NHS Yorkshire and the Humber is reaping the benefits of adopting a single platform for the integration and development of connected applications. Acute trusts such as The Rotherham NHS Foundation Trust are already seeing benefits.
Phil Molyneux, the chief information officer of NHS Yorkshire and the Humber, is a great believer in breaking down the barriers between departments and different care settings so that patient information can be shared effectively.
So is his senior management team, which has been tirelessly sorting out the architecture between applications in preparation for the arrival of NHS Connecting for Health’s electronic patient record solutions.
A key step in the process has been to encourage the adoption of a single, seamless platform for the integration and development of connected applications - InterSystems Ensemble.
Ensemble was previously available to the strategic health authority’s regional local service provider, CSC, which had chosen to use it to connect centrally hosted solutions to trust-based systems. However, Molyneaux and this team realised that wider, intra-trust use of the integration platform could deliver far greater benefits.
“One of the major advances would be allowing care providers to start sharing information immediately, in a way that supported actual patient pathways within and between the 37 trusts that comprise our SHA region,” he says.
“This would lead to a better patient experience, and enable healthcare professionals in different settings to work with far more reliable patient information. This would mean that they could use their time more effectively by avoiding duplicate data entry and reduce unnecessary admission entries.”
To fulfil this vision, the SHA created a budget that allowed each trust to acquire an Ensemble developer licence, along with the training to ensure they could make best use of it.
The starting point
Molyneaux further explains the problems that trusts faced. “As would be expected, trusts within our region have a multitude of different departmental IT systems, many of which could not exchange data.
“This meant that staff often had to enter patient information into more than one of their systems, which could result in a lack of consistent data from one system to the next,” he says. “The problems were compounded by the fact that there was no correlated update mechanism in place to alert the other systems when patient data had changed.”
With this in mind, Molyneaux and his team felt it was imperative to break down barriers between different departments by implementing “the same integration platform that could connect up the processes and ensure a smooth flow of relevant patient information.”
Why InterSystems Ensemble?
Since Ensemble was already made available to acute trusts by CSC, it seemed a logical choice as the SHA’s standard integration platform.
“Our next step was to convince as many acute trusts as possible to adopt it as their standard solution, as we saw the use of a single interface as being absolutely central to our strategic vision for a single, shared care record,” Molyneaux explains
“We managed to streamline this process by organising collaborative funding to support integration. Within this, we could ring-fence funds for the purchase by acute trusts of the Ensemble Developer (E2) licence and for training on its use.
“Once we explained our vision, the primary care trusts were keen to support this initiative, as they could immediately see the benefits delivered by shared patient and care information.”
In a further measure to support the acute trusts, the SHA appointed ReStart Consulting as a service delivery partner to help spread and standardise the use of Ensemble across the SHA.
Spreading the word
The SHA facilitates regular local Yorkshire and the Humber Trust Integration Forums (TIFs). These are hosted by different trusts every six to eight weeks. They provide an opportunity for IT to meet with Alan Baker, the SHA’s assistant deputy chief information officer, to discuss issues and support each other on the implementation of the integration strategy.
Reinforcing the importance of the TIFs, Baker says: “Each of the NHS trusts in this region faces very different issues. Each has very different systems to deal with. So it is difficult to set standard target timelines for them to deliver the integration capability.
“This is why it is so vital that we work collaboratively. That way, we learn from the early adopter implementations so that we can establish a blueprint for future Ensemble implementations in the region.”
Acute trusts are already realising the benefits of their newly created interoperability. For example, sharing information across departmental systems has made it easier for their clinicians to make better-informed judgements at the point-of-care.
Some trusts have found that interoperability has enabled a reduction in unnecessary hospital appointments for patients, since clinicians can now review notes remotely and only call in those patients they actually need to see face-to-face.
There has also been a measurable reduction in Accident and Emergency admission waiting times, as staff have the information they need at their fingertips to direct patients accordingly.
The way forward
Ensemble is now widely used as the SHA’s common integration platform, with just two of the 15 acute trusts in the region choosing other options for their integration projects.
Molyneux concludes: “The proven benefits of our approach to creating a shared care record definitely represents a template that I think the nine other SHAs could follow in their quest for better use of current IT systems.”
The Rotherham NHS Foundation Trust has only been working with InterSystems Ensemble for nine months, but already the benefits are very clear.
Previously, the trust used a managed service for application integration, based on a legacy integration messaging engine from Oracle, formerly known as eGate. This meant that every time the trust needed to create a new interface it had to pay more.
By using Ensemble as its application integration platform, interfaces are now far simpler, less expensive, and much quicker to deliver and use.
Head of IT David Brown explains: “One of the challenges we have at the trust is that we need to replace our old Patient Administration System and legacy departmental clinical systems with a fully integrated Electronic Patient Record solution.
“We also wanted to choose the right integration platform that would work with the NHS Connecting for Health solutions in the future.”
The trust has many disparate departmental systems that need interfacing and some external third party systems, such as the Care UK Picture Archiving Communication System. The PACs had previously sent X-rays and other images from an offsite location that was unconnected to the hospital’s infrastructure, and this made it hard to get the images to clinicians.
Therefore, the trust decided to move to an integration platform that supported HL7 and had further capability including DICOM image management. Utilising the very latest version of Ensemble with DICOM image management, the trust’s in-house team (with some support from InterSystems) was able to create a DICOM interface in just five days.
Assessing how Ensemble has affected the trust’s strategic approach to integration and IT, Brown says: “Ensemble is the cornerstone of the trust’s integration and interfacing strategy. The key thing is that we can now seamlessly migrate between new and old systems with minimal operational impact.
“It worked straight out of the box. Crucially, it allows us to interface with a system and then build more business value on top. Ensemble provides the increased flexibility and scalability that we need.”