Making Standards Deliver Great Health IT Outcomes: We Have Some Ideas



Last time we spoke, I mentioned how we have started to work with Trusts to open up a practical pathway to the common goal of an easy way for health and social care stakeholders to share information – the IDCR, the Integrated Digital Care Record (see here).

Plainly, information is the pillar of the IDCR – it’s what will keep the structure up. But the foundation that makes IDCR happen is data interchange. We’re going to need a safe, reliable and functional way of moving data around.

That foundation is also going to have to be pretty data-format agnostic. A hospital Trust will be familiar and happy with DICOM data, while a GP’s surgery may have never heard of the term. We are going to have all sorts of data, from Excel to HTML to other formats to manage here.

NHS England is of course well aware of the need for a way to work with heterogeneous data formats as it helps CCGs move to the IDCR target, which is why it supports the MESH (Messaging Exchange for Social Care and Health) service, the successor to DTS (Data Transfer Service). MESH will have a big part to play in any IDCR project, but it will need to have the right elements to work with in order to push information around. This is where we think we can help. We’ve been doing a lot of design and testing at SynApps, as well as talking with both existing partners (especially Alfresco) and new ones, like the team at Enovation, on this topic.

Our MESH-IDCR thinking is influenced by NHS England’s own stated route of travel, which is predicated on the central role of CDA, the ANSI-certified Clinical Document Architecture (see here). This is a great way to define how information can be packaged up using the XML language and easily moved around by MESH.

A blueprint for a practical way forward?

I think you can see how the stars are aligning. To get to IDCR we need MESH and it looks like CDA is the best way of making MESH work. The problem is all the heterogeneity of computerised British medical data. There’s a great deal of complexity out there, complexity we think could keep IDCR coming on-stream for far too long.

That’s why we have been involved in so much back room work over the summer, trying to work out how to address this challenge. We have some proposals we think could help, instantiated in a blueprint for an IDCR architecture that can offer a way for many different data owners to securely and efficiently share data, checking it in and out of a rich central Repository. That Repository and an associated Registry is coming from us and Alfresco, while the Enovation team is underpinning it with messaging bus technology.

We are heavily engaged with CCGs who are looking at taking this blueprint and the first fruits of our ideas to the next level so you will hear more from us soon on this. In the meantime I’d be happy to respond to any questions you might have about the proposed architecture.

The last thing I will say is that we are very sensitive to the fact that getting to IDCR is a challenge. There are vast differences in the levels of digital maturity in the NHS and its partners in social care and the public sector. Even neighbouring hospitals can have very different scores. Technology generally is hard but especially in the NHS context.

However, whatever your organisation’s level of accomplishment here, we think we can help. Our standards-based, open, highly partner- and interoperable style approach is a realistic way to get to where we all want to be with patient data as soon as is practical.

So what’s to lose by dropping us a line and seeing if we have anything that may help you?

I encourage any NHS team to get in touch to discuss their own LDRM (Local Digital Roadmap) or individual strategies on how they’re going to deliver IDCR.

We will be at the UK’s Largest Digital Health Show – EHI LIVE – November 1, 2, Hall 1, NEC Birmingham, and at the NHS Clinical Commissioners Annual members event 2016, Amba Hotel, Marble Arch, November 3, 2016, so we hope to see you there.

Or just drop me an email.

Gary Britnell

SynApps Solutions Healthcare Business

If You Too Are Struggling With IDCR – Let’s See If We Can Help



In the past decade or so, in various forms and to varying degrees of success as we all know, the government has been trying to introduce a more joined-up, computerised NHS. That’s been with the aim of improving efficiency, saving vital budgets, and offering the same kind of easy access and ownership of our medical journeys as we all get in our Amazon, Facebook and TripAdvisor-based daily lives.

There have been various programmes and names for this initiative, be they Care Records, a paperless NHS, EPRs (electronic patient records) and so on. We’ve made a lot of progress, and had some knockbacks (such as However I think anyone working in or with the NHS agrees that a really promising new push is the IDCR, Integrated Digital Care Records. The idea is to find a way to allow multiple stakeholders in both primary but also acute care and other bodies, especially social care ones, to be able to safely and securely share information about patients both in and out of the surgery and front-line care context.

The 2020 digital NHS agenda

Of course, the IDCR idea is not new. NHS England started talking about this three years ago (see its key ‘Safer Hospitals, Safer Wards’ document , where it discussed the need for a “a fully integrated digital patient record across all care settings by 2018” that could only be achieved “ when NHS providers are connected to the flow of information”. Another key document in the IDCR debate is the NIB (National Information Board’s) Personalised Health and Care 2020 white paper, which, while not mentioning IDCRs specifically, provides the direction of travel here – joined up care, with different stakeholders, in and out of the GP surgery and hospital, able to talk to one another. Plus it explains how that supports the Five Year Forward View agenda, too.

The other thing to flag is that despite IDCR not being especially recent, there hasn’t been a huge amount of progress made delivering against the IDCR agenda. One metric of this is the relative paucity of coverage of it on the main NHS England website; there’s a fantastic success story there, from Bradford and Airedale, which is really inspiring, but we should really be expecting to hear of a few more examples by now.

Wise third parties who monitor NHS progress in digital agree. In a presentation for The Kings Fund, now departed NHS IT supremo Tim Kelsey saw the co-creation of tools and resources to support IDCRs coming on stream last year, while 2020 would see “all local areas” at full local implementation stage.

I think the reality is that the IDCR idea maybe needs a bit of a push to get it going. I think we all know that is unlikely to come from the top of NHS England, which is all about setting strategic direction, and which encourages local, bottom-up thinking by CCGs and Trusts to find affordable, tactical ways of doing things (very much in contrast to the National Programme for IT way of doing things).

If you look out over the current NHS IT landscape, there are some technologies available that can help with IDCR projects. More are coming, and some of which we’re working with, like our partners over at Kainos.

But what a lot of these solutions (apart from Kainos) suffer from is a lack of openness – they are often closed and rigid. That may be changing, but the spirit of IDCR and the 2020 targets is openness and interoperability. It’s hard to see how a siloed package can really push around the wealth of data and data types you need for a good IDCR, like path test results, DICOM format scans, referral notes, social care records and so on.

It’s a lot to ask some software technically, but it’s also a lot to ask software that isn’t totally lined up with all the standards that will need to be at the centre of any convincing IDCR plan, like FHIR, Fast Healthcare Interoperability Resources and CDA, Clinical Document Standard (CDA).

Time to start your IDCR journey

The honest truth about IDCR in 2016 is that no-one has the silver bullet. But with SynApps’ proven track record in working with multiple data formats, our wide range of Open Source and innovative tech partners, and with our rock-solid commitment to open-ness and interoperability standards, it’s just a fact that our approach stands a better chance of delivering IDCR success than more restricted alternatives.

This is why I’m issuing an open invitation to the NHS community.

We are starting to have really promising early-stage discussions with CCG’s/Trusts who want to open the door marked ‘IDCR,’ but who don’t see how quite yet.

We suspect there are many more CCIOs and Chief Executives in the same position as those we are talking to, with the same problems as you.

Let’s open a dialogue about how an open, standards based, partnership-driven approach, backed by some of the best clinical content management technology on the market, can help you make a truly digital and integrated 2020 not another missed NHS ambition, but a real milestone of progress for you, your patients, and your social and health partners.

I encourage any NHS team to get in touch to discuss their own LDRM (Local Digital Roadmap) or individual strategies on how they’re going to deliver IDCR.

Gary Britnell