Using digital to make integration effective
Originally published 21 May 2021
Digital connections allow service providers to link previously discrete episodes into a continuous and interconnected process which both reduces costs and improves service delivery. Health and care services have been slow to respond and need to commit both to a step change in investment in information systems and to organisational changes to realise the opportunities created by these systems.
To enable the digital transformation of care pathways the government white paper, ‘Integration and Innovation: working together to improve health and social care for all,’ outlined plans for a legislative framework that allowed for more effective data sharing across the health and care system. Last month, PPP convened a roundtable of key stakeholders in the NHS, social care, local government, and ICSs to consider the extent to which the government proposals for the Health and Care bill are fit to harness the opportunities offered by digital health.
It is important to understand that technology is only part of the integrated care agenda. As Matthew Stickland, Director of Strategy and Communications at TPP explained: “No matter how good or how effective the technology can be… our supplies of technology are not going to achieve anything unless those skills exists within the organisations that are going to be using it”. As such, Matthews argued that ICSs need to look at bringing all care settings up to a basic level of knowledge and digital literacy.
Key tenets of technology
“Getting the basic digital infrastructure right is a prerequisite for successful digital transformation”
While ICSs in different areas face different challenges, there are some things they need to be getting right across the board. The first being good infrastructure. All ICSs need to have a reasonable standard of hardware and computers, Wi-Fi and connectivity. As Matthew explained, “getting the basic digital infrastructure right is a prerequisite for successful digital transformation”.
Secondly, we need a digital system that ensures different care settings can work effectively together. Such a system will need to be connected to national infrastructure. National programmes, such as the NHS spine, will need to act as the connector between different networks, roll out national standards for interoperability and provide the functionality required in care delivery. Importantly, Matthew highlighted that we need digital systems to be tailored to the care setting - “our systems for social care need to make sure that they work for the professionals in social care”.
The last is data, both for interoperability and for secondary usage. As Matthew explained, “On a population health level, we need data to be available in real time in order for ICSs to have insight on what’s going on in that population”.
Bringing health and care data together across multiple organisations presents a momentous challenge. Elaine O’Brien, Senior Population Health Executive at Cerner, said that “the key is joining up data and creating a longitudinal record. The goal is to have one data record available that is then able to be segmented by disease, wellness, different conditions, access, ethnicity, deprivation and a combination of these things as it is appropriate”.
ICSs have the potential to hold data in one central place, where it can then be accessed by multiple organisations. This provides an opportunity to remove duplication and utilise the workforce more effectively across an ICS.
Better serving health and care settings
"We are going to be judged on the benefits that it has for people’s experiences as citizens, as carers and as organisations”
As Rt Hon Stephen Dorrell, Executive Chair at PPP, highlighted: “digital transformation isn’t just digitising what we’ve got, it’s changing what we’ve got in order to take advantage of the opportunities created by digital”.
However, Matthew argued have that digital health providers “have not necessarily served health and care settings in the way we should have done”. The events of the previous year have demonstrated the power of what digital health can achieve when it is focused around the benefit it will determine for the citizen and for the health care professional.
“We’re not going to be judged on how slick or fancy the technology we actually put in place is. But we are going to be judged on the benefits that it has for people’s experiences as citizens, as carers and as organisations”, said Matthew. “I think we can actually admit that we can do this technically and at a reasonable price, and start thinking about how we want to work together to actually start achieving this in a practical sense and learn from each other and care organisations. ”
The ICS Experience
ICSs are exploring a variety of strategies to harness the potential of digital health. A representative of Lincolnshire ICS said they were exploring the notion of a “citizen atrium” – a centralised and virtual contact point for citizens to guide them along various care pathways. Such a system is proposed to have differing levels of authentication, with the ability to provide guidance across self-support pathways right through to highly guided pathways.
Devon ICS has trialled the use of EPIC – an electronic patient record system – in one of its hospitals and is now exploring the benefits and costs of rolling out this system across the whole of Devon and Cornwall. “We would save a lot of money because of all the save costs of not having to run the 700 plus different systems that we do at the moment,” explained Independent Chair of Devon ICS, Dame Suzi Leather, “In terms of complexity of people’s lives and the ability to develop shared clinical service innovation... There would be huge advantages”.
Patricia Hewitt, Independent Chair of Norfolk and Waveney ICS, highlighted that digital transformation has been their top priority for the past four years “We saw this as our biggest opportunity to improve quality, improve outcomes and improve efficiency. Our three acute hospitals are basically at the bottom of the league table for digital maturity in England - millions of ancient systems that don’t talk to each other and no electronic patient record. ”
As such, the ICS received funding to roll out an electronic patient record across the three acute hospitals and Norfolk County Council have been developing demographic and population analytics to track population health patterns in small geographies and communities. Patricia argued that such data was proving critical in debates around inequalities and where resources are prioritised, as well as for the GP community.
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