One good thing

Alan Baker

Trusts within NHS Yorkshire and the Humber have taken one approach to achieving system interoperability: one electronic patient record, one trust integration engine and one service delivery partner.

NHS Yorkshire and the Humber has taken a collaborative approach to assisting its trusts to achieve system interoperability. With 15 acute trusts, 14 primary care trusts, seven mental health trusts and one ambulance trust, the big problem was the exchange of patient information across disparate departmental systems.

Staff often found themselves having to duplicate patient information in one or more systems, resulting in a lack of consistency from one to the next. Having no update mechanism in place, the systems were not being alerted to changes where a patient update had been made.

The availability of new secondary care systems, coupled with the cultural adoption and access issues that inevitably came with them, made Alan Baker, the strategic health authority’s assistant chief information officer, and his informatics team, look for a new approach to interoperability.

They made a decision to utilise one electronic patient record (SystmOne), one trust integration engine (InterSystems Ensemble) and one service delivery partner (ReStart Consulting).

The vision

Yorkshire and the Humber had always wanted to share information across the healthcare community. But with such a vast array of systems, resources and capabilities across the trusts in the region, achieving system interoperability was never going to happen overnight.

Initially, NHS Yorkshire and the Humber had a strong EPR solution. SystmOne provided a full, end-to-end EPR, but it had to be developed to service the acute market to comply with the requirements of NHS Connecting for Health.

Having done this, the next challenge was to ensure that the systems could effectively share information, not only within the trusts, but across multiple care centres that serviced the patient community.

Ensemble is a seamless platform for integration and the development of connected applications, and NHS Yorkshire and the Humber decided it would be the TIE of choice for the region.

Now, all the SHA had to do was convince its trusts to implement the solution – not an easy task. “The key to securing adoption from the trusts was to provide them with the tools to deliver,” says Baker.

Funding was made available to all the trusts in the region that wanted to take advantage of the Ensemble integration solution, including the purchase of Ensemble, its development licence and 12 months support and training.

With one EPR, and one TIE now available, NHS Yorkshire and the Humber needed to find a single service-delivery partner to ‘buy in’ to the vision and work alongside it to deliver implementation and training. ReStart Consulting was appointed to do just this.

The challenges

The first challenge faced by Baker and his team was to secure the funding they needed. A business case was put forward to SHA managers and clinicians that didn’t focus so much on the technology as on the benefits the technology could deliver: namely cost-reduction and efficiency.

“It was important to highlight the benefits to our managers and clinicians,” says Baker. “We needed to demonstrate processes that recorded, reported and measured our success.”

NHS Yorkshire and the Humber had to overcome other obstacles, not least encouraging neighbouring trusts – which are normally competing for budget - to work together and share best practice.

“The best way to overcome this challenge was to empower the trusts to take control themselves,” says Baker. “By providing one EPR, one TIE and one service delivery partner, the trusts had everything they needed at their disposal to implement Ensemble, and hence, ultimately, to share information between systems.”

The trusts hosted a series of Integration Forums every six to eight weeks, at which trust IT directors met Baker to push the integration strategy forward. ReStart provided examples of best practice around Ensemble.

Baker adds: “Owing to the variety of systems, each of the trusts face very different issues, so it is difficult to set standard target timelines for them to deliver against. It’s more important that we work collaboratively and learn from the early adopter implementations in order to establish a blueprint for future Ensemble implementations in the region.”

A perfectly formed plan

NHS trusts including Doncaster and Bassetlaw Hospitals, Scarborough and North East Yorkshire and Hull and East Yorkshire Hospitals are already realising the benefits of interoperability.

Sharing information across departmental systems has made it easier for clinicians to make informed judgements at the point-of-care. Patients no longer have to endlessly repeat information and do not always have to travel to the hospital for an appointment – clinicians can review and action notes remotely and only see patients that they need to see.

All these trusts are also experiencing better resource-deployment and reduced wastage. Integrating A&E systems with other clinical systems has already improved the efficiency and quality of patient care in A&E departments. There are proven reductions in A&E admissions as staff have patient information at their fingertips, patients can be dealt with more effectively.

Going forward

The trusts have also established a common support infrastructure from which they can share knowledge, best practices and re-usable Ensemble components.

However, this is not always clear-cut. Whilst many trusts share similar clinical systems, they rarely share the same combination of system to system integration requirements. One approach to solving this type of challenge is to separate the system to system integration with a semantic abstraction of messages.

Sean Connelly, head of practice, Ensemble, at ReStart Consulting explains: “By using the same semantic abstraction of messages, trusts will be able to share the same interface solutions targeted at common systems.

“By sharing these interface solutions, trusts will be able to distribute effort, reduce risks and minimise costs across the SHA. As well as sharing interface solutions, the trusts will be able to share common utilities, libraries and dashboards that enhance their day to day development and administration of Ensemble.”

By holding a regular meeting within the SHA, the Ensemble developers have a platform for sharing information and combining initiatives. These meetings also provide an opportunity to invite guest speakers from ReStart and InterSystems to present information on new and advanced subjects on integration. Of course, none of this would be possible unless all of the Trusts were using Ensemble.

The remaining trusts in the region continue to take advantage of the Packaged Solution, and the region has a whole is expecting full implementation with associated benefits within the next two years.

Further developments being planned include providing trusts with an Interoperability Toolkit. This will support the elements that are not part of the CfH programmes, but none-the-less play an important role in the realisation of true system interoperability. NHS Yorkshire and the Humber are keen to share this best practice and methodology with other SHA leads.

In conclusion

“Trusts in my region wanted the Ensemble solution and we have found a way to deliver it to them,” says Baker. “What’s even better is that through the consultancy, implementation and training provided by ReStart Consulting, the trusts are becoming empowered to manage Ensemble themselves – this alone proves the ‘Investing now saves for the future’ methodology and will help us to achieve our targets as the years progress.”

NHS Yorkshire and the Humber is an IT community success story. The collaborative approach has improved links between primary and secondary care for the benefit of all; patients, staff and organisations.