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Connecting our way to integrated care

We need to start small, and connect data at all levels if the NHS is to realise the benefits of integrated care. Dr Joel Ratnasothy, medical director EMEA for Caradigm UK, provides a clinician’s view.

Healthcare is undergoing some exciting and challenging changes in the UK. There is a renewed political focus on how we should organise our healthcare system - and the unanimous answer is ‘integrated care’.

As a doctor the benefits of integrated care and the focus on quality outcomes are obvious. The World Health Organisation defines it as a ‘means to improve services in relation to access, quality, user satisfaction and efficiency.’

The question is: “How do we achieve this?”

Connecting our way to integrated care

One of the most promising features of the integrated care model is that it is patient centric. The model recognises that, we as patients, need to communicate with many different people. It promises a more joined up experience. It integrates the many different medical and social care services we may need. It makes our care services simpler, easier to engage and more cost effective.

Yet achieving this is not straight forward and given where we are -the challenge may seem overwhelming.

So where do we start? Integrated care will require primary, secondary and social care providers to connect their data like never before. This will not be achieved in one go. There is no ‘big bang’ solution. Instead, we need a strategy that can be implemented in a step-by-step approach.

There are four distinct areas of care that must be connected before these larger groups can be meaningfully integrated. Although each group is slightly different the problem of information sharing remains the same.

• Connect the departments – integrated care at the hospital trust level: The first challenge lies within the trusts themselves wheredata is fragmented between departments and different systems. Individual departments must connect their data so that doctors can see an integrated view of their patients. This means connecting radiology, pathology, biochemistry and other departments to where most of the clinical decisions take place, the ward round - the point of care.

• Connect the trusts –integrated secondary care: Once an individual trust has an integrated view of its own data it can be usefully connected to other trusts to provide a holistic view of a patients entire secondary care experience. Usually a number of different NHS trusts provide secondary care services such as acute, community and mental health services.

• Connect primary to secondary care–integrate the whole local healthcare referral network: By integrating primary and secondary care records we can benefit from having one version of the truth across the whole local referral network. GPs and patients will have access to test results, which saves time, money and empowers patients. In addition we can access local referral data together with patient flow so Clinical Commissioning Groups can estimate the cost of individual care pathways.

• Connect health and social care - integrated care: Combined social and healthcare budgets allow for smarter investments, save money and provide better total care. Combined data from both care services will allow us to move our focus from disease treatment to disease prevention and proactive population health management.

Healthcare IT’s role
The vision of an NHS delivering integrated care is the right one and information technology will be crucial in delivering it. But to achieve it we need to learn the lessons of the past – large 'big bang' IT implementations across multiple departments, let alone institutions will not work. We need to start small, connecting the most important systems first - project by project, business case by business case and build on a solid foundation. That is why I believe the best approach is to start 'connecting': departments, trusts, institutions and services, until we have achieved true integrated care.

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