Change story number 3: Story of Now

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The word ‘opportunity’ is defined as ‘a time or set of circumstances that makes it possible to do something’ which help to introduce our story of now.

As one of 25 Integration Pioneers, we have been given the opportunity to blaze the trail for change and new ways of working to support Health and Social care. With our successful bid to NHS England’s Integrated Digital Care Fund (IDCF), as mentioned in  our earlier story (the story of us), we have been given the opportunity to work with and support Integration Pioneers and the wider community on their own journeys towards integrated digital care records.

Across health and social care organisations, the top priority is to provide the very best care for people, to improve their care outcomes and ultimately to improve the lives people lead. We recognise that to do so we need to support the practitioners working across health and social care by giving them better information and better tools in order for them to provide the very best care.

Integrated digital care records therefore play an important role in the drive towards improving care. They bring together information from various care settings to provide a more joined up view of a person’s care. Without, there is a disconnect in care journeys as the information doesn’t flow between care settings, causing delays, inefficiencies and potentially impacting the care provided. With this technology change begins as people and process evolve to truly deliver integrated and thereby improved care.

The 25 Integration Pioneers on this journey recognise the need for integrated digital care records, as an important part in this change equation, allowing staff to work smarter to provide improved sustainable care in their respective cities and regions.  Each are at different stages on this road, some just starting out and some well on their way.

There are two common patterns appearing in the early work we have undertaken with Integration Pioneers in this area;

  1. the disconnect between the pressing need for change and the maturity and capability of care systems to meet these demands
  2. as pioneers, we are each doing our own thing, ploughing our own unique path and potentially encountering the same problems, when actually we all have the same core need – we need to work together

An open, collaborative and joined up approach is needed in the journey towards integrated digital care records. As Integration Pioneers an open approach allows us to act together, tackling the problems and learning once and sharing with all so everyone can benefit.

We have begun the Ripple community effort to support this approach. Key to that community effort, our experience has shown that there are six core components needed to support the delivery of an integrated digital care record system, explained here along two key themes outlined below:

Foundations

Open Requirements – Working with Integration Pioneers, we will identify the common requirements and capabilities needed for an integrated care record, along with their associated benefits. The identified aspects will be shared with all Integration Pioneers to save time and effort and to provide a consistent strategic direction to the community.

Open Governance – we will work with Integration Pioneers to standardise the governance arrangements for the sharing of information across care settings. At the moment this is seen as a real barrier to progress. Working with Integration Pioneers and with the support of NHS England we will provide standard governance templates and guidance to ensure the right arrangements are available and shared across the Pioneers and this emerging community across England.

Open Citizen – we will work with other Integration Pioneers on citizen engagement in sharing care information. It is essential to build trust as well as talking about care records openly, communicating widely and clearly. Working with Integration Pioneers and their respective communities, we will provide the common information and core tools  needed to support engagement in and communication of care record initiatives. In addition to this we will undertaken citizen engagement with the Integration Pioneers around the needs and requirements of a personal health record (citizen access to an integrated care record) and other key healthcare apps as a demonstration of this community effort in action.

Open source platform

Open Viewer – based on the Open Requirements identified by pioneers we will develop and deliver regular enhancements for an open source viewer for the community to use. As ease of use is critical at the front line of care, we will be working towards an Open Source care record viewer that makes the navigation around care records intuitive.

Open Integration –  In between the viewing and the storage aspects of any platform is an important element of bringing information together from the various systems Pioneers currently work with. To meet this need, we will be providing an Open Source Integration Engine which will be connected to those core systems that emerge from the Integration Pioneer analysis delivered by a series of related Open Application Programme Interfaces (Open APIs) to the community.

Open Architecture – Our learning to date has shown that many clinical groups require similar elements of clinical content, although they use them in slightly different ways to meet their own local need.  The current market offers a huge number of applications to accommodate this however these are very difficult to integrate. To move away from this approach and into the 21st century we need a more adaptive, modular, building block approach that allows the community to collaborate. Working with the pioneers we will provide a collaborative forum to develop these key building blocks, in line with international best practice, known as openEHR. With this in mind, we are working towards an open source storage mechanism to support this approach.

 

Why open source?

We believe Open Source and Open Standards are key to innovation and an alternative to traditional ways of purchasing systems from software suppliers.  Open source is owned by the Integration Pioneers and related community, though it can be reused by others across the health and care community.

We see the key features of an open source approach to Healthcare IT as;

  • Unconstrained Innovation – Ideas and ambitions can be shared by collaborators who work in different ways, in different organisations, different communities and different skills and experiences, including those not directly employed in healthcare IT
  • Transparent credibility – Allowing immediate detailed scrutiny immediately boosts credibility within the community
  • Decentralized control – amendments and improvement come from the community, bottom up

Based upon the findings from the initial survey issued we are now formulating programme plan around these six strands, aiming to deliver a release to the community every two months for the first 12 months of the programme. All the deliverables will be made available in the public domain under a recognised open licence.

Now is the opportunity to deliver a real change to care in the 21st century, to remove the barriers to progressing and to give the practitioners the tools they need to deliver more joined up care.

Ripple has begun, the community effort has started.

Hands up if you’re in!