The lack of interoperability of data and systems has been a significant blocker to the delivery of integrated care for years. It has caused the pursuit of a single view of patient information to be difficult and dependent on the willingness of vendors to work together.

It has largely been the job of NHS organisations to put pressure on their suppliers to make data available, with no formal incentive coming from the centre. There has been an absence of widely accepted data standards, making interfaces costly to build and not repeatable.

The good news is, this is changing. Orion Health is a founder member of the INTEROPen movement, dedicated to the development of open standards for interoperability in the health and social care sector. This group has achieved a huge amount since its creation in 2016, including a library of HL7® FHIR® resource profiles and interaction patterns (APIs). These include Care Connect APIs developed with NHS Digital. This movement has been voluntary and driven by those passionate about making interoperability a reality. So, it’s encouraging to see in the recently published NHS Long Term Plan that commitment to interoperability will no longer be a choice for vendors, in that compliance with published open standards will become a formal requirement.

Reducing drug-related deaths in Bristol, South Gloucestershire and North Somerset

So, why is interoperability so important? Is there a real-life use case of it improving efficiency and care? Yes. The Connecting Care Programme based across Bristol, South Gloucestershire and North Somerset has provided an integrated digital care record since December 2013. Since the initial go-live, many new integrations and functionalities have been added over time. Last year, the team had an ambition to reduce drug-related deaths for the homeless and vulnerable by bringing information on prescriptions for Opioid Substitution Therapy (OST) drugs into the integrated digital care record.

To meet this ambition, Connecting Care worked with Orion Health’s pioneering integrated digital care record and the Cyber Media drug and alcohol system, Theseus, which is used by Bristol City Council. To our knowledge, the project marked the first implementation of a Care Connect API in England. The project was very rapid, going from design to go-live in just seven weeks. The new FHIR supported interface can be viewed by staff working in 27 organisations, including 85 GP practices, NHS hospitals, mental health and out of hours services, social services, paramedics, charities and hospices.

This project proves what can be achieved when we embrace open standards and work together for the benefit of the patient. FHIR® is by no means a magic bullet, but it is only by using these emerging standards that we can refine them and move forward. This is complex stuff, but we are so much further ahead than five years ago when we were still discussing who owned data, and what could be shared, and what standards should be used for any sharing that took place.

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This piece originally featured in Digital Health's, Interoperability - Advisory Series, January 2019