If health and social care in the UK is to make the giant leap towards a new model for integrated care, the ability to share information across the whole system will be essential. At present, the NHS comprises too many islands of information. Connecting them together is the island utopia. But getting there may first require the creation of islands of excellence as exemplars for success. Michael Thick, Vice President of healthcare technology solutions and services provider, McKesson, explores how delivering the information revolution may be less about making a giant leap, and more about taking small steps.
The direction of travel for health and social care in the UK is misleadingly simple: we are moving towards a model of Integrated Care. But the complexities of the current model, from political, cultural and organisational perspectives, mean that the journey towards a patient-centric ‘whole system’ of care is likely to be a long and challenging one. In reality, that journey must start now. And while the end destination may seem very distant, there are progressive stops along the way that are both achievable and within reach – providing all stakeholders possess the collective will to travel together.
The journey so far…
The gauntlet for integrated care has already been thrown down. Just as 2011 closed with warnings of how the UK’s current model of healthcare delivery is no longer sustainable, 2012 opened in much the same way. Last December, NHS Confederation Chief Executive Mike Farrar said that the NHS needed to convince people to wave goodbye to the outdated “hospital or bust” model of care and urged health professionals to help improve the public’s understanding of the benefits of community-based health services and clinical homecare. As the new year dawned, Prime Minister David Cameron went further, issuing a directive to bring health and social care services together, and asking the NHS to make full service integration the same priority as had previously been given to waiting list targets. This same recommendation was subsequently, and indeed independently, reiterated by the King’s Fund and Nuffield Trust, whose January 2012 report Achieving integrated care for patients and populations argued that integrated care should be the decade’s “number one priority.” The publication, submitted as a joint contribution to the second phase of the NHS Future Forum’s consultation on the Health & Social Care Bill, argued that the government should create a framework designed to embed integrated care across the health and social care system – and develop a compelling narrative that places integrated care at the forefront of the hearts and minds of everyone working within the system.
Recent announcements from the NHS Future Forum, whose latest recommendations for revisions to the Bill were published at the beginning of January, indicate that winning the hearts and minds of NHS professionals will be a critical factor in achieving meaningful change and, in turn, delivering the much-vaunted model of Integrated Care. The challenge, it would seem, is largely a cultural one.
Information at the heart of strategy
The ability to capture and, crucially, share information across all facets of the patient pathway is a fundamental requirement that underpins any aspiration to forge a sustainable model of integrated care. At present, the way in which information systems have become embedded into the NHS – with a wide variety of individual systems set up across primary and secondary care, as well as in palliative and social care – has led to a health service that generates islands of information. But does precious little with it.
Historically, systems have often been built in a ‘tribal’ fashion by (and for) common NHS groups such as secondary care consultants, GPs, and PCTs. In the main, however, they have each proceeded to keep their information to themselves and have appeared unwilling to share it.
But if, as government rhetoric suggests, we really do intend to put the patient at the centre of care, the whole model for healthcare delivery, and the informatics that support it, is going to have to change. And the cultural mindset of those who operate within the system will need to change with it.
A new age
The NHS Future Forum has, quite reasonably, said that the health service needs to drag itself out of the “information dark ages.” But, in an environment where good technologies that can help support information exchange are already well established, the Forum has been quick to place the onus for making that change upon the healthcare professionals that have previously resisted progress. The barriers to making the information revolution a reality, it says, are “much more cultural than they are technological.” The Forum’s recommendations call for a change in mindset within the NHS so that there is a tacit acceptance, and indeed expectation, that patients should be provided access to any information that is pertinent to their own therapeutic process.
The responsibility for delivering a workable infrastructure for information exchange across health and social care should not, of course, be placed solely at the door of those that work within the system. Progress will require a collaborative effort – and both politicians and informatics experts will need to play a major role in driving the new environment. The government’s Information Strategy, which will finally be published this May having previously suffered delays, should help provide a framework, as well as a timetable, for change. Ahead of that, the NHS Future Forum’s recommendations reinforce the call for the universal adoption of the NHS patient number across health and social care by the end of 2013 – a challenge that should, at the very least, sharpen the pencil for mindset change and enable interoperability between systems.
But, despite such potentially pressing obligations, the cultural battle will not be won overnight. It will be a long and arduous slog that must begin with a sustained demonstration of the benefits of developing more informed patients – and by sharing best practice examples of where success has been proven. Such examples already exist – the challenge is to generate more.
Talking to each other: system interoperability
Much of the technology to facilitate an information revolution within an integrated care system already exists – it simply needs joining together. The issue of interoperability of systems, identified by the Future Forum as a key requirement for progress, will be pivotal to success. The NHS must challenge the model that has allowed it to develop fragmented islands of information without ever connecting them up.
At present, it is practically impossible to track patients as they move from one part of the NHS organisation to another and, as a consequence, the islands of information merely perpetuate. But with greater connectivity – interoperability – this dated model could quite quickly, and simply, become transformed.
There is a growing will among more forward-thinking NHS professionals to work in partnership with technology suppliers to address the issue of interoperability. Proactive clinical providers are increasingly attempting to improve communications with their peers in primary, community and social care, and are helping to pioneer efforts to link systems in ways that can transform service delivery right across the patient pathway. In the process, they are helping to convert islands of information into islands of excellence that can act as exemplars for others to follow and, indeed, improve upon.
There has been much talk in recent months of the concept of so-called ‘disruptive technologies’ – the notion that something very simple can transform the way we do things and, at the same time, make that process much more efficient. The consumer world is full of examples of disruptive technologies that were dismissed when they were first introduced but have gone on to become an essential way of life. ATMs are a perfect example.
Healthcare, now more than ever, needs to embrace the concept of disruptive technology and explore ways in which it can move steadily towards meeting some of the ambitious objectives being thrown at it by the reform agenda. Facilitating interoperability may yet prove to be that simple solution that acts as a game-changer – but this will not happen by accident: healthcare professionals have got to want to make it happen. Other industries, notably airlines and banking, faced – and overcame – the challenge of interoperability years ago. They did so because they wanted it to work. Healthcare must develop the same appetite.
Taking small steps
The journey towards integrated care, supported by an ‘information revolution’ that hopes to arm patients and clinicians alike with the right information at the right time – with the patient at the centre – does not need to be viewed as a giant and hurried leap into the unknown. It is simply not possible to turn around a whole national healthcare delivery service in anything less than ten years – but it is possible to take incremental steps towards the stated destination, and along the way generate ideas and examples that may help others reduce the journey time.
There is, of course, a danger that the government’s ambitions to impose an integrated care model and revolutionise patient access to information can, at times, be dismissed as political rhetoric. This can lead to a temptation at ground level to sit tight and wait for nothing to happen. But there seems little doubt that the UK’s current health model is no longer sustainable and that a significant overhaul of the system, and the culture, of healthcare is required to meet the demands of the modern day. Doing nothing, therefore, is not an option.
But for healthcare professionals, the move from rhetoric to reality can be achieved by adopting some simple solutions. Changing the old world tribal systems into systems that satisfy the most appropriate ways of working doesn’t happen by brute force – that’s been attempted in the past and has failed. Instead, there are examples of disruptive technologies – small, simple applications – that allow people to review the way they work and do things differently yet more effectively. We are not going to go from the old world systems to a new way of working in one jump – but small, incremental steps, starting perhaps with a willingness to link systems together, can help the NHS make a steady journey towards integrated care. And from fragmented islands of information, build bigger and more effective islands of excellence.