Electronic patient record interoperability in NHS England is benefiting patient care but facing substantial barriers, according to a new KLAS report. NHS England’s Five-Year Forward View and the National Information Board’s response have thrust interoperable systems into the national spotlight in England, including the development of a Local Health and Care Record Exemplar program. This report represents KLAS’ first look at interoperability within the NHS.
The report, NHS Interoperability 2018: Data-Sharing Efforts, Obstacles, and Progress in England focuses on measuring the ability of care records and case management systems to receive outside patient data and present it to clinicians, not their ability to transmit such information.
KLAS notes in its research that while the transmission of data is vital to interoperability, it does not guarantee that the data is being used on the other end (this is one of the major challenges with the “meaningful use” program in the United States—it focuses on the outbound transmission of data rather than the ability to ingest and make sense of incoming data).
NHS Data Sharing
The KLAS report reveals that a substantial amount of patient data is being shared within the NHS, mostly via 61 local shared records across England. However, much of this sharing is limited in breadth and cumbersome in nature since it falls outside of the clinician workflow. These factors prevent ideal interoperability—defined as consistent access to needed outside patient information in an easily located and viewable place within the care record/EPR.
Barriers to NHS Interoperability in England
The report identifies 3 core types of barriers to NHS interoperability in England (market, supplier and internal barriers):
1. Market barriers include insufficient technical and clinical standards, lack of patient education or willingness to share, lack of clarity on information governance, and lack of understanding of disparate care settings among care.
2. Supplier barriers include unwillingness to enable data sharing, lack of supplier resources and/or expertise, poor quality or missing interoperability tools (e.g., inability to share structured data), pricing model, and inability to accurately match patient records.
3. Internal barriers include lack of strategy or interoperability roadmap, lack of resources/expertise, internal data-sharing difficulties, clinician unwillingness to adopt tools, and unwillingness to share data.
“While people may be happy with the solutions [for interoperability] today, consulting the solution road map will allow them to see if their vendors are moving towards the interoperability standards needed to support future requirements,” said Rachel Dunscombe, CIO at Salford Royal NHS Foundation Trust in the report.
The data in this report comes exclusively from a supplemental evaluation developed in conjunction with CIOs, CCIOs, and other health and care leaders within the NHS in England and was collected over the latter half of 2017 and the beginning of 2018. The data in this report reflects the insights into care records and interoperability of 141 individuals from different organizations/roles within the NHS across 149 unique care settings and numerous care records/EPRs.