Integrated Care Systems (ICS) are at the heart of the NHS vision for joined-up service provision and cost-effective patient care. But how can these new organisations integrate acute care with primary care and social care while ensuring efficient, relevant, and immediate communication between providers and patients at the point of care? EPRs and shared care records are only part of the solution, argues Jonathan Elliott, managing director of Epro
The exchange of information between providers will be vital to underpinning the role of integrated care services
The speed of digital innovation throughout the NHS has accelerated over the past few years.
The demands of the pandemic changed perceptions, enabled rapid transformation, and inspired bold ambitions.
Certainly, the ICS vision is compelling, bringing together diverse organisations, consolidating services, eradicating inefficiencies, and reaching out into the community to provide truly-joined-up health and social care.
However, every ICS has a complex mix of digital maturity within its trusts.
Multiple EPR systems are likely to be in used across the geography, as well as many legacy solutions.
And organisations are at different stages in their essential migration to the cloud.
Given the current problems caused by both long waiting lists and staff shortages, the priority for the NHS is to drive efficiency and minimise errors
In the future, information needs to flow across the ICS, into social and mental care services, as well as primary care. And it needs to cross boundaries to support those patients who need to access services across more than one ICS.
It is simply not possible for ICSs to consolidate into just one system – certainly not in the short term, and probably not in the longer term.
NHS organisations have made significant technology investments, including shared care records (SCR) and EPRs. So, should a trust be asked to ditch an expensive Tier 1 EPR investment that has been implemented in the last five years, simply because its neighbour made a different choice?
Should clinicians and administrative staff be expected to move away from a solution they like and value – and endure another round of change management and disruption?
And should bold ideas regarding services sharing – such as pathology and radiology hubs – be compromised, or vital improvements in service delivery be delayed, by a decision to make a large-scale, strategic IT investment?
Given the current problems caused by both long waiting lists and staff shortages, the priority for the NHS is to drive efficiency and minimise errors.
Clinicians will welcome any digital change that can improve their ability to deliver better patient care. Whether that is rapidly eradicating rekeying errors to providing immediate access to deep patient information at the point of care, the focus is on data and data flow.
The key question for ICSs to consider is not which EPR to consolidate on, but how can systems be integrated in an effective way to present data in a logical way, with embedded workflow that reflects NHS processes and rapidly enables clinical change that supports both patients and clinicians.
Systems will need to link up to acute, community and primary care providers
These goals can be achieved quickly and cost effectively through strong integration between systems across primary, acute, and social care that delivers an immediate flow of patient centric data.
Building on established interoperability standards, including HL7 and FHIR, ICSs can maximise the value of existing digital transformation investments and quickly deliver the rapid access to patient data that underpins the NHS long-term digital vision – irrespective of existing technologies, both digital and legacy.
The phenomenal innovations achieved during the pandemic have proved the value of fast change. But they also highlighted the way technology can be used to achieve immediate benefits in patient care with specific, targeted developments
With a commitment to interoperability, ICSs can ensure a safe, trusted, fast information flow throughout the extended organisation and achieve the rapid change required to address immediate problems. For example, integrating speech recognition can rapidly address the backlog in outpatient clinical correspondence that is leaving GPs and patients waiting many weeks to receive post consultation information and referrals.
Using speech recognition and digital dictation to automatically populate forms, medical secretaries need only to rapidly check the information prior to distributing it to the GP and patient, radically speeding up the process, improving the patient experience and eradicating the additional demands created by patients chasing secretaries for information.
With interoperable solutions integrated into the existing acute and primary care systems, the entire process becomes seamless, with end-to-end data flow and efficient, automated workflows ensuring both clinicians have access to the information required, and patients receive care more quickly.
The phenomenal innovations achieved during the pandemic have proved the value of fast change. But they also highlighted the way technology can be used to achieve immediate benefits in patient care with specific, targeted developments.
ICSs are a bold vision – and they are tasked with achieving bold targets, including virtual wards and integrated clinical pathways.
If ICSs are to make rapid progress and meet these goals, there is little room for extended projects and extensive change management.
The priority must be to achieve effective, relevant data flow, embedded into workflows that truly accelerate the delivery of care across primary, acute, and social services.
Large-scale projects are expensive, disruptive, and morale sapping. With a commitment to achieving interoperability across systems, successful digital transformation can be achieved in bite-sized chunks that deliver fast, incremental value, especially to those on the frontline of patient care.