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UK’s evolution to integrated care systems will require interoperability 

NHS Five Year Forward View has called for better integration of general practitioners, community health, mental health, hospital services and home care. To accelerate this way of working over the last few years, it has encouraged local partnerships amongst care providers and commissioners in an area, known as Sustainability and Transformation Partnerships (STPs).

Some of these STPs are ready for the next step in the integration journey, which will be to form Accountable Care Systems (ACSs), now called integrated care systems. These are “evolved” versions of STPs that accept collective greater responsibility for coordinated care and better population health. In return, the NHS will give these organizations more freedom on how to deliver care and access to a funding package from 2018.

The technology infrastructure of many organisations will need to evolve to adequately support this complex transition. As we move toward integrated care, it is unlikely that general practitioners will leave their well-differentiated systems behind. They rely on their systems to holistically manage their diverse populations of patients. The systems prompt them to use patient contact for opportunistic preventative care, screening and education. As a by-product, collation of clinical data in these systems results in the primary revenue generating reports for their (state-funded) practices

It is also unlikely that any electronic patient record (EPR) used in an acute hospital will be suitable for managing the complexities of mental health facilities. In the UK, hospitals must report on patients who are detained under the Mental Health Act, and clinical systems must help them manage the intricacies of the sections of this act, so that dates for review and appeal are not missed.

Social care is another area where data from these systems will be a crucial part of the tapestry of patient information, combined with information from healthcare, palliative care, private clinics and beyond.

At Allscripts we focus on delivering safer and more efficient care. Our platforms enable healthcare organisations to exchange, integrate and leverage meaningful information to improve the quality, safety and efficiency of care. Collecting useful data from disparate sources can help measure performance, analyse utilisation, manage risk, reduce costs and improve quality of care.

Caution against a false hope in monolithic systems

There are some vendors in the marketplace who are advocating that the best way to achieve seamless health data exchange is to have one digital ecosystem. They would have people believe that a rip-and-replace approach is the only way to satisfy the evolving requirements of an integrated care system.

Allscripts enable organisations to integrate patient data from diverse care settings, such as health and social care, regardless of IT supplier, into a single longitudinal patient record. dbMotion provides semantically normalised data, point-of-care tools, and an analytics gateway. This reduces the cost of care delivery, enables clinicians to provide more informed patient care, drives clinical outcomes and supports the transition to accountable care.

Whilst things may work really well inside a one-vendor ecosystem, no single vendor can deliver everything an integrated care system will need. You’re always going to have elements – other systems and devices – that are outside of it. And it won’t be just about aggregating clinical systems from healthcare organisations; you’ll need a platform that can aggregate data from the prolific range of patient apps that empower patients to collaborate on their care decisions and monitor progress.

Rather than pursue a monolithic ecosystem, you’re better off evaluating how well your solution will enable you to connect elsewhere for both sending and receiving clinical data.There are many approaches to digital maturity, but Trusts that implement core EPRs that are open and interoperable are better positioned for success.

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