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data interoperability for Integrated Care Systems in the UK

Balancing interoperability and empowerment: New challenges for NHS England’s Integrated Care Systems

The introduction of NHS England’s 42 Integrated Care Systems (ICSs) on July 1st heralds huge steps forward in how care and patient services are planned, paid for and managed across the country. 


The ICS strategy was devised to help achieve some of the most ambitious and critical goals set out in the NHS Long Term Plan. The ICS model has the potential to improve communication and collaboration between primary and secondary care providers, support a shift towards population health management, and help the NHS better meet the diverse needs of local populations across England.


But, there’s an important NHS goal that the ICS model isn’t fully aligned with — its push to increase the interoperability of data and systems to support modernization, improve patient experiences, and enable innovative approaches to care delivery.


Balancing local and national demands


The ICS model helps care teams and organizations make precise decisions at a local level. Each ICS is empowered to tackle the challenges faced by its local population in whatever way best suits them. For example, if there’s a high number of people that depend on in-home care in remote areas, the ICS can prioritize and enable that. But that level of local flexibility and freedom can create new national challenges; especially when technology is involved.


With every ICS responsible for its own technology decisions and investments, and prioritizing its tools and solutions investments to meet local needs, there’s a risk that the model moves NHS England further away from its goal of interoperability and connected data across the country. 


As a result, patients are well-served within their local areas, but once they move around, or cross-ICS teams want to use data to collaborate and improve their operations, there’s no standardized foundation for them to easily do so.


Success starts with the right standards


Clearly, ICSs can’t afford to prioritize national interoperability over solving local population health challenges. So, what can NHS England do to overcome this national level issue?


The solution starts with stronger, better-supported and more relevant integration standards, and guardrails to enable a light-touch approach to guiding the digital decisions that ICSs make. With the data and digital landscape evolving so quickly, several of the standards currently in place across the NHS have already started to feel outdated, and are pushing organizations along costly upgrade paths, rather than ensuring interoperability at a national level.

ICS collaboration doesn’t necessarily have to be direct. By choosing to use solutions built on open source software, an ICS can open the door to digital collaboration and standardization, without having to make any specific plans with other ICSs.
Scott Davies
Technical Director, UK Public Sector, Thoughtworks

ICSs themselves have a role to play in enabling interoperability too. As they start to make their own plans for future data and digital investments, it’s in their interest to collaborate with other ICSs and make technology decisions that will help them work together in the future, such as choosing to use open source tools and platforms.


Interoperability is key to innovation


For NHS England, ICSs, practitioners, and patients, a standardized, interoperable data and system foundation is in everyone’s best interests. Supported by a consistent digital foundation, teams and organizations across NHS England can:


  • Collaborate with ease and learn more from data by sharing it with one another as purpose-built products that achieve an outcome, rather than wholesale data dumps
  • Strengthen digital strategy and move towards being able to make strategic digital decisions as one NHS
  • Improve patient experiences by removing friction and reducing delays as they move between ICSs and specialist care providers anywhere in the country
  • Embrace patient-driven care and establish powerful new services such as permanent static-linked digital patient records, and personalized and self-service care


Creating that standardized, interoperable foundation could mark the beginning of a new digital era for the NHS and its ICSs — one characterized by rapid data-driven decision-making, smooth and satisfying patient journeys, and simple, disruption-free data sharing.


Total interoperability is a lofty goal, but the benefits are closer than they may appear


Getting to a point where every ICS across England has 100% interoperable systems, software and digital tooling would require significant effort and change. But even if just a small number of ICSs started collaborating more closely to make joint digital decisions, they could start sharing costs and realizing a lot of the benefits of greater interoperability very quickly.


Take secondary care for example. Across the UK, there are more than 20 different Electronic Health Record (EHR) systems utilized by secondary care providers for similar purposes. If that number were brought down, interoperability quickly becomes a much smaller and easier-to-tackle challenge.

Achieving 100% standardization across 42 ICSs is a very lofty goal — and one that’s probably not practically achievable. But, systems and solutions don’t need to be 100% standardized across the board for ICSs to start seeing some of these benefits.
Phil Smalley
Health and Social Care Industry Lead, Thoughtworks

It’s a journey that needs to be tackled incrementally, but one that NHS England and England’s 42 ICSs should start in earnest soon. Without it, the ICS model opens the door to regional digital divides, potentially reducing the accessibility and equality of care.


Balancing freedom and control is hard.
But it’s getting easier.


This situation isn’t unique to the NHS. It’s symptomatic of one of the most common and persistent challenges in the tech world — balancing local freedom and empowerment with standardized frameworks and centralized governance.


In order to achieve the best of both, many organizations are increasingly exploring modern architectural paradigms like Data Mesh.


Data Mesh is a decentralized architectural approach that puts diverse domains in control of their data, enabling them to create their own data products that best serve their needs. But the foundation of the mesh also ensures interoperability between every product, supporting the wide reuse of domain-oriented data products across an organization.


For organizations like NHS England, that balance of domain empowerment, central standardization and built-in governance may be exactly what they need. But, until that can be accomplished, progressing standardized integrations like GPConnect can help create more responsive and resilient systems capable of meeting emerging data and patient demands as they emerge.


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