Digital healthcare technology: information sharing

Published 9 abril 2019

Technology is changing the way both clinicians and patients can access their data.

Gradual digitisation of patient records from paper to online has enabled clinical information to be shared more easily and rapidly, although the tendency is for it to remain stored in separate electronic silos, rather than across allied systems.

However, with information sharing key to making integrated care a success, there are significant opportunities and challenges to address. Information sharing provides clinicians and other staff working in the health and social care sector a platform to work together for the benefit of the patient, and plan multi-disciplinary care proactively, without having to merge services and organisations.

Open application programming interfaces (APIs)

Almost two decades ago, a central Government initiative (the National Programme for IT) was an expensive failure and, while the same challenge of combining data from different legacy systems remains, technology that enables data sharing has evolved and become more affordable. Rather than creating a centrally held record, the focus now is on open application programming interfaces (APIs) that can bring in real-time data from multiple sources, with the use of public cloud enabling these platforms to be extremely adaptable.

“We are now seeing a move where standards are being adopted across the system, which means in time data will become much more accessible to clinicians and eventually for patients as well,” says Sam Shah, Director of Digital Development at NHS England.

While historically the NHS has been reliant on big IT suppliers to provide top-down solutions, the use of APIs means that this is no longer the case. “It will be easier to have small and medium-sized enterprises that meet those standards that can work with other suppliers,” says Shah.

“We need to work hard on improving market access, which is not easy because of the historic contracts in place. There are reasons why many systems existed, and their primary use may have been for something else. That means there may have to be difficult conversations and it may require the community of buyers to work differently as well.”

Local solutions

The focus needs to be on local organisations working together to create tailored solutions that meet their needs.

Trusts in south-east London have developed such a platform, enabling hospitals to access patient information from GP records which previously they were not able to do.

Every trust uses a different electronic patient records system, explains Murat Soncul, Head of Information Governance at South London and Maudsley NHS Foundation Trust. “For years we had these isolated systems that didn’t speak to each other, so sadly we often ended up sending faxes or post to the GP.”

The existence of the new platform means that doctors can access test results immediately during a consultation, rather than needing another appointment. Patients can opt out but are warned this may have an adverse impact on their post-discharge care, Soncul says.

NHS England has allocated funding to the regions to link up patient information, so a London-wide project has just started. Soncul notes that: “In big cities you don’t just live in one borough you move around so it is very important to be able to link-up records. It is still early at the public engagement phase though. Nothing technical has happened yet.”

All patient data at the Trust is now stored on the cloud, as part of its digital strategy, which began in 2015. The strategy has also involved the implementation of digital collaboration tools that enable staff to communicate via instant messaging and sharing of documents. Unlike WhatsApp, the instant messaging system keeps an audit of conversations that can be accessed if necessary, for example to investigate the lead up to a clinical error, says Soncul.

The time is right for change

Soncul says several other trusts have embarked on similar programmes because the environment was right for making the change. “In the NHS people are quite risk averse, and there was hesitation over some of the technology that has become more commonplace in the last few years, such as cloud technology and some of the mobile apps. We had more examples of technology used in a sensible way, without risking data, and improving clinical care. That has reduced people’s hesitation and anxiety and made them more accepting of technology.”

He adds that there has also been more funding available from NHS Digital and other NHS funding streams. This includes the local health care record exemplar program from NHS England.

“Technology will always be ahead of legislation because legislation normally reacts to technology. Personally, I would like regulation to positively shape data governance safeguards around the use of digital technology,” Soncul says, and describes the 2018 Data Protection Act as a welcome step forward in updating the legislative framework to take account of advances in digital technology over the past 20 years.

There has also been a big roll out of role-appropriate desktop and mobile technology to staff at the Trust. But challenges in training staff to use new devices remain. There is also significant work to do in change management to expel long-held attitudes and update historic working practices.

West London NHS Trust has an ongoing ambition to encourage more mobile working, says Christopher Hilton, Director of Strategy and Clinical Director for Integrated Care, West London NHS Trust. “Historically, some elements of the workforce would do home visits then return to the office to write up their notes. By deploying more mobile devices, which can securely and speedily access the trust network, our hope is to support staff to write-up their reports while with the patient or in-between community visits.”

NHS App

Greater empowerment and awareness of patients’ rights over their information means patients are now encouraged to be actively in control of their data, says Shah. “We are certainly seeing a shift in the powerbase, where the citizen is more in control. They are not just agents or passive recipients. They are actively in control of their healthcare information.”

The new NHS App – a collection of evolving tools and techniques - enables patients to take more control and order repeat prescriptions, make appointments, state their preferences for organ donation and end of life care, and gain access to third-party technology products to support their efforts in self-care. Potentially, it will also enable more widespread data sharing with the care sector and private hospitals.

Patients will be able to access the NHS App using their NHS login, says Shah. “In time we hope that as the NHS grows in its use of technology, that the NHS login becomes the mechanism by which products that are used within the NHS will also give citizens access.” For example, if a local integrated care system or a hospital is using a product that is patient facing, patients will be able to use their NHS login to access it and their preferences, including on data sharing, that will be carried across to these third-party products.

“Technology offers the opportunity to improve the accessibility and availability of services. We are a long way from the delivery of clinical services through the use of technology, but we are much closer to being able to reduce the friction and make it easier to access services, and to make their availability more known to individuals,” says Shah. “Within the next three years, those are the things we will focus on – getting the basics right. In the following two years, it will be about building more capability, going from transference to transformance. Eventually we hope to adapt and start building new types of technology to improve the delivery of care.”

Darryn Hale, Associate at DAC Beachcroft, has been working with NHS commissioners and providers, as well as private sector technology providers, on projects across London to facilitate arrangements between primary, secondary and social care to share patient data. Hale comments that: “Integrated services have huge potential benefits for patient care. Sharing the right information at scale can help commissioners and providers proactively plan care for the most vulnerable patients by adopting a population health approach with the data.”

He highlights the National Data Guardian and the Secretary of State for Health and Social Care’s clearly avowed aspiration to increasingly embrace technology. “There is a real opportunity to implement information sharing arrangements to benefit patients in the short, medium and long-term,” says Hale. “But information sharing on this scale must take place in a manner that is secure, ethical and fully compliant with the onerous requirements of data protection legislation.

“It must all be underpinned by robust legal compliance-assurance, as well as good governance. We have worked on a number of arrangements, and whilst the sharing of risk across very different organisations in the NHS landscape is challenging, finding a mutually agreeable solution is certainly possible."

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