The move to remote working has brought with it some unexpected benefits, such as spending more time with my family, doing up the house and being reacquainted with unfamiliar household machinery like the washing machine. Most surprisingly, it has afforded me more quiet time to just pause and think. While taking the time to ponder may seem like a luxury in a global crisis, I believe it’s a necessity to make sense of the new environment we’re facing and find new paths for success.
One of the things I’ve been thinking about is the orchestration of care – the ability for healthcare providers to harmonise care without the need to undertake significant, lengthy and costly “rip and replace” digital transformation programmes. Too often, these programmes are just the beginning rather than the endpoint of a digital transformation. They also don’t provide the right foundations on which to build the complex intertwining of systems, processes and clinical practice required to establish a foundation for future success in the ever-changing healthcare environment.
The UK context
The NHS is increasingly thinking and acting in regions, whether across Integrated Care Systems (ICSs), Sustainability and Transformation Partnerships (STPs) or Clinical Commissioning Groups (CCGs). The aim of this centralised approach is to provide more efficient and improved healthcare services to the population that they serve. However, the digital strategy of the component organisations within these bodies will likely swing between two main camps, that is:
1. Best of Breed model: Software from different vendors is deployed to address specific clinical and business requirements with integration to share relevant data
2. Electronic Patient Records (EPRs): A digital version of a patient’s paper chart where most of the clinical and engagement information will reside in one software solution
In addition, the digital maturity and pressures of each organisation are likely to be equally distinct. In this context, it’s not hard to see that pursuing a rip-and-replace approach may feel like the only option for those in the driving seat. However, there is another option.
With the right tools and approach in place, it is possible to unlock value from existing digital investments without necessitating a replacement. In parallel, there are proven mechanisms available to join up those disparate system(s) to provide a full, modular electronic record that can adapt and evolve to the ever-changing needs of NHS organisations.
A model for orchestration
So, what do we need to support that innovative approach? Well, I believe there are four component pieces that allow us to deliver a transformative approach to healthcare. Those components are interoperability, data quality, clinical engagement and connecting care.
Interoperability provide the foundations on which we can build our approach, by allowing component systems across a healthcare ecosystem to “talk to each other”. This promotes data liquidity, data integrity, removes duplication and identifies a source of truth in our model. If achieved, interoperability helps to deliver a multitude of benefits, including:
- Improving patient care, experience and privacy
- Streamlining clinical interaction and workflow
- Increasing productivity and reduces costs
- Promoting a partner eco-system for other suppliers and innovators to extend
- Creating the foundations of a system of engagement, not just a system of record
The key foundation of orchestrating care is moving beyond superficial interoperability and towards what I would term “organisational interoperability”. That is, achieving the fusion of not only data but also of social and organisational elements of the system, including workflows.
Data quality is critical to build clinically connected solutions. This has been brought into sharp focus over the last few months as we encountered the challenges of COVID-19. Data is critical to support decision-making in healthcare and helps to facilitate an open, data-centric approach to healthcare technology. Data is often moved or migrated from one proprietary format to another, which often comes at great expense and potentially introduces risk as not all data is always migrated, diluting its value in the process.
Health data is currently stored and exchanged in numerous formats across multiple standards. This creates a headache for both the NHS and healthcare providers alike in normal running, let alone in the midst of a global pandemic. Convergence to agreed standards is crucial to facilitate the openness of our orchestration layer. For Alcidion, that means focusing on FHIR as a strategic direction for future proofed standards development, which removes the need and headache of multiple mappings and transformations for our customers which can diminish both the meaning and the value of their data.
Clinical engagement and connecting care
By overlaying our open orchestration layer on top of existing solutions, we can build a longitudinal healthcare record that unlocks value from the data as we bring it into an open schema and standard. By designing and developing innovative, clinically engaged capabilities on top of that data layer, such as eNoting, Clinical Decision Support (CDS) and mobility, we can provide the right information at the right time presented in an intelligible way through the lens of risk to the clinician.
Our open approach allows organisations to react to evolving local or national healthcare demands. For example, allowing different clinical algorithms and decision support to be built quickly to reflect the nuances of local care provision during COVID-19. This flexible approach also enables the rapid deployment of other capabilities such as focused clinical monitoring dashboards that draw data not only from our solution, but from across the enterprise and extending to patient wearables.
Of course, overlaying existing systems doesn’t mean that they won’t ever need to be replaced. However, our approach extends the lifetime of existing systems of records, while delivering a full, modular electronic patient record. This affords healthcare organisations the ability to swap systems out without impacting the clinical experience once our electronic record is up and running, rather than undertaking a huge replacement program before realising any value.
Achieving true orchestration is possible today – the models and technology are available now.
Tom Scott is UK Sales Director at Alcidion