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Report: Interoperability in NHS England Faces Similar Barriers as U.S. Healthcare

May 23, 2018
by Heather Landi
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Electronic patient record interoperability in NHS England is benefiting patient care, but interoperability efforts are facing barriers, including limited data sharing and cumbersome processes falling outside of the clinician workflow, according to a KLAS Research report.

KLAS Research, based in Orem, Utah, reports 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/electronic patient record (EPR).

Similar to what U.S. healthcare providers say about interoperability efforts, NHS respondents to the KLAS survey say some vendors are making progress to make their systems more interoperable, but delivery has been slow. Many vendors enable sharing among their own customer base, but exchanging between disparate systems is extremely challenging.  And, NHS respondents to the survey also said secondary care suppliers are not proactively driving cross-platform interoperability. “Without a paradigm shift among suppliers, change will continue to be driven by pressure from customers,” the report states.

Just over one-quarter (26 percent) of organizations report having no means in place to electronically receive outside patient data (with the exception of faxing and core NHS Spine services); acute trusts—which have a significant need for shared data—account for most of this gap in sharing, the report states.

According to KLAS, 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.

The report, “NHS Interoperability 2018: Data sharing efforts, obstacles and progress in England,” is based on 141 individuals at 124 unique organizations across England who participated in the research. All told, these 141 individuals provided insights into care records and interoperability across 149 unique care settings and numerous care records/EPRs. The report examines how well organizations (i.e., primary, secondary, mental health, community, and social care organizations) are able to receive outside patient data. And, KLAS examined what types of electronic data sharing are taking place today, how frequently, and with what benefit. The research firm also looked at what technologies are relied on most, and how suppliers are perceived by customers relative to the suppliers’ role in facilitating interoperability.

Eliminating extra steps for clinicians, nearly one-third of organizations (30 percent) display patient data from other health or care providers within the care record’s fields or on a separate tab. Another third (35 percent) use portals to display data from other care providers; this represents the broadest type of data sharing going on today. However, portals don’t fully meet clinicians’ desire to have patient data integrated into their normal workflow. Even those organizations with full integration don’t meet all clinician needs since their use cases are limited to ingesting results or transferring data from one GP to another who uses the same supplier. There are instances of structured information being shared across care settings between disparate suppliers, though such sharing is limited to date, the KLAS report states

“Clinicians are starving for data, and expectations for data presentation are rising. Respondents at organizations that pull outside information directly into the record (either fully integrated or on a separate tab) are about 20 percent more likely to say that their clinicians can access exchanged patient data “often” or “nearly always.” While there is room for improvement, 57 percent say exchanged data frequently benefits care (compared to 49 percent in the U.S. for sharing between different EMRs),” the lead report author, Jeremy Goff, wrote.

The report also notes that the most widespread sharing happening today within the NHS is through the 61 local care record (LCR) initiatives facilitated by health information exchange (HIE) technology—a bright spot in supplier offerings. Though still early, LCRs are aggregating data from numerous sources and presenting it to clinicians—usually via a separate portal. “InterSystems and Cerner are the top performing HIEs thanks to the relative ease with which they can connect disparate data sources and their ability to share information between care settings,” the report states.

The report identifies market, supplier and internal barriers to improved interoperability within NHS. 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.

Supplier barriers include unwillingness to enable data sharing, lack of supplier resources and/or expertise, poor quality or missing interoperability tools, such as the inability to share structured data, pricing model, and inability to accurately match patient records, the report states. Internal barriers include lack of strategy or interoperability road map, lack of resources/expertise, internal data-sharing difficulties, clinician unwillingness to adopt tools, and unwillingness to share data. 

In the report, Rachel Dunscombe, CIO at Salford Royal NHS Foundation Trust, commented, “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.”

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