A new era in interoperability
Integration and interoperability have become the keystones of developing joined-up digital healthcare systems.
While integration of local administrative and clinical systems is a challenge many healthcare organisations have long been familiar with, the complexity of this challenge has increased dramatically in recent times.
Where previously NHS trusts needed one-off, point-to-point integration between local systems, they now need effective and flexible integration tools to manage a far more heterogeneous eco-system of local and remote systems
Speaking to E-Health Insider Phil Birchall, Director of Healthcare Business Development at InterSystems, says that NHS trusts and others involved in healthcare have entered "a new 'era' of interoperability, based on more complex 'business critical" integration needs".
Birchall says that the first generation of integration typically involved hospitals having a "dominant application" such as a PAS, with local interfaces to departmental applications, typically to address a single data-transfer requirement. Most PAS vendors took the lead in defining an approach to integration, and that set the landscape for subsequent integration projects within a hospital.
This is now changing, he says, with hospitals now recognising that they need to implement more complex and widespread integration projects themselves to meet the demands of running a modern healthcare institution.
Second generation integration needed
"First generation integration might mean batch integration between PAS systems and other departmental applications for the purpose of sharing demographic information," says Birchall. "Today we are seeing real demand for order communications, results reporting, e-prescribing, radiology / PACS integration, e-referral and discharge summary."
With the deployment of solutions such as order communications, the requirement is now for integration that provides "real-time data exchange" with the added significance that these solutions are now being used by patient-facing clinical staff. In this situation, IT finally becomes indivisible from care delivery, and the technology must be fit for purpose.
In addition to these increasing “internal” demands, healthcare organisations have the challenge of integrating their clinical systems with national systems being delivered by the National Programme for IT in England, and equivalent initiatives in Scotland, Wales and Northern Ireland.
"Across the broader NHS landscape, we see that organisations are facing a range of business initiatives that demand significant new levels of interoperability. These include electronic referrals, demographic service integration, electronic transfer of prescriptions, GP2GP record transfers, links with social care and new e-health applications like telecare. These initiatives will involve unprecedented levels of interaction with other institutions and systems."
Managing a mixed economy of systems
For NHS trusts in England, this means that they are moving into a mixed economy. Many sites are still running their own local patient administration systems interfaced to local clinical and departmental applications. These sites need to have these existing systems interact with national applications including the spine personal demographic service and Choose and Book.
A radical new challenge for most hospitals is the need to integrate local trust systems to the core LSP-delivered solutions. "Hospitals preparing for LSP solutions need to be able to look beyond their firewalls in order to integrate their in-house systems with the new data-centre applications," says Birchall. “This integration needs to be undertaken with the increased levels of rigour promoted by the National IT Programme”.
In many cases, extended delays to the strategic solutions have led LSPs to deliver 'interim' systems and a significant number of trusts have elected to deploy tactical departmental applications to meet pressing requirements. This in effect has made the range of systems in use even more heterogeneous and makes the future integration challenge even more daunting.
Local integration challenges of CfH
However, within the world of NPfIT integration to the LSP application is not explicitly a part of the centrally-funded contracts and is a responsibility that trusts have to prepare for and manage. So while an LSP-hosted PAS solution such as iPM or Millennium may be run out of a data centre, key departmental systems will remain locally at the trust. This means that the trust needs to be able to take an active role in managing the integration between these systems and the LSP application.
Just to add to the heady mix some trusts have chosen to not yet take the core applications from LSPs but instead take some of the additional departmental applications offered such as theatres, maternity or A+E. "In this case the challenge is to connect the data-centre hosted applications their own local PAS," explains Birchall.
He adds: "The difficulty for trusts is to be able to effectively manage this level of complexity and diversity. Many trusts are now rising to this challenge and looking for new generations of technology to support them”.
InterSystems approach to integration challenges
Birchall says that the challenges of integration are faced by all modern healthcare systems attempting to digitise the flow of information and sharing of knowledge.
“InterSystems has nearly 30 years experience delivering technology that supports successful healthcare initiatives in over 90 countries,” says Birchall. “The decision to introduce our Ensemble integration platform was driven by a recognition that our worldwide customers and partners were looking for innovative new technology to help them deliver connected healthcare.”
“We are delighted that Ensemble has already proved to be successful in a wide range of projects,” Birchall continues, “it is important that we have been able to contribute to projects ranging from individual NHS trusts, through to large-scale initiatives such as the Netherlands national messaging infrastructure.”
Building on the experience of its Ensemble health integration engine the company has now launched its Healthshare platform - designed to help build regional and national-level Electronic Health Records.
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