03 Nov 2022
by Robert Walker

Health and social care interoperability update: DCMS Bill, use cases and blockers to standards adoption survey

Last Friday, techUK welcomed Luke Readman, Regional Director of Digital Transformation at NHS England, and Hanida Tomlinson, Programme Manager, ICS Strategy and Future Vision at NHS England, to provide an update on the work done on crowdsourcing use cases, a project undertaken to identify interoperability, integration or data architecture issues and blockers in patient pathways that involve several care settings survey on blockers to standards adoption, which members were asked to complete earlier this year and the DCMS Bill on Information Standards for Health and Adult Social Care and potential impact on the supplier community.

Luke opened the discussion by detailing how his team have been working over the past few months to outline where NHS England (NHSE) are on their interoperability journey. Luke passed over to Hanida to further set-out NHSE’s progress on crowdsourcing use cases and the survey on blockers to standards options. 

You can watch the full video here 

Crowdsourcing use cases  

Hanida outlined that the purpose of gathering use cases was to identify interoperability, integration or data architecture issues and blockers in patient pathways that involve several care settings. The intended outcome of this exercise is to gather evidence and clear articulation of care settings impacted, better determination of the priority areas that interoperability needs to be improved in, its value and the case for change. Evidence gathering started on May 20th and is still ongoing, however NHSE have received about over 500 use cases to date. They have received a good number of use cases for the care effectiveness, and care efficiency categories, but more are needed in research and planning as well as integration issues that include social care. Hanida also stated that the use case analysis is likely to start this month.  

Survey on blockers to standards options 

Hanida then passed on to Seb Tallents to discuss the survey on blockers to standards options, which was completed on July 31st.  Seb provided the context to the survey, which sits alongside the interoperability strategy and outlined the challenges to actually implementing interoperability across the healthcare system. This project consisted of two main aspects: 

  1. An internal workstream analysing the value of each interoperability initiative and establishing connections from policy drivers and benefits to the specific use cases and associated standards that deliver the use cases. 

  1. The Blockers to Standards adoption survey, identifying the specific blockers that need to be addressed to effectively deliver this strategy and associated recommendations that need to be actioned.  

Seb passed on his gratitude to all those who responded to the survey and highlighted that they had received over 180 responses. He then summarised some of the key results: 

  1. The survey provides quantitative evidence to demonstrate that standards are not widely adopted and used 

  1. The ability for carers to quickly and easily access information remains low 

  1. The internal decision-making processes do not prioritise interoperability and the benefits that it brings 

  1. Providers are not equipped to effectively manage interoperability solutions 

  1. Differing views from providers and suppliers on what are the blockers  

  1. There are, however, some unifying blockers - there are five blockers where total agreement between provider/suppliers is higher: 

  • Lack of clear prioritisation (80%) 

  • Lack of financial incentives (78%) 

  • Procurement and contracting (74%) 

  • Lack of line of sight to operational impact (72%)

  • Speed of getting standards created, as well as updated (72%)

7. Despite some differences between provider/suppliers perspectives on what the key enablers are, the survey results indicate there are some unifying enablers, including:  

  • A clear set of consistent specifications across all national services and/or a clear path to transition (37%) 

  • A clear and published national interoperability roadmap of APIs that once published, has delivered commitment (34%) 

Recommendations 

Having detailed the results of the survey, Seb then set out some of the recommendations and next steps to the top 5 most cited blockers. 

In relation to lack of clear prioritisation, it has been recommended that there is coordination of the ‘ASK’ to the market and coordination of the ‘RESPONSE’ by the market, ensuring the right commercial frameworks are in place to facilitate interoperability and make such projects commercially viable. 

Investment coordinated at both ends of the interface was recommended to combat the lack of financial incentives.  

In order to address issues relating to lack of line of sight to operational impact, the analysis has recommended a formal and independent stock-take across national interoperability initiatives against the “Value Chain Interoperability Framework”. In addition to this, a formalised set of actions per interoperability initiative in addressing gaps in mitigating against this blocker.  

Finally, the recommendation to alleviate concerns surrounding the speed of getting standards created, as well as updated, is to take a product mindset approach to ensure the continuous improvement of standards based upon a prioritised set of features, so that standards remain relevant even when programmes have finished. 

DCMS Bill on Information Standards for Health and Adult Social Care 

Following this, Hanida then provided an overview of the DCMS Data Protection and Digital Information (DP&DI) Bill. 

The Bill was introduced to the House of Commons on July 18th, with changes to Information Standards included in part 4 of the Bill.  

The intended outcomes of the new changes are improved clinical outcomes for patients, improved clinical decision making enabled by access to accurate and complete information, better procurement and commissioning by health and care providers, among others.  

Hanida explained that the changes that are being proposed in the Bill aim to address issues across a number of areas including; the inability of service users and care team to easily access or share the health and/or social care information that is relevant to a patient’s care.  

According to NHS England, the changes are focused on requiring all relevant organisations and stakeholders to use standard coding, encourage use of FHIR and standard APIs and promote a more open approach to data architecture and fluid data sharing amongst the health and care sector. Hanida said the primary powers within the Bill are an extension of already existing legislation for the NHS and providers, include suppliers.  The Bill would enable the Government to enforce this on behalf of the NHS and adult social care through a system of compliance notices, public censure and financial penalties, along with the power to establish and operate an accreditation scheme. Hanida stressed that these were still high-level proposals and would use existing bodies to enforce the provisions of the Bill.  

Timeline 

Hanida outlined a high-level timeline for the implementation of the Bill, which is likely to receive Royal Assent in May 2023, but emphasised that this is subject to change.  

The Asks 

Hanida went to outline what the NHS Transformation Directorate requires from industry. They very much want to continue gathering evidence on use cases and the priorities that need to be focused on, particularly involving interoperability, integration, data architecture issues and blockers in patient pathways – these can be sent to [email protected] Any immediate queries about the Bill can also be sent to this email address. 

Question & Answers 

The presentation was then opened to the audience for questions.  

Q: Shane Tickell asked if there was a reason the Bill was only focused on adult social care and queried if there was a reason children services weren’t included at this stage.  

A: Hanida replied that at the moment the main requirement is adult social care and that it’s more complex to include children services just now but that it’s on the horizon. Hanida also highlighted that the Bill doesn’t include devolved nations as of yet but once the Bill has passed there will be efforts to push this onto their respective agendas going forward.  

Luke also added that because there is separate legislation covering children services, that it’s a more complicated area to define but that it’s definitely on the longer-term pathway.  

Q: John Hayden asked if there was case for building a bespoke NHS interoperability team that can review solutions and projects coming through the pipeline which could establish if there was a way to evolve interoperability across the estate rather than establish a single standard from day one and then determine if that project has a big impact? 

A: Luke Readman replied that this had been attempted before but one of the issues that has held this back is the structure of the NHS and its differing organisations, which are legal entities in their own right. In addition to this, public policy also favours local decision-making about contracts rather than driving it through a single pipeline. This Bill is an attempt to bring all that together but retain some local decision-making but with conditions attached.  

Q: Fiona Dawson asked if the team could define Information Standards. 

A: Luke replied that the Information Standards notice is a general term that refers to Standards which are defined and published through an authorised route within the NHS. Luke then provided some examples as what it may refer to, i.e. a taxonomy standard or a data standard.  

techUK members that want to find out more about our work on interoperability can contact [email protected]. If you'd like to talk further about the DCMS Bill, please reach out to Dani Dhiman, [email protected], techUK lead in this area. 

Leontina Postelnicu

Leontina Postelnicu

Head of Health and Social Care, techUK

Alex Lawrence

Alex Lawrence

Programme Manager, Health and Social Care, techUK

Robert Walker

Robert Walker

Programme Manager, Health and Social Care & Justice and Emergency Services, techUK

 

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