One, two, two point one

Keith Naylor, head of data standards for the interoperability toolkit, is excited. He’s just launched ITK 2.1 and has made a call for the NHS, clinicians and vendors to get behind it and start working with it.

He even has some money behind him to support this. He won’t say how much and promises that there are more exciting announcements on the way.

But as with so many things in the NHS right now, he is waiting on the passage of the Health and Social Care Bill and the forthcoming NHS information strategy before he can divulge more.

ITK is morphing

The ITK has, he says, “morphed quite considerably” since the summer, when ITK 2 came out. This was a set of standards, an accreditation process, and operating guidance for trusts.

It built on ITK 1 and introduced four new functionalities: mini spine services; electronic document transfer; admission, transfer and discharge processes; and clinical dashboards.

“Since then, Katie Davis has taken over [from Christine Connolly as head of IT for the DH and NHS] and she has brought her own emphasis,” says Naylor.

“ITK 2 is still on the books, but whereas previously it was built around the idea of an app store or a toolkit to save on implementation costs, now it is really being viewed as something that will help us deliver elements of the Health Bill.

“Where before we were stitching systems together inside a hospital, now it is about how we make a system in one hospital talk to social care or prisons or other care settings; with a big emphasis on measurable patient benefits.”

So ITK 2.1 is all about sharing information between NHS organisations, with other care providers and with patients. It is, if you like, the tool that will support the integrated care agenda.

Naylor agrees: “We are trying to move ITK into that space. When you start to read through it you will see themes like commissioning, patient access to data, drilling down through systems to retrieve data.”

Scaling up

It is also about taking local ideas and scaling them up nationally – something that proved beyond the pilots carried out under ITK 1. Naylor is now looking for people’s ideas and projects in what he calls an “information sharing challenge”.

“It’s been set up by the DH with the idea of bringing innovation out of the NHS. We want to hear ideas of how to get different care settings to interoperate, have them exposed and see whether they are sharable across the NHS,” he says.

“We will look at the best and fund some of them, developing them through the toolkit and made available to the rest of the NHS.”

Naylor is looking in particular for existing work in four priority areas: improved co-ordination between unscheduled care and primary care; mobile working; providing transactional services (such as ordering tests or scheduling appointments) online; and interactions with social care.

The last is, he says, a “really big theme” - and yes, he is aware that information sharing between the NHS and social care providers is a subject that makes information governance managers’ blood run cold.

“We have not bottomed that out yet. We know that there is a conversation to be had with information governance.

“But what we are being told by our clinical colleagues is that information still lives in silos and they cannot get access to information that they know is there and that could help them to provide better care.” Information sharing will also be crucial for commissioning in future, he adds.

Naylor is adamant that there is “tons of stuff going on in the NHS” but adds that it is uncoordinated. “The question is ‘how do we get local organisations to think about the bigger picture and look beyond their horizons?’” he asks.

Working with others

That Naylor and his team are ready to support organisations towards ITK accreditation and in sharing their systems is born out by the experience of EHI award winners in Plymouth, who developed the RAPA (Risk of Admission Patient Alert), system.

What started as a clinically-led project to provide community nurses with email and SMS alerts about the unscheduled admission of patients is now in the process of being made available regionally and possibly nationally.

“We have been working with Plymouth [NHS IT Shared Service] to help them with their road map that takes them from local to regional and then national as well as the architecture,” Naylor explains.

But this local engagement is only one part of the picture. What about the vendors who will have to come up with the interfaces?

“We have started a dialogue with Intellect and have had two meetings to work out the best way of engaging the vendor community,” says Naylor. “This is just one of the communication channels that needs to be opened up.”

Then there is the clinical community. Naylor and his team (which operates under the leadership of Paul Jones, chief technology officer, within the NHS Technology Office) have already worked closely with the Royal College of Physicians Health Informatics Unit on discharge summaries.

The ITK team developed the technical information sharing standards while the RCP HIU developed the professional standards about what information should be included.

“We want to do more work like that where technical and professional standards come together to provide a solution,” says Naylor.

There is now a big push for the team to be more clinically engaged but he admits that it is a struggle. “We need to find mechanisms for getting out there and pulling in clinical contacts.”

Vision on

He believes that the ITK team has the capacity (it now numbers around 20), the skills (members come from a mixture of NHS and commercial backgrounds) and the expertise it needs (its members include experts on messaging, technical architecture, accreditation and business analysts).

It also has the strategic direction to move forward, and it has work in the pipeline, with 15 to 16 projects now undergoing accreditation.

“We do have a bit of a problem in that we could be seen as the emperor’s new clothes,” admits Naylor. “But I think that right now the technical piece is ready. What is not ready is the NHS.”

For more information about the information sharing challenge, contact toolkit.enquiries@nhs.net

This feature first appeared in eHealth Insider's regular special report on systems integration.