The Government’s vision of future health care is focused on sharing more information across the system to produce better outcomes for patients. Darren Solomon of Clinisys tells Health Tech World that sharing diagnostic data will better inform clinicians and ultimately lead to better patient care
In a recent white paper, Working together to improve health and social care, the Department of Health and Social Care outlined its vision for better, joined up care across the health and care system. The paper painted a vision of integrated care systems (ICS) playing a central role with different parts of the NHS working in collaboration, and the NHS and local government forming dynamic partnerships to address some of society’s most complex health problems.
This work builds on the eight sustainability and transformation plan areas in England, named by NHS England in 2017, which were primed to create space for innovative thinking about how to transform health and care at scale.
One of the challenges that the ICS’s have is the sharing of diagnostic test results across modalities. We know that patients don’t just visit one hospital to receive care. They are often transferred between specialist sites and are increasingly also receiving care in the community and so the need for data sharing across sites and across geographical locations is rising.
When talking to the diagnostic lead in one of NHS England and Improvement’s regions, I was challenged to think about “the art of the possible” to solve some of the challenges he faced. He explained how we needed to overcome these barriers but needed to remain using the systems in which the region has invested already – something I knew could be tricky with the renowned interoperability challenges within NHS technology.
Never one to turn my back on a challenge, we looked at how we could remove the barriers in place to create a central diagnostic hub that would take results from across the region and give clinicians a holistic view to support patient care.
The intention is to start with pathology results, using the technology embedded in the Clinisys Integrated Clinical Environment, or ICE. But then move on to other areas such as radiology, cardiology, endoscopy…and so on.
The diagnostic hub uses a feature called ICE OpenNet that enables one instance of ICE to share results with another. It is a very simple concept. It means that clinicians working in trust A can see results from trust B and vice-versa. So, if a patient presents in trust A, and they’ve already had bloods done in trust B, their clinician can take a look at the results. That way, they avoid the need for taking more blood which can cause delay and further patient anxiety and discomfort. Or, if they decide to order the test again, they have a baseline against which to compare the result.
ICE OpenNet is great, but because you are making calls from one trust system to another, you couldn’t use it across a whole region – it would be too network intensive. This is where the diagnostic hub comes into its own. It has an ICE underneath it that all the other ICEs can talk to in order to get the chatter under control. It is hosted in the cloud, handles all the processing, and creates the region-wide view.
Trusts that don’t use ICE can still integrate with the diagnostic hub by using the ICE application programming interface. Essentially, we will publish a specification and an API to enable any system to send us properly formatted messages. A lot of electronic patient record systems allow third-party applications to launch in context, so trusts can let clinicians view results that way. Or they can render our information for display within their system.
We believe the future for major healthcare IT systems is interoperability and our vision is to be very open. We will publish the ICE API and then it is up to trusts and their vendors to display in context or do the work to render it.
During the early project work for the diagnostic hub, we had a look at how trusts across the region that we are working with are using ICE OpenNet. We found that in just one conurbation, with three major acute centres, there were more than 58,000 OpenNet connections in a single month.
By making some assumptions about the kind of tests results that clinicians were likely to be looking for, we were able to calculate that each trust was saving about £70,000 a month, or around £1 million a year, just from not running those tests again. Scaled up, that suggests the diagnostic hub should save the region about £5 million a year. So, it’s a great investment in getting a lot more out of technology that already exists.
Looking to the future, we already have other regions interested in the diagnostic hub concept. We’re having quite detailed discussions with a second region in which ICE is much less prevalent. It would need to do more of the integration using the ICE API; but it can still see the benefits.
We would love to get diagnostic hubs working in all eight regions. If we could do that, we could also create a national diagnostic repository, by linking the hubs together. Ultimately, what we want to provide is a full picture for the clinician, wherever they are working, and at whatever point on the patient pathway. The more diagnostic data we can route into the hub the better – the clinician’s will be better informed and the patients will receive better care which let’s face it, is what it is all for.