Tags: IDCR

Making your Local Health and Care Record initiatives Real in 2019

2019 is going to be a very important year for the NHS, and I wanted to resume our ongoing conversation here with a timely reminder to all NHS leaders that the clock really us ticking on a very crucial piece of work – what you need around your STP work.

As I won’t need to remind you, STPs – Sustainability and Transformation Partnerships – were set up by NHS England back in 2016, split into organisations covering every part of the country.

The idea is to find new local and integrated ways to improve health and care, with NHS organisations and local councils in England being asked to join forces to co-ordinate services around the whole needs of each person.

STPs are very much part of the idea of delivering against some of the key goals of Simon Stevens’ Five Year Forward View vision of a much more sustainable and digital NHS. But they are also very, very local – the stated aim is come up with plans to plans drawn up in your area that will set out practical ways to improve NHS services and population health where you live.

STPs then in turn have led to another great programme, Local and Health Care Records – an attempt to enable the safe and secure sharing of an individual’s health and care information as they move between different parts of the NHS and social care. To make that idea a reality, a number of a number of so-called Local Health and Care Record Exemplars have been set up that have been given special finding partnerships of up to £7.5 million over two years to put in place an electronic shared local health and care record that makes the relevant information about people instantly available to everyone involved in their care and support.

Exemplars were supposed to be 2018 spend drawing up requirements for what a ‘local health and care record’ is supposed to look like. They were meant to be building a Proof of Concept (PoC) against that definition that can then be proven and tested, leading to building of a full solution by the end of the 2019, and rolling out to all members of their STP during the 2020 Financial Year.

But here’s the problem: A lot of organisations really trying to do the right thing here are a bit stuck, as there are no clearly defined requirements

A ready-to-use Local Health and Care Record Demonstrator

We’ve talked to lots of organisations on the ground on both the NHS and the local council side of this who are struggling to find a suitable technology to use to build their PoCs.

This really does prove how far we are from the days of NPfIT, when the plan was that a central system should have been provided to work with. Now, the onus is on the local teams to find their own best fit for this work – and it’s not easy. A big issue seems to be scale… a lot of the systems people have been testing out seem very precarious at connecting multiple back-end systems together in the secure way that NHS England will want.

So we have addressed this head on.  Working with a number of frontline NHS organisations, we at SynApps have built a Local Health and Care Record proof of concept (POC) to demonstrate how this works.

What that means in practical terms is that we have a testbed ready based off our NHS Integrated Digital Care Record system.  It is proven technology and utilises all of the power of our Vendor Neutral Archive (VNA) and Enterprise Document Sharing (XDS) solution and which you can literally plug in to you and your partners’ systems tomorrow to help you build a convincing PoC.

That also means you will have a system which can support every sort of content a Local Health and Care Record will need – from path lab results to X-ray imagery, NHS Records to GP notes and even your social care records.

So if you are starting 2019 concerned about what you can do to capitalise on the opportunity the Local Health and Care Record programme represents for your area, fear not – we can likely help you.

Get in touch to see what we can do to help you move your Local Health and Care Record ideas off the PPT and into real instantiation in working software.

Chris is Director of all SynApps Solutions’ Sales & Marketing activities

How the market finally caught up with the Vendor Neutral Archive (VNA) promise

I hope you spotted the great news that came in at the end of last month that the most trusted name in the IT commentary world, Gartner, rated us extremely highly in that part of the market known as the VNA.

VNA is not the sexiest term for a technology ever, I’ll grant you – but actually, it’s a really important tool and one that could really help a lot of people.

That’s because the name – it stands for ‘Vendor-Neutral Archive’ – doesn’t really convey what its power or potential actually is. We know – we’ve been marketing some excellent VNA solutions, especially for the NHS market, for a number of years now, and the vagueness of that name has perhaps not been to its help.

Why? Because NHS buyers see the VNA as in, essence, a medical device… it’s a bit of software that is good for storing my medical imaging data, specifically all the PACS and DICOM data that I needed to find a safe and secure home for when the old off-site PACS storage NPfIT contracts came to an end in 2015.

Which it is – a VNA is a fantastic way to store very large data files and access them really easily. But that was never what a VNA was only supposed to do. That’s because, out of the gate, you had this really cool XDS tech built into it – XDS standing for ‘Cross Enterprise Document Sharing’.

Why XDS is so useful is that it is a standards-based way to work with multiple forms of content, of all different types. That means that a VNA isn’t actually just a place to stick big X-ray image files, though please carry on doing so… it’s actually an Enterprise or Document Management System.

Why should I care, I hear you thinking? Well, a VNA might not be a whole lot of use to a manufacturer, a retailer or a financial services CIO.

But if you are

  • an NHS CCIO or CIO trying to help colleagues in different departments
  • and/or an NHS CCIO or CIO tasked with helping connect records with other stakeholders
  • a local authority social care team looking to join up information on vulnerable or elderly patients to help address their complex, cross-team needs
  • a GP surgery looking for better ways to document the patient journey
  • a CCG committed to more paperless ways of working with patient data
  • a policymaker in an NHS England STP (Sustainability and Transformation Project) interested in the power of digital to revolutionise patient care

Well, then – yes – what a VNA can do suddenly becomes absolutely central. How: because it’s the proven, available and tested way to keep all patient data – from notes to prescription charges to medical imagery to social care interactions – in one place.

And from cradle to archiving – across multiple stakeholders.

In that Gartner report, that route of travel has been clearly signaled. The good news is that here at SynApps Solutions, we spotted the potential for this years back, and have accumulated relevant expertise and intelligence on doing just this kind of Super-VNA work (and have some significant trails underway to make a VNA-based Shared Care Record a reality – an in months, not years).

It’s brilliant to see that Gartner has caught up with us – but we’re not boasting, we’re just saying that we are ready whenever you are.

Let’s work together to make VNA do what you and your patients and service users really need it to.

Chris Brice is SynApps Solutions’ Director of Sales and Marketing

SynApps Coverage In Document Manager


In key industry publication DM Magazine, an article has been published by our head of Healthcare Practice Gary Britnell on the best response by the UK health IT community to Secretary of Health Jeremy Hunt’s recent apparent dismissal of the importance of NHS paperless targets.

For Gary, NHS IT leaders should instead look at the great progress to paperless made so far. He discusses how getting to a paperless NHS is not going to be easy, but practical techniques like the integrated digital care record (IDCR) are emerging as a great way to get there.

Read the article in full here

SynApps In The News


In this key public sector publication, Head of the Healthcare Practice at SynApps Gary Britnell discusses the interoperability challenge the NHS faces as it tries to become fully digital.

According to US digital health guru Robert Wachter, brought in by the Department of Health to advise the government on how to transition to a digital health service, “If I had any one piece of advice for the NHS around going digital, it’s to get interoperability right from the start. We have hospitals in the US that have great computers, but where 95% of the systems can’t talk to each other.”

He’s right: hospitals want to share patient data internally, as the paper chase chokes productivity, as our everyday experience with our NHS Trust customers shows. They also know that they’ll want to share that data with other providers as we move to break down the barriers between health and social care.

Many practitioners believe the best way of doing that is the Integrated Digital Care Record, the IDCR. The challenge: there’s no central, top-down route to get an IDCR; Trusts are going to have to build their own.

Getting to the digital NHS we need is not going to be easy. The good news is that once we have this in place, we will be able to do great things in the NHS, such as route information without any need for re-keying or asking the patient the same questions, allow collation of data for better analysis of the bigger trends, programmatic search, and so on. SynApps is actively engaged on building just such a practical way of doing so.

Read the article for yourself here

2017: A Year The SynApps IDCR Moves From Blueprint To Proof Of Concept


SynApps Solutions’s Joint CEO and Sales & Marketing Director Mark Winstone shares his thoughts about what he thinks 2017 will bring

For SynApps, 2016 has been very much about the NHS. But that doesn’t mean other markets haven’t been of huge interest to us. Our work in the Police market actually shares many of the same urgent business drivers as the health one, so there’s some useful commonality there.

However, the drive to interoperability in the NHS has dominated our work this year, as we’ve talked about [see here and here]. That’s to say that we very much agree and support the call from the very top of NHS England and NHS Digital, for a better way to use NHS IT to share information better.

That sharing has to be internally and externally, of course – which is why the CCGs, who are delivering not just a more interoperable NHS but also a more integrated and unified NHS and health and social care system, have been looking for ways to work toward the Integrated Digital Care Record, the IDCR, fast emerging as the most solid foundation for the next-generation NHS.

Think of it this way: you’re a CCG running a big city that’s got a chunk of countryside latched on. You could be talking about eight or nine Acute Trusts, maybe 80 or 85 GP surgeries. Throw in a couple of ambulance trusts, some mental health entities and local Social Services. It’s a complex network of people who want to partner better but don’t know how, and an awful lot of patients (many very vulnerable) who need to be looked after.

You will need technology to knit all this together, and patient information is the main ‘unit of currency’ that will make it work. This is so important and critical a problem for the NHS that we have spent the majority of 2016, led by my colleague Jason Scholes and his healthcare team, working on a framework for delivering the IDCR in a practicable way.

We know from all our experience with VNAs and data formats in hospitals that there are incredible disparities of technical knowledge and resource across the NHS. NHS England has been finding this out in its groundbreaking Digital Maturity Assessment work this year. We know there are different EPRs and different PACS systems and different IT systems in the NHS – even in the same hospital. So an IDCR is incredibly important, but also hard to deliver from scratch – which is what we have been putting our engineering and design resource into, in a bid to help the CCGs do this (our proposed IDCR blueprint work is here).

In 2017, this work will take a big step forward. Rest assured real proof of concept IDCR work is going on already at NHS customers, convinced by our vision and capability around clinical content and its safe management. IDCR will take a long time, but we will get there, and standards – always something we have lived or died by at SynApps – will be a key enabler, such as CDA, MESH and XDS.

We’re ready to make 2017 a really successful year!

Not all NHS organisations will get to any kind of IDCR finish line, of course. We anticipate that many won’t, and will want to instead benefit from the success of others, who may lease out IDCR capability through partners like us as cloud-delivered services.

This is something we see in our other big public sector ICT market, criminal justice. Individual Police Forces, the CPS and other stakeholders are also wondering if there might not be a more efficient, seamless way of sharing suspect information. Again, standards are being pushed and probed to see if they can help, and we are also working on demonstrators and PoCs to show what can be done.

The takeaway from all this is, I hope, clear: SynApps is working with its public sector and technology partners, doing important and interesting work – and 2017 looks set to be the year that these seeds bear fruit.

2016 – and 2017 and beyond – are about consolidating and building on the strong foundations that we think previous architectural work we did has laid down.

Can I now wish you all a great Christmas, hope you have a wonderful break, and see you in 2017 – when I hope you’ll join us and our partners and NHS IT customers in building more IDCR frameworks that will help patients, budget holders and the country as a whole.

Mark is SynApps Solutions joint Chief Executive Officer, as well as its Sales & Marketing Director

Coded And Non-Coded: Why It Matters


October 21st, 2016 – In a recent blog article, SynApps has given more details on how to get to the the Integrated Digital Care Record (ICDR) via not just CDA and MESH but other ‘pieces of the jigsaw puzzle’. That’s because while we now have a format for producing some documents and a great way to send them, there is information that is falling between the gaps. Hospitals can generate a PDF for a discharge note, but then end up printing it off and posting it to the GP, which is not really the mission.

The heart of the matter is that not enough NHS stakeholders have understood the difference between coded and non-coded documents. Non-coded documents are less useful than coded, though a lot more useful than just paper, says the article. With coded documents, you can add in more information that health systems at the other end can pick up automatically.

Ideally all data formats (and there are lots) should be coded. In the meantime, your ICDR needs to work with the non-coded ones, as well as the coded ones, so that information is not falling in the gaps (think those posted discharge notes).

To read the full article, go here

NHS Interoperability Is The Main Reason We Need IDCR


“If I had any one piece of advice for the NHS around going digital, it’s to get interoperability right from the start… we have hospitals in the US that have great computers but where 95% of the systems can’t talk to any other system.”

For me, if there’s any one sentence that sums up why we’re working so hard at SynApps Solutions around interoperability at the NHS, that’s probably it.

And it’s from an absolutely impeccable source, someone who really knows what he’s talking about – Dr Bob Wachter, the US digital health guru the government brought in to advise the UK on how to better utilise digital technologies.

Wachter told the delegates at HETT recently that of his three main messages to the Department of Health, interoperability built on a solid foundation of standards was just as important as his other two.

The warning is incredibly timely for NHS leaders. That’s because we have designed a standards based architecture here at SynApps Solutions helping build a practical solution to help NHS leaders avoid that fatal lack of interoperability (1).

Let’s remind ourselves what the agenda is here. Hospitals want to share patient data internally, as the paper chase is killing off productivity and is increasingly recognised as archaic by smartphone-savvy users. They also know that soon, they’ll want to share that data with other providers in a more integrated health and social care chain.

A new way to exchange health information and data

To that end, NHS England and NHS Digital are promoting the IDCR as the ideal way to achieve that. The challenge: unlike in the days of NPfIT, there’s no central, top-down procurement process to get an IDCR. You’re going to need to build one.

The good news is that SynApps and our partners can help. But it’s still a significant undertaking. There are two big parts of the puzzle emerging – CDA and MESH. CDA is an HL7-controlled standard for working with Clinical Document Architecture (think things like discharge summaries and progress notes), so is a great way to put your output into a useful XML-based format, while MESH (message exchange service for health),which is replacing the older NHS DTS standard, is a new way to exchange health information and data (2).

So now there is a format for producing at least some documents and a great way to send them. However, there is also information that is falling between the gaps. Hospitals can generate a PDF for a discharge note, for example, but then end up printing it off and posting it to your GP. That’s not really the mission here, clearly.

The heart of the matter here is that not enough NHS stakeholders have got their heads around the difference between coded and non-coded documents. Put simply, non-coded documents are less useful than coded, though a lot more useful than paper. With coded documents, you can add in information that health systems at the other end can pick up automatically, which gives the recipient a lot more context and useful information about the patient and the case.

So what we want to do is to provide a way for NHS practitioners to a) more easily start using coded electronic documents that best exploit the power of the CDA standard and b) allow them to start using the power of MESH to safely route and share such digital assets. The key to this is realising that hospitals have lots of different types of documents and data, e.g. DICOM and non-DICOM. We have to work with all these data formats to get to the kind of interoperable future Dr Bob, Jeremy Hunt and NHS Digital wants us to be moving to.

A fantastic opportunity

What we want to offer is a way to check in all those different sorts of documents and formats into a safe place that means they can get routed out again in packages that conform to the CDA and MESH protocols. It will be able to work with coded documents – and we think non-coded is the stepping stone we have to work with to get there.

Once we have this basis in place, just think of the things smart documents could do in the NHS – route information without any need for re-keying or asking the patient the same questions 20 times, allow collation of data for better analysis of the bigger trends at the local, regional and national level, programmatic search, and so on.

We are convinced IDCR is a content problem. Our distinctive contribution to all this is content. We are a content management company; to us, CDA and coded documents are just more content forms to store, manipulate, access and share. We are also very experienced in hosting, and IDCR is a prime candidate for being delivered via a web-based solution to promote intra-stakeholder collaboration and partnership.

We can deliver on the Watcher Review’s aims and get interoperability bedded down as soon as possible here, as well as make IDCR a really fantastic way to share data tomorrow.

If that sounds like work that will help your organisation, then get in touch to discuss how to build the best IDCR to meet your team needs. Drop me an email today.

Gary Britnell

SynApps Solutions Healthcare Business

  1. We’ve also discussed this fascinating work here and you can check out the details of Wachter and his team’s recommendations in the full report, Making IT work: harnessing the power of health information technology to improve care in England, here
  2. see this NHS England guidance for more on that transition