Less choice of system and mandated interoperability are likely to be the future of general practice IT, according to the Department of Health’s programme director for GP IT.
Kemi Adenubi told last week’s EMIS National User Group conference that no decisions had been made about future funding for GP IT when GP Systems of Choice ends in 2013.
“Nobody knows what’s going to happen in the new world and whether GPs are going to hold the money for GP systems and where choice is going to sit and that’s actually very empowering," she told conference goers.
Adenubi, who led the negotiations for GPSoC, said the number of GP systems on the framework was “unsustainable” for the NHS and for suppliers such as EMIS, which now has three GPSoC-approved systems.
She added: “We need to look at how we consolidate from the ten or so systems in the marketplace to four or five systems.”
Adenubi said a series of four workshops were being set up with the Joint IT Committee of the BMA and Royal College of GPs to look at the way ahead.
One of these groups would look at who should hold the funding for GP IT in future, including the possibility of funding being held at GP practice level or by clinical commissioning groups.
A second group would seek to define what should be the scope of a GP system and a third would examine interoperability.
“It will look at what systems that GP practices use should be mandated to have interoperability,” she said.
Adenubi added that could mean mandating a GP interface for the document management systems GPs wanted to use as well as what she described as “functional interoperability” with other care settings.
A fourth working group will develop a survey of GP IT systems to get feedback on what practices think about the systems that they use.
Adenubi said the working groups would not have decision making powers but seek to establish a consensus before decisions were made. She said a new system would be in place to take over when GPsoC ends in March 2013.
Adenubi told the conference NHS Connecting for Health was also looking at changing the way it provided assurance of NHS IT systems, which she said would mean GP IT suppliers taking “even more responsibility” for their systems.
Adenubi also said it was not going to be possible to deliver all the GP IT needs outlined in the DH’s Liberating the NHS white paper.
“There is a long list of needs to support commissioning and a long list of needs for clinical care and we are not going to be able to support all of them.”
She told the EMIS NUG, which attracted around 400 GPs and NHS managers, that a further group would be formed with around 12 to 15 people covering policy makers, suppliers and GP representatives to categorise what she defined as “core” requirements for GP IT in future, “strategic” requirements and requirements which would be left to the market to deliver.
Adenubi said she herself had been frustrated by the slow pace of development of GP IT systems through the GPSoC framework and described how the DH had done a “deadly dance” with EMIS to bring it on to the GPSoC framework.
“We desperately needed each other. GPSoC had to sign up EMIS and it was important to EMIS so they would be on an equivalent funding level to the LSP solutions.”
She argued that ultimately the future of GP IT lay with GPs because she said the choices GPs made, such as whether to stick with EMIS’s LV and PCS systems rather than move to EMIS Web, would dictate what happened in future.
© 2011 EHealth Media.
Just a GP trying to plan for my practice...Mary Hawking 161 weeks ago
As a GP with a practice to run and dependent on my GP EPR system, I need to have some information about the future plans for GP IT.
Before 1990, GPs paid the full cost of their systems.
!990 to 2002, GPs received 50% reimbursement BUT DH mandated developments in GP systems, and there was no support for non-accredited systems.
With the new GMS contract, GP IT was supplied by the PCTs (who had their baseline budgets recurrently increased for this) who held the contract - and developments were mandated by CfH.
All I want to know is who will hold the contracts, who will decide what developments are mandated and how practices' GP systems will be funded after 1.4.13
Surely not too much to ask?
What did Douglas Adams Whale say?Guildfoss 162 weeks ago
I guess Kemi Adenubi would have been absolutely right in 2001, but its now 10 years after ground zero, and I don't think people have the appetite for yet another market consolidation in healthcare!
What is wrong here is the formula that national needs need to be funnelled through 'national contracts', rather than encouraging local procurement against national standards. Is GPSOC exempt from this?
Mandated interoperability from the centre is a nice soundbite, which delivers up the prospect of nice big clean mountains of health data to analyse for the public good. But surely by now we have learned that this is impossible on such a large scale without reasonably mature open standards supported by a healthily competitive supplier market, which we certainly don't have here (yet).
But even IHE, in leading OASIS, DICOM and HL7 standards use for ordering, imaging and document exchange in the acute sector, does not yet have a sufficiently strong grasp of workflows in primary care to offer up a standards solution here. The function and interoperability features that appear to be so desirable here need to be the subject of open analysis and debate through the open standards ecosystems to fuel healthcare software innovation and the development of open standards and commoditisation rather than the unaffordable alternative.
So it seems that we are heading down a very familiar road again. But on the positive side - at least we have this open debate with the Department of Health's willing participation in the discussion!
Cementing the IT landscape and enforcing an Oligopoly?Eckhard Schwarzat 162 weeks ago
Is that really the role of CfH?
Economics 101 tells you that in an oligopoly prices are kept artificially high and the 'power of a free market' is not working.
In consequence, spending to much money on IT instead of patient care is the right way forward?
Is the CfH stuck in a time-wrap? Are we in the 1990s (where this might have been a reasonable approach) or are we in 2011?
The role of the DH and by extension CfH (or whichever successor organisation) should be to go down the path of commoditisation of software and nothing else.
That brings us back to the comments raised before namely:
* CfH has to force the use of open standards.
That means truly open standards, which are not bound by high licensing costs and IP frameworks which make them unusable for open source projects and small start-ups. Case in point are HL7 and Snomed CT.
* CfH has to create an even playing field for open source projects.
Nothing more, but nothing less. One of many examples are costs for interoperability test with NHS BSA renumeration interfaces, etc...
* CfH has to work on standards/definitions in areas which are necessary for commoditisation of software.
Really the big surprise is that CfH still thinks it can go completely opposite to the declared policy of the Cabinet Office in respect to open standards, open data and open source.
Data Handover at end of contractNeelam Dugar 162 weeks ago
PACS image data is relatively easy to migrate from 1 vendor to another at the end of a 7-10 year contract-Thanks to DICOM as a vendor neutral standard. However, PACS vendors still often like to lock you in---scare-mongering, cost of releasing the data etc. We are encouraging Trusts to actually write it in their PACS contracts (prenuptual agreement) that vendors are required to handover data in DICOM format. We are also asking DICOM standards body & IHE to develop a profile to ensure that there is plug & play data migration at the end of contract.
This is key to ensuring innovation continues in PACS---underpinned by customers being able to change IT systems with ease.
Overbearing RegulationHealthCTO 162 weeks ago
I continue to be amazed about how invasive the DH is in its regulation. As others have stated, they should publish the criteria that any system vendor must meet and let the market decide who wins. If you're going to empower the GPs, then empower them by giving them a variety of vendors who have been qualified/certified to a set of interoperability standards. Of course, that would require DH to actually have a strategy that governs information and interoperability...oops.
HL7 and IHE need to make it workNeelam Dugar 162 weeks ago
I agree Tim it is not easy. But DICOM makes it work.
Images can transferred from one hospital to another or 1system to another with almost plug & play interoperability.
HL7 CDA &. IHE can surely do the same. Why not use XDR to transmit path results. We needs strategists who are visionary......
Mandatory Interoperabilitytimbenson 162 weeks ago
I applaud the idea of mandatory interoperability, and I would support the view that interoperability should be the prime criterion for any form of reimbursement.
However, interoperability is not just a matter of ticking the box that says we do HL7, CDA and XDS. The problem with interoperability is that it requires two translations, each of which has to be bit perfect. The first translation is from System A into the interchange language which codes what goes down the wire; the second translation is from the interchange language to System B.
The main difficulty is usually with the semantics (the codes used), rather than with the message syntax (the interchange format) or transport protocols.
The most mature examples of interoperability in GP computing are pathology results reporting, which still only covers clinical chemistry and haematology and the problems are now beginning to be understood and dealt with. These messages were originally defined in the early 1990s. Every other clinical information interchange creates similar problems which need to be addressed as a matter of priority.
I agree with Rob DykeNeelam Dugar 162 weeks ago
What NHS (primary or secondary care) needs is
1. Mandated interoperability standards--HL7, CDA, DICOM, XDR, XCA, XDS
2. A prenuptual agreement with vendor--data handover at end of contract in standard format so that it can be migrated to the new vendor.
Lack of ability to migrate from one vendor to another---vendor lock-in is the key to lack in progress of NHS IT. If we can commoditise NHS IT we will keep vendors innovating as there is a buyers market out there. We often want development work from our vendors. Unless there are market forces there to support the development the executives will not invest in the development.
Global standards & ability to migrate data should be the key strategies for NHS IT.
More Collaboration NeededKemi Adenubi 162 weeks ago
Thank you for your comments and to eHI for highlighting some of the points that I made in my talk at the EMIS National User Group last week. This is an important debate. My primary point was that there are huge expectations of GP systems that are unlikely to be met if suppliers have to develop new functionality in every system in their stable. There was no question of central market manipulation and more talk of how GPs, policy makers and suppliers can work better together to determine what %u21Ccore%u21D functionality should be delivered in all systems, what functionality should be considered to be %u21Cstrategic%u21D for development in their flagship product only and which should be left entirely to the market. My hope is that the core and strategic elements will form a relatively small part of system roadmaps, leaving space for the innovation that we all desire.
I have been working on GP Systems of Choice for five years now and know better than to imagine that market consolidation will come from central diktat. The reality is that practices will vote with their feet %u213 either by staying steadfastly where they are or by moving to systems that prove that they can better meet the practices%u219 and their patients%u219 needs. That is what will actually determine the future of GP IT.