“Technology needs to enable neighbourhood working, not constrain it”

By Andy Barker, strategic advisor for digital health at Harris Health Alliance, and formerly IT director for East Kent Hospitals University NHS Foundation Trust and digital transformation lead for Kent and Medway ICB.

Neighbourhood care brings many benefits. It means that a multidisciplinary care team can look after patients, whatever their needs. That team can include acute, primary, community, and social care, and mental health professionals.

Neighbourhood health is a key part of the delivery of the government’s strategy for healthcare. And yet, it is being held back by the challenges associated with connecting systems together across organisational boundaries.

Talking to clinicians about neighbourhood health, I find there is a lot of willingness and cooperation – they really want to make a difference and to provide better care for patients.

Clinicians who care for patients at home or in their care setting, for example, want to see more neighbourhood working and are actively trying to make it happen.

But digital capability is holding back the development of true neighbourhood working.

The interoperability challenge

When clinicians are from different organisations, they always hit a barrier with the systems they are using. At best, they can see each other’s information, but cannot update it.

For example, a community nurse may have to type up the same notes twice, because there is one system for the primary care team and another for the community trust.

We need to remove the need for double or triple entry of information. Healthcare professionals should not be expected to enter the same information into two or more systems.

The development of shared care records some years ago, was transformational.

Clinicians at the point of care can now see significantly more patient information than was previously available.

But the difficulty has always been: how do we handle the situation where information, such as from patient notes, needs to go from a clinician to elsewhere in the system.

And how do we deal with a piece of information that is owned by a collaborative team, and not by any one single organisation – for example, the ReSPECT form, which every neighbourhood health team uses and needs to be accessible to any clinician engaged in the patient’s care.

We can present that information, but we can’t necessarily collect it easily.

In care homes, taking patient observations electronically using wearable technology is an increasingly common approach.

But while this observation data is available within a specific system, such as a virtual ward system, it is not necessarily available to the patient’s GP, for example.

These are the sorts of barriers that we need to break down.

To ensure successful neighbourhood working we need the right data at the right time presented to the right people.

The right people are those who care for a patient, irrespective of the artificial boundaries of organisations they are employed by. And the right data is from whatever source that is used with that patient.

But inertia is preventing effective neighbourhood working. It’s not been a high priority. Acute care, for example, has traditionally been provided in isolation.

We’re playing catch up because of the legacy we’ve been handed, and now we need to look for solutions that go beyond those that were created with shared care records.

From a digital perspective, everyone’s been working separately. Now with the shift to the left, there’s a drive and a need to work together.

My digital colleagues who have worked for years on introducing shared care records might say: “We’ve done all this work to share information”, and that’s true.

We are way better than we ever used to be. But, while we have made a lot of progress, in order to drive neighbourhood care there is more to do.

There is clearly a competitive advantage to creating information sources that really make a difference within the context of a system.

For example, with electronic observations, the suppliers of those systems need to be able to develop their functionality and improve the way in which they care for patients or support their care.

We don’t want to be holding that back, and we want to support innovation.

But at the same time, we need to be able to impose a level of interoperability that suppliers perhaps wouldn’t necessarily choose in order to maintain their competitive commercial advantage.

That’s the challenge.

There is a way through this though.

Most of the suppliers we talk to are keen to interoperate by making their information available through APIs, but it is less common that they support updating their information through controlled API usage.

Bringing together organisations onto a single interoperability platform

That’s what Harris Health Alliance is trying to navigate; bringing together organisations onto a single interoperability platform that breaks down some of these barriers and removes any potential concerns about loss of commercial advantage.

For example, the Harris Health Alliance conneQT Toolbar was developed to provide access to child protection information in any health setting, whether that’s in an emergency department or in a GP surgery.

On the back of this success, Harris Health Alliance then expanded the range of sources of information it worked with, and continues to do so today.

Across Kent and Medway primary care, the toolbar is being rolled out to provide access not just to the Child Protection Information Sharing (CP-IS) system, but also a range of other information sources, including secondary care through Altera Digital Health’s Sunrise product, pharmacy trackers and remote monitoring systems.

And within care homes, information generated by a remote monitoring system is not just available within that system, it’s now available within the toolbar, alongside other sources of information, such as secondary care.

Neighbourhood working is the right way of working

A patient, whatever their care context – which could be a neighbourhood, acute hospital, or consulting room – should receive the same care across all the clinicians involved in providing that care.

There is strong support and belief that neighbourhood working is the right way of working. Not just because the government is driving it but because everybody at the front line believes this.

At its heart, the value of neighbourhood working is that patients are cared for in the most appropriate setting, and will be provided with the best possible care, whatever that setting is.

Technology needs to be an enabler of this vision, not a constraint as it so often is today.