INTEROpen is a really welcome industry initiative. NHS care providers are wrestling to flex our enterprise architectures to deliver the 5YFV via Sustainability and Transformation Plans (STP’s). Several years ago, when closer to Health IT, I spent considerable time and effort trying to push the ITK from the NHS side. Reflecting on the lack of traction over the years a couple of points stand out to me.
It was partly related to the lack of levers the NHS had to make the change. Occasional contract windows opening and tendering, with considerable supplier inertia to unlock, didn’t create enough momentum. ITK was embraced by some new entrants, but in the end I think we have only two ITK interfaces onsite in our acute architecture. I think the interoperability solution has to be supplier-led (NHS guided) and driven by those who control software development resources in vendors. This was always Keith Naylor and his team’s aim but think in the end inertia in the market constrained resources being allocated.
Wind-forward 5 years, and I believe the business imperatives for care providers to co-ordinate care are even more paramount. The whole demand for co-ordination has been ratcheted up by epidemiology (more multi-morbidity), demography (greater ageing) and economics (increasing healthcare inflation, more tariff deflation and austerity.) In addition the NHS has moved to place-based planning via STP footprints, rather than institution-based planning. This puts care co-ordination centre stage.
The STP process is forcing real engagement with system-wide digital planning. The market is aggregating and changing quickly. If suppliers think there is a future in the paradigm of remaining an island to grow market share selling to individual provider of care they need to stop and re-think. Strategic spend will be overseen by the STP process. Technology fund money will need to be coherent with STP plans for care-coordination.
Without old system suppliers embracing the use of open standards such as FHIR [Fast Healthcare Interoperability Resources], the pressing need for Shared Care artefacts mean clinical content will migrate from established system suppliers into new system portals, despite the problems therein. Clinical co-ordination just has to happen even at a sub-optimal level. This will leave legacy systems with poor integration to recede from clinical usage to become administrative minor players.
Even the administrative system niche is not a place for complacency. Existing provider payments models, which incentivise utilisation or poor quality input restricted care (PbR or Block) will not survive the 5YFV. Outcome based contracting will inevitably disrupt this market. These legacy administrative focussed systems will become increasingly irrelevant. Co-ordination of care is increasingly the core business of transforming any system. This will be delivered outside of established systems if they are unwilling to acknowledge and engage with FIHR and get behind the likes of the INTEROpen initiative.
Once planning at the system level, rather than the institution, the quality impact and cost of uncoordinated care is surfaced and immense. Unnecessary hospitalisation, late disease diagnosis, unmanaged exacerbation and poor quality palliative pathways are just some of the salient areas. If suppliers don’t stand up and develop more agile FIHR coupling they will have to be bypassed, as the problems and costs are just too high. The business cases at a system level will be for enabling co-ordinated care, not same old silo lock-in and atrophy. The spend will be approved at STP level. The agenda is strategic and place-based not institution based and suppliers need to evolve or be left behind. .
It is very encouraging to see some of the what might have been considered traditional laggards in this field embracing FIHR in this INTEROpen declaration. As someone who will be investing in co-ordinated care for a large footprint this is almost generating a short list of suppliers to work with, and is very welcome. Great effort pulling it together and I personally hope for a strong following wind and rapid progress.