From fragmented to unified: why interoperability is key to integrated healthcare

This article is part of our Opinions section.

The English healthcare sector is on a journey toward more integrated and cohesive care systems, driven by the urgent need to create a seamless experience for both patients and clinicians. At the heart of this transformation lies the concept of interoperability — a critical enabler that allows different digital systems within health and social care to work together, ensuring that patient information is accessible, accurate and up-to-date across various care settings.

The challenge of fragmented clinical systems

Currently, the UK’s health and care services operate using multiple clinical systems, many of which do not communicate effectively with one another. This fragmentation poses significant challenges, including the unnecessary repetition of tests, delays in care and an overreliance on patients to accurately recall their medical history. 

In an emergency, when a patient is overwhelmed or flustered, they may be unable to provide a complete history of their allergies, medications or previous test results themselves. If a healthcare provider is also unable to access this critical information, it can severely impact the quality of care, leading to poor treatment outcomes.

This lack of interoperability is equally frustrating for clinicians and administrative staff. The process of chasing down patient information across various systems is not only time-consuming but is also limited by the operational hours of different services. This inefficiency can delay treatment and affect patient outcomes, especially in situations where timely interventions are crucial.

What is interoperability?

Interoperability, as defined by the NHS, is “the capability for people involved in the provision and receipt of care to interact and complete a task across software and organisational boundaries; and use equipment, systems, or products from different vendors, which operate together in a coordinated fashion, with minimal to no human intervention.”

In simpler terms, it is the ability of different systems and devices to exchange, understand and use information in a way that is seamless and without unnecessary complications. Achieving this level of interoperability is not just a technological challenge, but a fundamental requirement for the future of healthcare in England. It ensures that patient data flows smoothly across different health and care settings, providing clinicians with the information they need, when they need it, to deliver the best possible care.

The importance of interoperability in integrated care systems (ICSs)

ICSs are at the forefront of the NHS’s vision for a more connected and people-centric healthcare experience. The aim of an ICS is to bring together various organisations — including hospitals, general practices, and social care providers — to work collaboratively to improve the health and well-being of the population they serve. However, for this to function effectively, there must be a robust framework of interoperability in place.

The NHS Long Term Plan, published in 2019 outlines the key priorities for redesigning patient care over a 10-year period, and emphasises the need for interoperability as a cornerstone of digital transformation. Building on the findings of the 2016 Professor Bob Wachter review, “Making IT work: Harnessing the power of health information technology to improve care in England,” the Long Term Plan highlighted the critical role of technology standards in achieving a truly integrated care system.

NHS England (NHSE) has been tasked with developing and enforcing these standards, ensuring that digital systems across health and care services are interoperable and fit for purpose. This involves mandating that all technology suppliers to the NHS comply with open standards that facilitate interoperability and allow for continuous improvement in digital health solutions.

The role of standards in driving interoperability

Standards are the building blocks of interoperability. They ensure that different systems can communicate with each other in a common language, enabling the seamless exchange of information. The NHS Long Term Plan commits to rigorously enforcing these technology standards, making it mandatory for every technology supplier to comply. This requirement is not just about meeting technical specifications, but ensuring the right information is available to the right people at the right time.

The Department of Health and Social Care’s policy paper, “A plan for Digital Health and social care,” further supports this vision. The policy outlines the need for data sharing across health and social care settings to provide more integrated, better joined-up, and people-centric care. This ambition is underpinned by the principle that data should be interoperable and accessible across the different systems used by healthcare providers.

Overcoming the challenges of diverse systems

One of the most significant challenges in achieving interoperability is the diversity of clinical systems used across the NHS. General practices in England, for instance, do not operate on a single clinical system, nor are they expected to do so in the near future. This diversity makes it even more critical for different systems to be able to access, exchange, and utilise information in a way that preserves the integrity of clinical documentation.

But interoperability can be achieved through various mechanisms, with application programming interfaces (APIs) being a critical component. APIs enable information sharing between different systems by acting as a centralised point where two software components can communicate. Using a defined set of protocols and standards, they ensure different systems can understand and use the shared data without human intervention.

Peer-to-peer interfaces provide another approach to interoperability. These interfaces enable direct communication between different systems through a third-party mechanism that uses common standards. This method allows various healthcare providers to exchange data directly, ensuring patient information is accessible across different platforms.

Technology providers are also developing solutions specifically designed to enhance interoperability across the ICS. These solutions aim to ensure that the same patient records can be accessed and viewed across different ICS sites, enabling a more connected and efficient healthcare system. By continuously developing and enhancing these offerings, tech providers are helping healthcare organisations face the challenges of interoperability head-on.

The future of connected healthcare

The journey towards a truly integrated and interoperable healthcare system is complex and requires concerted efforts from all stakeholders involved. However, the benefits of achieving this vision are significant. 

For patients, it means a more coordinated and personalised care experience, where their health information is readily available to all their care providers, reducing the risk of errors and improving the quality of care. For clinicians, it means less time spent on administrative tasks and more time focusing on patient care.

Interoperability is not just a technological goal; it is a foundational element of the NHS’s vision for the future of healthcare. By ensuring that different systems can work together seamlessly, the UK healthcare sector can move towards a more integrated, efficient, and patient-centred model of care. The NHS Long Term Plan, with its focus on enforcing technology standards and promoting digital health, sets the stage for this transformation, paving the way for a connected healthcare experience that benefits everyone.

Suggested reading

• HPE claims AI will ultimately cure dementia
• Qilin apologises to NHS victims for attack but demands $50 million ransom anyway
• Google Pixel Watch 3: upgraded for fitness