collected. This resulted in some surprising new findings, which are set out in this report. This report concludes that it is not plausible that large falls in calorie consumption, offset by even greater falls in physical activity, have caused the rise in obesity. Instead, it proposes that the apparent fall in consumption can be explained by an increase in underreporting of calorie intake in official statistics.
Behavioural Insights Team
Report
BIT publications

Pokemon Go health benefits monitored using NHS technology

Pokemon Go health benefits monitored using NHS technology

One example is Smart Specs, a visor created by Oxford University. It is used to improve eyesight, and can, for example, stencil outline around faces to make the image more pronounced. Mail Online