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Winter pressures in the NHS: An interview with Healthcare Gateway’s Managing Director, Liam King

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Winter pressures in the NHS: An interview with Healthcare Gateway’s Managing Director, Liam King

Liam King, Managing Director at Healthcare Gateway, talks about the difficult time that the health system face as winter pressures mount and what role digital health technologies play in supporting clinical activity.

What do you see as the key concerns for ICSs/Health Boards with winter pressures this year? 

Before winter pressures even kicks in, we have a system that is already overstretched in resource and services: we’re seeing a resurgence in COVID, delays across acute services, plus a backlog care that is still prevailing following the pandemic.

Data from NHS England shows that the waiting list for planned elective NHS treatment has been growing steadily since June 2020 and by June 2022 there were 6.7 million people waiting, which is more than ever*.

Suppliers to the NHS have an important role to support the healthcare system, working hand in hand, to deliver clinical benefits to potentially improve the mounting pressures. Planning and preparation are critical to recognise gaps where there is considerable demand for services and to highlight what digital tools could be utilised to maximise clinical time to deliver patient centred care. I think it’s vital to consider the role that data and interoperability can play in preparing organisations to deal with the increased demand even when experiencing these extra winter pressures.

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What do you see being the key concerns for clinicians with winter pressures this year? 

Healthcare professionals across all settings are front and centre dealing with the strain of winter pressure challenges head on.

Resource and capacity are spread thin because of rising pressures. Adopting digital health technologies means that clinicians have access the right digital tools including information about their patients at the right time, in the right place so that they can make faster, safer decisions. There is a reliance on digital health technologies with interoperability as a key component to help address the pressures by sharing health information where it’s needed and when it’s needed.

I think it’s vital for us to consider the impact this can have on the wellbeing of healthcare professionals. Throughout the pandemic, we read stories of frontline workers who worked and gave their absolute all to try and care for every patient to meet demand. Expansion of the NHS workforce is needed but also ensuring healthcare professionals are supported from a wellbeing perspective through challenging periods of high demand.  

We have already seen the significant impact increased interoperability can have in saving time for clinicians and patients. Where the Medical Interoperability Gateway (MIG) has been implemented across Bristol through Connecting Care, pre-operative assessments went from taking 2.5 hours per person, to taking under a minute. The time this frees up for clinicians is crucial and has a considerable impact on capacity and ability to care for patients.

What measures do you think the NHS can take to prepare for winter pressures?  

I believe the key here is, of course, planning, preparation and access to key data that helps build that picture of how winter really feels on the ground.

Actively managing the demand by triaging patients via a choice of channels and directing to the correct pathway such as social prescribing, signposting to alternative services and implementing virtual technologies that are designed to take the strain away from key settings ensures patients receive the most appropriate care but also where appropriate empowers people to support themselves. Not only does this benefit the patient, but it also alleviates the system pressures. Promoting awareness of the existence of alternative services and the message that supports access to the right care, in the right place, at the right time can relieve the demand on services. Providing citizens with the information of available alternative services and how to access them can lessen unnecessary visits to the GP, calls to 999, and trips to hospital.

However, it is also essential that we connect the data in these siloed systems to avoid delays in care and wasted time. The CQC’s report on the state of care in 2021/2022 highlights the urgent need for better communication and collaboration across teams and settings**.

For example, if Sheila comes into hospital, and she has a community record that would readily inform hospital clinicians of the best course of action to get her home, but those clinicians can’t see this information, then we have a problem. The hospital staff use valuable time trying to contact district nurses, or social care, or whoever else may be involved in Sheila’s care, to find the information that allows Sheila to be sent home with the appropriate care. However, if those clinicians can access Sheila’s record in real-time and find all the relevant information, they can make appropriate arrangements to get her home quickly and safely. It saves time across all the teams involved and frees up beds in hospitals.

That’s where I see the role of data in supporting the NHS to cope with winter pressures. We can deliver interoperability solutions quickly in order to fill the gaps in shared care records. Where there is gaps in records, there is less clinical efficiency, meaning additional pressure on clinicians, organisations, and the NHS as a whole.

Get in touch 

To find out how we can support your organisation in preparing for winter pressures, get in touch with one of our interoperability experts here. 

 

*‘The state of health care and adult social care in England 2021/22’ – Care Quality Commission (CQC): Access to care

**‘The state of health care and adult social care in England 2021/22’ – Care Quality Commission (CQC): Gridlocked care

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Healthcare Gateway: healthcare managed service providers

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Healthcare Gateway: healthcare managed service providers

What is a fully managed service and why is it important in healthcare?

A fully managed service looks after all parts of a process, in any industry. Particularly in healthcare technology, it means that the contracting company oversees everything from scoping, planning, implementation, and support. Having an expert taking control of all these areas means that a higher quality of service is provided and ensures a smooth project, right from the beginning.

Benefits of healthcare managed service providers

To fully understand the benefits that a managed service provider can bring to the healthcare industry, it is worth looking at what it is like without a managed service.

Let’s say Mark is a Chief Information Officer for an NHS Trust and is looking to implement a service to provide real-time patient information from a GP record into a hospital. He needs to find a company that offers this service, but Mark will need to tell them exactly what the Trust needs. Once contracted, the company will then implement the software, but no training is offered on how to use the system, therefore the clinicians using it don’t understand how to view the data. The company who implemented the software don’t offer ongoing support, therefore the clinicians struggle when they run into problems whilst using the system. The experience Mark and the clinicians have, is not great and the return on investment isn’t realised.

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But what if Mark had chosen a company that provides a managed service along with a solution to provide real-time data from GP records into hospitals, such as Healthcare Gateway? What would that look like?

Mark would contact Healthcare Gateway and explain the NHS Trusts’ needs and their goals for digital transformation. We then take these requirements and will make suggestions on how they can best solve the problems faced by the NHS Trust, whilst advising on Information Governance. Once contracts have been signed, our Project Manager ensures the implementation of the software goes smoothly. Post implementation, we provide an Account Manager who helps keep the relationship between the company and the NHS Trust going, so they can ensure any further requirements of Mark and the NHS Trust are met. The Account Manager also provides onboarding MIG Awareness Sessions where they talk through how to use the system with the end users, to ensure they get the most out of the software. Enhanced reports are also provided which shows Mark how the MIG is being utilised within the organisation so they can ensure they are getting the most from their investment. The Account Manager also provides onboarding sessions where they talk through how to use the system with the end users, to ensure they get the most out of the software. Healthcare Gateway also provides a Service Desk, where the end users can contact the team if they are having any problems with the software. The customer experience with this company is much better, as every stage of the process is managed by experts.

Healthcare Gateway as a healthcare managed service provider

Over the years, Healthcare Gateway have provided health and social care organisations with solutions to help overcome interoperability challenges. At the heart of these solutions is the Medical Interoperability Gateway (MIG), a middle-ware technology which enables the two-way exchange of patient data between different health and social care organisations, regardless of digital maturity.

However, we offer more than just technology, we’re interoperability specialists and healthcare managed service providers. Our managed service supports our customers in achieving their interoperability goals at scale and pace.

This fully managed service puts the customer at the heart of what we do, to maintain safer patient care. Below you can see the different aspects of the managed service from the experts in the team.

Account Management

“As an Account Manager at Healthcare Gateway, my role is to be the bi-directional point of contact between the customer and the business, bringing ideas, issues, and feedback to the business, whilst also feeding business, product, and market updates to the customer. I work alongside our customers to identify products that will help to solve their data requirements, and once the customer has procured their first product or service, I take over responsibility for the account to ensure open communication. My role also involves working alongside the projects team when on-boarding the new product to ensure it fulfils the requirements of the customer.”

Catriona Davis, Account Manager at Healthcare Gateway

Project Management

“In my role as Project Manager, I am the single point of contact for our customers and partner organisations to ensure that Healthcare Gateway’s products and services are delivered and deployed promptly and to a high standard. I also advise on Information Governance, which is a huge challenge for the healthcare industry, aid in identifying project risks, issues, benefits, and service improvements and handle any configuration changes. We ensure that there is a smooth and effective handover from our Commercial team at the beginning of the project and when services are deployed, we hand the customer over to our Account Management and Service Delivery teams to ensure that the required support is provided in a business-as-usual context.”

Luke Raynor, Project Management at Healthcare Gateway

Service Delivery

“The role of the Service Delivery team is to provide technical assistance throughout the integration process through to a partner systems successful accreditation. Post implementation, we work closely with customers to provide excellent levels of support by solving any operational problems they may have. We have developed a Service Desk Portal which is used by our customers to raise any problems they have by logging tickets, which we then solve and monitor to ensure our customers get the best experience using Healthcare Gateway services as possible.”

Matthew Walters, Service Delivery at Healthcare Gateway

Don’t just take our word for it, our customers have realised the benefits of our fully managed service too!

"So, the initial dealings we'd have when doing a new deployment to an organisation or service would be to go through the Account Management team. That is fairly straightforward and quite transparent with the pricing structure and that side of things, letting us know what would be best value for money for us as well, which I think is quite important to us as an NHS organisation. The next stage is usually for us to go through the projects team. The transition to the projects team that has always been seamless. So, they pretty much know exactly what is needed and of how things work with us. As an area in Nottinghamshire, they've got the historical information of past deployments and a lot of the information that is needed to make the process as easy as possible."

Kalpesh Raithatha, Project and Business Change Manager, Connected Nottinghamshire

“We knew what concept needed to be applied to help us achieve our digital transformation goals and Healthcare Gateway turned our concept into a reality. The team owned the delivery and moved it forward by liaising with third parties directly, providing a seamless pilot project experience.”

Murray Glaiser, eHealth Project Manager, NHS Dumfries & Galloway

To find out more about the MIG Managed Service that we provide, take a look here.

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Integrated Care Systems (ICSs): What are they and what do they mean for healthcare?

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Integrated Care Systems (ICSs): What are they and what do they mean for healthcare?

The NHS Long Term Plan was published in January 2019 with the aim of integrating care to meet the needs of the population. A key part of the plan is for all parts of England to be served by Integrated Care Systems (ICSs). ICSs will bring about changes to the way that health and care services are planned and delivered across England. Changes to structure can be confusing and can cause problems in knowing what actions to take to make it a smooth and successful transition.  So, what are ICSs and why do we need them? In this blog we’ll aim to answer these questions and explain how Healthcare Gateway can support.

What are ICSs?

ICSs are partnerships bringing together organisations, bridging the gap between providers of NHS services, local authorities and partners. They’ll plan health and care services together to meet the needs of a certain geographic location.

Their main purpose is to:

  • Drive improvements in the health of the population
  • Tackle health inequalities across geographic areas
  • Enhance productivity and value for money
  • Help the NHS support broader social and economic development.

ICS map

As of April 2022, there are 42 ICSs across England:

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Map showing Integrated Care Systems (ICSs) across England

As you can see, ICSs will cover large geographic areas. Because the areas are so large, they won’t be suitable for delivering change within services to meet the needs of local populations. NHS England and NHS Improvement have set out a three-tier system to allow functions at different levels to support each other in integrating health and social care.

  • Neighbourhoods are based on natural geographies. They’re made up of groups of GP surgeries which form Primary Care Networks (PCNs). PCNs share resources and work closely with other local services, such as community and social care to provide a wider range of services than a single GP surgery.
  • Places may match local council boundaries or natural geographies where services are delivered. Their aim is to connect PCNs to other services such as those provided by local councils or community hospitals to make the best use of resources.
  • Systems are the level at which strategic leadership is provided across the whole of the ICS. They’re responsible for providing high quality services and addressing health inequalities.

NHS England’s Designing Integrated Care Systems in England has a great explanation of the three-tiered system if you would like to find out more. For an animated explanation, visit Kings Fund.

Features of an ICS

Each ICS is made up of two parts:

Image showing the purpose of ICBs and ICPs.

How will ICSs benefit healthcare?

Now that the Health and Care Act has been published, it has put in place a legal framework that means health and care services must work more closely together to provide more joined up care. This will make it easier for patients to receive the care required, when and where it is needed. The end goal is for the health and care system within England to better meet the health needs of the population, now and in the future.

How Healthcare Gateway can support ICS aims

We offer a fully managed service which supports ICSs through their digital transformation journey. The Medical Interoperability Gateway (MIG) allows for two-way exchange of real-time patient information between health and social care organisations, joining up health and care services, improving the health and quality of life for all.

  • The MIG supports data sharing cross-border, helping to unite what used to be individual Clinical Commissioning Groups (CCGs). The whole ICS can provide joined up care, helping to tackle health inequalities across geographic areas.
  • Solutions we offer to improve interoperability increase efficiency in clinical settings, saving time and money. By providing clinicians with access to real-time patient data, it eradicates the need to contact other health and social care settings to gain a full picture of the patient improving the quality of care.
  • The MIG Managed Service supports all organisations in their digital transformation journey. For ICSs, it can assist new organisations or organisations that are finding their feet in their transition into the new structure.
  • The solutions improve patient care by providing clinicians with accurate, up to date information so they can make faster, more informed decisions. This helps to drive improvements in the health of the population.

How Healthcare Gateway have helped ICSs achieve interoperability goals

At Healthcare Gateway, we are interoperability specialists. We support health and care organisations all over the country to achieve their interoperability goals, and over 60% of ICSs in England are using the MIG. Watch our video showing how the MIG and the managed service is supporting interoperability across Nottinghamshire.

Find out more

Offering sophisticated and flexible integration technology, the MIG currently connects 5,200 health and social care providers in the UK, sharing a total of 30 million patient records.

If you would like to find out more about the MIG and get in touch with a member of our team, please get in touch here.

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Why is interoperability important in healthcare?

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Why is interoperability important in healthcare?

Interoperability in healthcare is crucial because it enables medical professionals to make more accurate and swift decisions about patients’ care. 

It does this by connecting real-time patient data from multiple organisations, which provides healthcare professionals with a patient’s detailed medical profile immediately.

The NHS has placed technology at the heart of its long-term improvement. It identifies healthcare interoperability as a priority in its digital transformation strategy. Healthcare Gateway plays a huge role in developing it across the NHS. 

But what is interoperability in practice, and what are its benefits?

Healthcare without interoperability

To understand the function and importance of interoperability, it’s useful to first consider what healthcare looks like without it.

Let’s imagine that Eddie, an elderly care home resident, has been admitted to hospital with an unknown illness. 

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The professionals treating Eddie need to gather as much information about his medical background as possible – existing conditions, allergies, medications, care plans and so on. 

They need to get this information from any organisations that have been involved in Eddie’s healthcare. This could include the care home, his GP, district nurses, social services and more. 

The hospital may be able to share data with some organisations through direct integration. However, this can only connect one organisation with one other. Since it requires a separate connection with each organisation, the practitioners may need to go through the process of accessing data several times to get the information they need. This causes delays in diagnosis and treatment.

Furthermore, direct integration isn’t always possible because the systems and technology of two different organisations may not be compatible. When this happens, medical professionals at the hospital must contact other organisations by telephone to get the information they need, causing further delays.

Sometimes, they even rely on patients to provide information, which is risky when their condition impairs their cognitive function. 

These inefficient methods of communication could result in a delay of several hours before Eddie’s illness is properly diagnosed and treated. Even then, the information obtained might be out of date or incomplete, resulting in inaccurate decisions about his healthcare. 

This increases the risk of poor healthcare outcomes. Of course, it could turn out that Eddie didn’t need hospital care after all. In that case, other patients who were in genuine need of hospital care would be denied the bed taken up by Eddie as he waited for a decision to be made.

Now let’s look at the ways in which that situation would have been much better had the hospital and its partner organisations implemented interoperability to join up patient information using the Medical Interoperability Gateway (MIG). 

Healthcare with interoperability

Time is of the essence

As the strain on the NHS’s resources increases, anything that reduces the time taken to make medical decisions is invaluable.

With the MIG, staff at the hospital can access Eddie’s comprehensive medical data in real-time, the moment he arrives. 

No multiple sign-ins to different systems, no phone calls chasing information, no distressing conversations trying to get him to remember his medications. 

They have all the information they need to act swiftly. Not only does this give Eddie the best chance of recovery, but it’s also great news for other patients. 

Once clinicians have made their informed decisions about Eddie’s care, they’re free to see other patients. Additionally, diagnosing and treating him quickly means it’s more likely he’ll be discharged sooner rather than later, freeing up the bed for someone else in need. 

Detailed data = accurate decisions

Connecting the medical data from all of the organisations involved in Eddie’s healthcare provides a truly holistic picture of his medical background.

The more information healthcare professionals have, the more likely they are to make clinically safe and accurate decisions about his diagnosis and treatment. 

They no longer need to fill in the gaps through unreliable means such as out-of-date records and the patient’s memory. 

With the MIG, data is updated in real-time. In the same way that an online banking app shows a transaction moments after it’s completed, any new information on Eddie’s record is immediately accessible across the entire network of organisations. 

This greatly increases the likelihood of effective care and reduces the risk of errors that could lead to readmission or worse. 

A better patient experience

Interoperability makes the jobs of medical professionals a lot easier, and this leads to many benefits for the patients.

Naturally, the longer a patient stays in hospital, the greater the risk of mental distress, catching infections and physical deconditioning. The good news for Eddie is that the chances of him suffering from the effects of a long stay in hospital are reduced.

Not only is he more likely to be diagnosed and treated sooner, but staff can also quickly establish the most suitable alternative setting where Eddie can continue to receive care if necessary.

A further benefit for patients and their families is the reduction of uncertainty. It can be distressing for patients (and their relatives whose loved one is ill) when medical staff are unable to give them a prognosis as they don’t yet have enough information.

With access to Eddie’s complete and up-to-date medical profile through the MIG, staff would likely be able to provide this much more quickly. This would give Eddie and his family a degree of clarity and reassurance. 

What’s more, neither he nor his relatives will need to face uncomfortable questions about his medical history or repeat his story to every professional involved in his care. 

Conclusion

Eddie’s scenario demonstrates the importance of interoperability in healthcare. Instant access to his complete medical data could save hours through swifter diagnoses, reduced time in hospital and fewer readmissions due to errors.

The NHS deals with thousands of patients like Eddie every year. If every healthcare provider dealing with them brought interoperability into their systems, the cumulative gains in efficiency and quality of care across the service would be phenomenal.

But hospital admissions are just one area where interoperability can lead to great improvements. It can bring huge advantages in all areas of healthcare.

Sirona Care & Health was able to greatly improve the efficiency of its range of community services by linking with Connecting Care, an extensive MIG-supported data-sharing project.

And since the West Midlands Ambulance Service integrated the MIG into its systems, it’s been able to reduce the number of ambulance callouts and enable more supportive care thanks to increased data-sharing.

More examples of how interoperability has improved healthcare for our partners are available on our case studies page.

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It will take a village to improve the backlog

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It will take a village to improve the backlog

When I came to work at Healthcare Gateway my experience of  interoperability was only from the patient’s perspective. I didn’t know the complexities of healthcare systems, but I did know that repeating stories at every appointment slowed down my care. I was also pretty sure daily inefficiencies mounted up to significant time lost for those providing care, who were already under huge time pressure to cope with their workload.

Now two years into my role as Product Manager, I’m delighted to be working on products that confront the issues I felt as a patient and I want to ensure our product roadmap continues to tackle the biggest problems felt in the sector. One of the dominating stories I have recently been looking at is how to deal with the huge backlog of patients waiting for elective care*. A Guardian report I recently read highlighted that a tenth of England’s population is already on the elective care waiting list and worst-case predictions are that this will rise to one sixth by 2024. The statistics are extremely worrying, moreover the personal stories of worsening health conditions causing despair and anguish for patients in the long wait for surgery are heart-breaking. Stories like that of Sybil Williams, 86, a retired nurse and amputee who waited 17 months for a hip replacement and developed debilitating shoulder pain after prolonged use of mobility aids. Sybil lost her independence and described feeling suicidal during the agonising wait.

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This topic of concern across health and social care has been recognised as a challenge and earlier this month NHS published the Recovery Plan for Elective Care. The plan details the targets every area needs to make, including:

  • improvements on long waits
  • reducing diagnostic waiting times
  • delivering faster cancer diagnosis
  • improving patient experience.

Areas of collective focus in the proposal are:

  • increasing capacity
  • splitting out elective and urgent care
  • prioritising diagnosis
  • offering alternative locations to patients with long waiting times
  • ensuring patients are better informed and supported whilst they wait.

Amanda Prichard acknowledged that ‘this won’t happen overnight’ and that we needed to apply ‘the same determination and ‘can do’ spirit we have displayed throughout the pandemic making the best possible use of the investment to accelerate progress’ . Amanda talked about flexible working between teams and smarter use of digital care being at the forefront of this approach and I wanted to highlight how Healthcare Gateway’s current products and services can support this.

We can increase capacity

The plan commits to give clinicians more time to care and one way it aims to do this is to reduce the administrative burden on staff. The Medical Interoperability Gateway (MIG) does just this; it allows clinicians and healthcare professionals to view real-time patient data provided by other services and settings involved in a patient’s care. Thanks to MIG technology, this data is seamlessly integrated within existing patient record systems, enabling single-sign on, with no need to navigate new systems.

On average it takes as little as 1.3 seconds to return and present patient data, which is faster than making phone calls to all services involved in a patient’s care. A unique feature of the MIG is the Service Discovery Locator which uses an intelligent look up functionality to identify all patient records available via the MIG meaning clinical staff are presented with all available data feeds at the point of care.  One recent case study highlighting the solutions we provide across Nottinghamshire estimated that the MIG was saving two minutes per consultation and 30 minutes a day for each clinician working at the trust, furthermore these time saving benefits were reflected at the GP surgeries who would previously have handled these enquiries over the phone. Another case study featuring Connecting Care Bristol, North Somerset and South Gloucestershire told us how pre-operative assessments used to take around 2.5 hours per person and now take under a minute because real-time details pulled through the MIG are being used to support this process.

Infographics showing the benefits of the MIG

We can support new pathways and networks for elective care

The Recovery Plan aims to set up a network of surgical hubs and diagnostic centres covering the entire country. Other measures include more people being offered treatment at alternative locations, including the independent sector, where waiting times may be lower. Additionally, more patients will be cared for at home via virtual wards and community services, building on the benefits these options offered in the pandemic. These pathways will create efficiency but will require robust interoperability solutions to be fully effective and ensure that a patient’s data doesn’t lag behind them.

The MIG is already used in more than 5200 healthcare settings and we have over 80 partner systems accredited to the MIG, so we have a multitude of connections in place that can support new pathways and alternative treatment locations. Our technology supports cross border and wider regional sharing programmes such as OneLondon which help when patients are treated out of area. Additionally, our Shared Record Viewer (SRV) provides a mobile compatible “front end” viewer for MIG data. This can be rapidly deployed and provides a short-, medium- or long-term solution to view MIG data – for example if partner integration with the MIG is not immediately possible or a wider sharing programme of work is underway.

Infographics showing the benefits of the MIG

We can improve the patient experience

We understand that waiting for elective care plays a heavy toll on a patient’s physical and mental health, so naturally we want to do everything we can to make sure that a long-awaited appointment goes as smoothly as possible. We know that giving clinicians access to GP and specialist data feeds, such as our long-term condition care plans, removes pressure on patients to remember the details and avoids further admin related delays. One patient representative recently described the MIG as a ‘goldmine of information’ that ‘helps ease the load’ and that’s great to hear.

Patients in the recovery stages of elective care also benefit from MIG technology joining up services like community health teams and physiotherapists with patient data. Additionally, our document services allow the GP, to receive letters and documents, such as discharge summaries, back into the GP record in real-time. Document Services means that the patient is not relying on a paper trail to catch them up as they return to primary care and reassures them that their GP is acting with up-to-date details from any recent treatment in other settings.

We want to expand our support

There is no doubt that tackling the backlog of elective care is going to be one of the biggest challenges facing an already stretched and exhausted sector, and it is very clear that the additional funding is not enough to solve this problem alone. Our products already provide the tools for smarter, collaborative working and can be swiftly deployed but we’d like to offer even more support to the village of organisations working on this problem. We’d like to extend and enhance our reach of current products so that even more patients benefit from MIG technology, and we’d like to build new solutions that address even more of the problems related to elective care. As a product team we would welcome conversations with clinical staff, digital leads, programme managers and partner systems to provide real-world insights on problems you’d like us to solve or discuss collaborative opportunities for innovation, please get in touch at here.

* (a broad range of non-urgent services, usually delivered in a hospital setting, from diagnostic tests and scans, to outpatient care, surgery and cancer treatment)

  By Su Jones, Product Manager at Healthcare Gateway  

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Reflecting on 2021 and looking forward to 2022

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Reflecting on 2021 and looking forward to 2022

As 2021 and my first year as Managing Director comes to an end, this marks an important time for us to reflect on the progress made towards a fully interoperable and digitalised healthcare sector, and the significant changes we have seen within the healthcare technology landscape throughout the pandemic.

By looking back at everything we have learnt over the past year, Healthcare Gateway can remain adaptive to the next stages of the nation’s response to new COVID-19 variants. Looking forward to 2022, we can set goals which continue to put patient care at the heart of everything we do.

From the outset this has been another year of significant change as we have all become accustomed to the new normal. Healthcare Gateway has continued to follow government advice, whilst doing everything we can to look after our employees: we’ve continued home working alongside voluntary nominated days in the office, as well as the use of collaboration hubs and meeting facilities to bring teams together for in-person working and social events. Employee health and wellbeing remains paramount at Healthcare Gateway, and allows us to keep serving our customers through these challenging times.

We recognise that our NHS colleagues have also changed their ways of working, and we have worked hard to support this using remote meetings as a normal now that we have proven technology can, in most cases, provide the same level of interaction. In situations that have required onsite, in-person meetings, we have supported this whilst working hard to ensure everybody’s safety.

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During the year, Healthcare Gateway has become independent as we separated a host of functions from parent companies, and we are now responsible for all back-office functions. This includes: HR, admin, contracts, finance, and internal IT infrastructure. This independence has led to the development of a new department within HGL, and a restructure which sees key individuals taking lead roles with Customer Experience and Product Development. I am confident that this restructure is best designed to aid us in improving healthcare for all and provide our customers with interoperability products and services that meet their needs today and in the future.

Between the transition away from our parent companies, our internal restructure, and the ongoing challenges of COVID-19, there has been a lot to do at Healthcare Gateway. This allowed us to review our corporate and social responsibility which has resulted in a host of positive changes. We encouraged home working, removed company cars, reduced travel, closed an office as our staff transitioned to home working, removed all printing facilities, plus recycled old equipment.

Throughout 2021, we collaborated closely with our 80+ partners to make even more vital patient data available to those that need it. Nurturing and developing relationships with our partners is crucial to our success in facilitating data sharing and supporting our mutual customers in their efforts to provide the best possible patient care. We’re incredibly proud of what we have achieved by working closely together and realising the benefits for patients. In 2022, we’re looking forward to dataset developments including the launch of Mayden Iaptus (IAPT) Dataset which will enrich Shared Care Record ambitions with even more patient information via the MIG. Moreover, we’re looking forward to the development of Personal Demographic Service (PDS) functionality which will provide the foundation for us to be able to progress the retrieval of GP Connect data.

Our overarching strategy is to continue to support the NHS in their response to COVID-19, and their aims to advance ICS-wide digital solutions. Healthcare Gateway is not just a technology provider; we offer an end-to-end managed service to support every step of an interoperability journey, regardless of digital maturity. Our focus will continue to provide ICS-wide digital solutions as well as expanding our Medical Interoperability Gateway (MIG) coverage to support NHS Health Boards across Scotland to provide solutions solving interoperability challenges, enabling clinicians access to vital real-time patient data.

News of plans for NHS Digital and NHSX to merge into NHS England and NHS Improvement, bringing all the National Healthcare System’s tech, digital and data expertise together under ‘one roof’, is a move that has been expected. In reality, the challenges in making digital transformations are not technical; they are clinical, human and cultural. Combining these entities and providing a collaborative approach with a shared agenda should accelerate digital transformation. We are excited to see what comes of the merged organisation.

Wishing all a Merry Christmas and Happy New Year from the team at Healthcare Gateway

Liam King, Managing Director, Healthcare Gateway

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Easing winter pressures in the NHS with interoperability

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Easing winter pressures in the NHS with interoperability

Winter is always a difficult time for the NHS, with some health conditions being worsened by cold weather, including asthma. This, along with other ‘seasonal illnesses’ such as flu, means the NHS is often overwhelmed during the winter months.

These pressures occur during winter every year, but with Covid-19 still a threat nearly two years on, this winter could create an even greater demand on the NHS services.

Preparing for winter 2021/22

The Academy of Medical Sciences have released a report titled ‘Covid-19: Preparing for the future – Looking ahead to winter 2021/22 and beyond’ which outlines the challenges that the NHS will face this winter. These include:

  • A resurgence of respiratory infectious diseases – There is expected to be a surge of winter viruses and with some of these illnesses having similar symptoms to Covid-19, it will become harder to distinguish between them, increasing the spread of Covid-19 and adding further pressure across the NHS.
  • Wider health and wellbeing impacts of the pandemic – During the pandemic, there has been a rise in delayed diagnosis of illnesses and treatments, which has led to a poorer physical and mental health across the UK. This could mean that there will now be higher rates of conditions such as asthma, COPD and heart attacks this winter.
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  • Continued disruption to health and social care delivery – Prior to the pandemic, winter bed occupancy in the NHS regularly exceeded 95%. This year, the NHS will be operating with a reduced number of beds in line with inflection control guidelines, which will be a huge challenge to overcome.

How can interoperability help to ease these winter pressures?

By definition, interoperability in healthcare is the ability of health information systems to work together within and across different organisations to advance the effective delivery of healthcare for individuals and communities. With the increasing pressures on the NHS this winter, here are the ways in which interoperability can help overcome these challenges.

More informed care

Having greater access to real-time patient data from health and social care settings, allows for more accurate diagnosis and treatments. A holistic view of a patient’s full medical history can aid in reducing errors or duplication of work, saving clinicians both time and resources. This saved time can be then spent treating patients, to speed up their recovery, increase beds available in hospital settings and work to reduce the backlog in care.

More efficient care

The pressures on the NHS system show the need for better connected systems across health and social care. Joined up systems means joined up patient care. Connecting health and social care systems reduces the duplication of effort between different settings. Saving time in this way allows for more time to be spent face to face with patients, reducing errors and improving quality of care. More efficient care may benefit the patient by reducing the length of stay in hospital, helping free up staff resources crucial during the winter months. Plus, saved time can be used to focus on the backlog of treatment caused by the pandemic.

Improved transfer of care

Sharing patient data between health and care organisations allows patients to be treated at the right place at the right time, whether that be at a GP practice, in the community or in a hospital. Coordinating care effectively in this way can help increase treatment outside of hospital settings and reduces hospital admissions, to ease the pressures within secondary care. For those who do require treatment in hospitals, there is a reduction in delays in transfer. With access to all necessary data, clinicians can make faster more informed decisions, which allows for rapid discharge and reduced readmissions.

Conclusion

In conclusion, the pressures upon the NHS will face this winter are ever increasing. By implementing interoperability solutions, day to day processes can be simplified and made more efficient which will help to relieve the challenges.

At Healthcare Gateway, we are interoperability specialists, and provide a managed service which helps organisations to achieve interoperability goals at scale and pace in order to improve the quality and efficiency of care in health and social care settings. Get in touch to find out more about how working with us can help ease winter challenges.

 

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Standards: the key to providing a show stopping interoperability service

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Standards: the key to providing a show stopping interoperability service

As the cold, dark nights draw in there is nothing I like more than settling onto the sofa on a Tuesday night and getting my weekly fix of the Great British Bake Off. The technical challenge is always an amusing section, watching the bakers try to interpret the minimum instructions and create a super-sized baklava that will meet Paul and Prue’s professional eye. How many different interpretations of Baklava can there be? 

Interoperability without standards is a bit like baking a cake without a recipe or ingredients, it’s complex, if nigh on impossible. For systems to communicate with each other, we need to know what resources should be included, what transportation method should be used, how we should transform it etc. This is where standards come in. They give us the full recipe and ingredients to enable us to make the right information available at the right time to the right person and remove that need for interpretation…we can all produce an identical show stopping cake that Paul and Prue would be proud of. 

Standards in Healthcare Gateway

Healthcare Gateway have been providing interoperability for over 10 years and our product strategy is to enable our customers to conform to nationally mandated standards, where applicable.

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PRSB

With regards to standards, we were delighted this year to be provided with the opportunity to become a PRSB (Professional Records Standard Body) partner. This partnership has enabled us to attend events to hear about the standards that are in development and the impact that these standards have had on users and other system suppliers, and we hope to build some of these into our roadmap for next year.

FHIR

FAST Healthcare Interoperability Resources (FHIR) is essentially a standard for exchanging healthcare information – a specification on how one system asks another system for data and what it gets back in return. It covers both the technology and an agreement on what the data means. We are currently working with NHS Digital to gain accreditation for their Personal Demographic Search (PDS) FHIR API and have recently gone through conformance testing for this development. Gaining this accreditation will enable us to proceed further and become accredited to use GP Connect as a middleware supplier, allowing us to provide our customers with the ability to conform to national standards. PDS accreditation also enables us to integrate with a wider range of products produced by other providers, as well as to conform to best case information transfer schemas.

SNOMED

SNOMED (Systematized Nomenclature of Medicine) CT is a clinical coding language used in electronic record systems in health and care. It is an international standard language that is being adopted by the NHS in England for the use in all systems used for the direct management of care. It is seen as the most comprehensive and precise clinical health terminology product in the world. SNOMED covers a wide range of clinical specialities, disciplines and requirements. It is used in more than fifty countries and is mapped to other international standards. Applying SNOMED CT as a standard means clinical information is recorded in a consistent, common way through all clinical records and supports the sharing of information with all individuals involved in the care of a patient. Our content model and some of our specialist datasets are going through a transformation to conform to SNOMED CT. We are re-specifying our content model into SNOMED CT and working with PRIMIS to enhance our content model to include additional items such as, Accessible Information Standards, radiotherapy and chemotherapy procedures, cervical cytology, Rockwood scores, height, weight, BMI and many more. We are also going to apply the national exclusion list to the content model to ensure sharing exclusions conform to national standards. Whilst this transition is in flight, we are working with our GP system suppliers to ensure that any new SNOMED CT that do not have a backwards map are incorporated into our existing content model, such as COVID-19 codes and you will be notified of any updates through our newsletter.

REST

REST (Representational State Transfer) is the communication service used to allow services to connect to other servers/API and it uses a standard list of commands. REST is lighter weight and more efficient as it can use smaller message formats, and it also has the ability to handle multiple types of call and return different data formats. As part of their annual objective, our Development team have been working on creating a “RESTful MIG”. They are in the process of creating Extended Patient Trace, Patient Search and Detailed Care Record version 2 as a customer facing RESTful service. Creating these services in REST means we are future-proofing our services and provides us with more flexibility to enhance our services. It will also make it easier for new consumer systems to accredit to consume MIG data.

Looking forward to 2022

As 2022 approaches, we are excited to continue on our standards journey and receive that Star Baker apron. However, we’re always looking for ways to improve and innovate our services and help you conform to standards and would love to hear your views and ideas. If you would like to discuss your vision, ideas, gaps that need filling or hear more about what we have planned in the future, please contact the Product Management team.

Sarah Dunwell-01By Sarah Dunwell, Head of Projects and Product at Healthcare Gateway  

Sarah began her journey with Healthcare Gateway four years ago in the role of Product Manager, and since has built a wealth of expertise in product management. Sarah has recently been promoted to Head of Projects and Product where she will be bringing together different teams to efficiently manage and deliver the whole product life cycle.

 

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Leveraging scrum in interoperability

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Leveraging scrum in interoperability

Middleware is tricky. It’s extremely technical, solutions require a lot of moving parts, a lot of collaboration and a substantial amount of dependencies across people and technologies. This in itself can lead businesses to want to take a ‘less risky’ approach to developing the solution by managing the projects in a waterfall method. But is it less risky? We at Healthcare Gateway have been leveraging Scrum to develop our interoperability solutions in an agile way for several years now and this is what we have learned.

Creating alignment is key

In our case, we are between systems that provide data and systems that consume data, and these are plentiful within the landscape of the NHS.

Scrum advocates cross functional teams, everyone in the scrum team should have the skills to do all parts of the work required. You cross train each other in specialities and work on removing single points of failure so the team is sustainable. For this concept to truly take hold you need to embrace the agile principle of ‘Business people and developers must work together daily throughout the project’. Soft skills are your superpower! Not all integration projections are built equal and the difference between developing a solution and delivering a solution is in your ability to collaborate and communicate effectively across multiple internal teams and also in our case, across multiple external parties. Creating alignment here is crucial to the successful delivery of a project that meets the customer’s needs. Utilise daily stand-ups, create alignment in your roadmaps across development, product and commercial. Create tribes or design trios to get ahead of the impediments and requirements but most importantly take time to acknowledge when something isn’t working and use those soft skill superpowers to learn and create better collaborative solutions.

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Focus on end to end

One of the most important factors in a Product Owners role is to understand what to deliver each sprint that will provide the most customer value. This can sometimes be tricky when developing middleware solutions. “How do you deliver a demonstrable potentially shippable increment each sprint with no front end?” This question arose time and time again not only in our teams but also in my CSM training from teams across the country not only in middleware but also in those using scrum in IT and hardware.

You may not have a front end, but you do have the ability to develop an end to end connection between the two systems you are trying to connect. Start with a basic connection, basic test data, basic security and then iterate. 

Leveraging mock data

One of the biggest challenges for us and our development teams is the vast number of systems we develop interoperability for. This limits our ability to test how our solution for data providers may function across multiple consuming systems with their own specialist eco systems of security protocols, UIs and requirements. Providing your development teams time to build mock systems, mock providers and create a space in which they can test and demonstrate their work provides enough confidence in their solution to continue on while in the interim removes the impediment of access to supplier / source test systems.

Utilising the sprint review

We’ve worked on our sprint review a lot with our teams over the last year, working from home during the pandemic has in some ways helped us innovate and harness our collaboration power more effectively online. We’ve looked more closely at what the scrum guide requirements for sprint reviews are and put what we can in place but it brings us back to the question of “how do you demonstrate middleware solutions in a non-techy way?”

Internal stakeholders can include a wide variety of people from across the business so while the demonstration in an internal sprint review can be more technical, you still want to encourage the Scrum Team to demonstrate an end to end potentially shippable increment covering the technical benefits of the increment in a more user centric way.  The benefit of this is buy in at every stage.  We want our internal teams to be excited about what we are building, we want them to talk about it, question it and feedback.  For this our teams have been using tools like swagger and postman to provide the front end demonstration of data moving from source to target in a digestible way, incrementally demonstrating and explaining the additional functionality that has been added and why.

External stakeholders for us are our partners and end users.  Demonstrating to these stakeholders can sometimes come a little later. This is due to access to test systems, data and moving away from mock to real world testing.  Setting up later demonstrations out of sprint reviews so far has worked for us here, but we are always pushing ourselves to reach that goal of having our end users feedback directly on sprint reviews to further close that feedback loop and decrease our time to market.

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By Zoe McLean, Agile Coach at Healthcare Gateway

Zoe became the Agile Coach for Healthcare Gateway in February of 2021, after working as Scrum Master supporting the development team with agile practices. As Agile Coach, Zoe has been working with the wider business to implement agile methods and increase our overall agility.

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Going digital: Integrating care where limited interoperability is in place

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Going digital: Integrating care where limited interoperability is in place

The fundamental benefit of healthcare interoperability is to facilitate the reliable and secure transfer of information across systems to improve data sharing, optimise clinical outcomes and join up data to support the continuity of care. The realisation of these benefits is reliant on the ability of clinical systems across health and care to be interoperable; enabling seamless access and exchange of patient data when and where it is needed.

The NHS Long Term Plan sets out priorities for digital transformation across health and social care in the UK. The plan recognises the increasing need for effective data sharing across organisational and geographical boundaries to achieve improved patient care. Particular areas of focus include: putting in place solutions to support interoperability needs, and ensuring clinicians can access and interact with patient records at the point of care.

Interoperability is essential in achieving joined-up care, read our blog to find out more: What is interoperability? 5 benefits of interoperability for safer, improved health and social care.

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How to achieve integrated care where limited or no interoperability is currently in place

Integrated Care Systems (ICSs) are partnerships that bring together providers and commissioners of NHS services across a geographical area with an aim to collectively integrate care across different organisations, improve population health and reduce inequalities. Despite the drive for digital transformation, organisations, settings and systems still work in silos. Data sharing limitations are a core obstacle to optimising the delivery of effective connected care across ICS regions.

What are the perceived challenges in the uptake of interoperability and technology in health and care settings?

  • Concerns from end users about the scale and pace of changes
  • Lack of training for end users and benefits of integrated care technology
  • Availability of resource and skills to implement interoperability solutions
  • Scoping of required clinical system connections, and tailoring of data access to the needs of local patient population and clinicians
  • Disruption to current workflows
  • Need for simplified, single portal access to all required patient data to inform clinical decisions.

Addressing the challenges

Improved interoperability can be easier to achieve than you may think. With the right support and expertise, solutions can be deployed to join up care, addressing the complex digital challenges faced in achieving digital transformation goals.

The Medical Interoperability Gateway (MIG) is a secure middleware technology which enables the two-way exchange of patient information between health and social care organisations. For organisations with an existing system in place, the MIG provides real-time patient information at the point of care from our 80+ clinical system partners. In instances where an existing system is not in place, our MIG Shared Record Viewer, an independent web portal, provides healthcare professionals with instant access to MIG data. It can be accessed through the HSCN/N3 and allows end users to search for patients and view their medical records in one place. The MIG facilitates data sharing in any system, in any setting so single sign on can exist, providing seamless access to rich patient data, including an array of specialist datasets from mental health, social care and primary care.  

Integrated care technology can be implemented easily by specialists in the health technology space but it’s the end users and their patients that will gain the most.  Therefore, building awareness to improve knowledge will help increase the adoption of services in an organisation. When new technology is used to its maximum potential and embedded into day to day workflows, the patient is kept at the heart of decision making.

Healthcare Gateway recognise the importance of providing end users with knowledge and clarity of available services. By providing wraparound interoperability support, including MIG Awareness Sessions, our team of specialists help improve knowledge and understanding of the MIG with an aim to increase the adoption of the service across healthcare settings.

A managed service takes the burden away and given the pressures on services today, no healthcare provider would want unnecessary disruption. As a managed service provider, Healthcare Gateway not only deploys the technology, we maintain the technology by keeping it running, in a cost and time effective way.

Interoperability for care homes

There is an increasing need to reap the benefits of digital transformation in care homes and ensure that staff in care homes are digitally equipped to support their important role at the heart of patient care. NHS England report that residents in care homes account for 185,000 emergency admissions each year and 1.46 million emergency bed days with 35-40% of emergency admissions deemed potentially avoidable. By improving the digital infrastructure and allowing appropriate access to patient data in care home settings, care staff are more effectively equipped to provide informed, personalised care, which in turn helps to avoid emergency admissions. Interoperability between clinical systems and settings along a care home resident’s care pathway is critical in reducing pressures on emergency care and improving outcomes.

Digitalisation of care homes is not just about cost savings, it is about enabling staff to:

  • Save time and resources in care

  • Spend more time caring for their residents

  • Focus on prevention

  • Minimise the avoidable use of emergency services

  • Improve patient outcomes.

Interoperability for hospice care

Brightree report that 60% of clinicians and organisations which refer patients to hospices state, they require increased electronic health record (EHR) interoperability. With a particular need for hospice’s to receive clinical documents, such as electronic referral. However, only 4% of hospices reported that they are digitally prepared to accept referrals from an interoperable EHR system.

Within palliative care settings, real-time access to patient data is crucial to the multi-disciplinary teams involved in the provision of hospice care. Access to medical records enables the delivery of tailored care plans, which meet individual’s needs and wishes when approaching the end of life.

Healthcare Gateway provide solutions including end of life data that improve communication between healthcare settings, saving valuable time for clinicians to support the provision of more informed care.

Our conclusion

To achieve integrated care where limited interoperability is in place, the key is to seek expert advice and guidance. This will allow you to fully understand the benefits interoperability technology can provide for your organisation, and how you can feasibly integrate this technology to effectively meet the needs of your patients and clinicians. Additionally, it is essential to conduct detailed project scoping to identify the system connections you require, to gain the rich datasets needed to inform care in your organisation, and achieve your organisation’s transformation goals.

At Healthcare Gateway, we’re interoperability specialists, and more than just a technology provider. Find out more about how our managed service can help you to achieve your interoperability goals at scale and pace.  

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