What is the plan to address these needs?
Providers and commissioners need to plan their future information technology systems to ensure that they can support Whole Systems Integrated Care. There are two critical enablers needed:
- Interoperability for sharing information
- Centralised data repository and analytics (also known as a data warehouse)
These enablers have to be supported by reasonable legal consent from service users and information governance agreements across organisations.
What is interoperability?
Interoperability is the ability to make different systems and organisations work together to enable information exchange. The development of an interoperable informatics architecture is a key enabler for the future management and delivery of Whole Systems Integrated Care, supporting needs like sharing care records across organisations.
Inter-organisation information transfer has been hindered by incompatibility of information systems.
This is because health and care providers have historically developed their own systems within their own organisations that allow for little electronic information exchange with other organisations. This leads to organisations having to rely on analogue methods such as mail and fax, which are time consuming, unreliable and restrict the ability for advanced analytics. We need to use new technologies to overcome these challenges. Health and care professionals and service users have expressed their need for easy, rapid, and fluid cross organisational information exchange. This could support newer innovations such as direct communication between service users and professionals and a single, shared care record and care plan that all professionals and the service user can access. All these ambitions require interoperability.
The guiding principles to the approach of creating an interoperable information architecture are:
- Maximise the potential from existing IT assets. For example, rather than whole scale and costly investment in replacing existing systems, look for incremental developments that support interoperability
- Streamline the number of existing systems and upgrade where appropriate, for example considering consolidation where there are economies of scale from the using the same system
- Allow a limited number of different systems as long as they support interoperability. This allows for competition between different suppliers and avoids over-reliance on a monopoly system and for providers to adopt more tailored systems where this is appropriate
What is a data warehouse?
A data warehouse is a centralised data repository that gathers, organises and then stores information from across many external systems. By assimilating data from health and care organisations, it is an essential enabler of integrated care. This organised and consolidated data can then be analysed by tools to support decision-making (i.e., for population grouping, allocation of funding and payment, tracking care delivery for improved quality & outcomes)
The first step for North West London is the build and development of a Data Warehouse. The second is to begin developing the new analytics and front-end tools that draw upon the data in this warehouse and support the delivery of whole systems integrated care.
The diagram below shows the information system architecture for North West London. The bottom level shows the existing source systems used by providers. The information from these will be assimilated into the Data Warehouse, which is shown in the middle layer. The top layer shows the proposed analytics and front-end tools that can then analyse and display the information in the data warehouse.
Background on the North West London Data Warehouse
The Whole Systems Data Warehouse will act as a central repository and hold data from both commissioners and provider across North West London. It will gather data from existing systems, link across systems so records are organised by individuals irrespective of care setting, store and pseudonymise information from participating organisations (subject to the correct and appropriate Information Governance) to support the Whole Systems Integrated Care Programme.
By hosting local level data from health- and social-care organisations the warehouse is able to link data sets together, allowing us to understand the full picture of activity and needs of an individual. This has the power to inform better decisions about care, improve quality and safety standards and identify trends in the local population. Tools that analyse this data will then be developed and are discussed below.
Investment for Whole Systems Data Warehouse has already been secured and its development will conclude shortly. The data warehouse has a Application Programming Interface (API) facility so providers and commissioners can add their own analytical tools. An API facility is a set of programming instructions and standards for accessing a web-based software application that allows users to design their own tools to meet their own needs. This will be overseen be a governing body of partners to ensure the right controls and processes.
The Whole Systems Data Warehouse is due to begin operating from April 2014. It can be used by early adopters (See Chapter 12: Next Steps for more detail on early adopters) to track progress against shadow capitated budgets and draw upon these to inform actual capitated budget values that will be used in future contracting arrangements when real changes in financial flows begin from April 2015.
Making data universal
Matching records in the data warehouse across a whole system at an individual level requires a unique identification number for everyone in the population. This means that everyone has a single unique number and that no one number can belong to more than one individual. The number must be recorded in all care providers’ records if they are to be organised accurately within the data warehouse. The Better Care Fund requires the NHS number be this unique identifier. All providers and in particular social care will need to make sure an individual’s NHS number is accurately recorded. This may require some providers, particularly social-care, to change their operational processes to make sure this number is always recorded and attached to an individual’s records.
What additional informatics considerations are there for care plans?
Individual care plans are an essential intervention for Whole Systems Integrated Care. Their principles, purpose and the information they should include are discussed in detail in Chapter 7: How do we innovate a new model of care working with users and carers? As they are shared across service users and provider organisations, interoperability between systems is vital. They will also be supported by the data warehouse. There are two further informatics considerations for care plans that should be taken into account.
Data captured during the consultation, assessments or in real time directly from people whose services will be sent directly to our Whole Systems Data Warehouse, subject to the correct IG compliance, where it will be stored and used to generate reports needed by provider and commissioner organisations, meaning that they will be able to access real time to support key business functions such as Risk Stratification and pathway analysis.
Structured care data can be collected in an aggregated way via the care record and will provide the best source of information to underpin service evaluation and local research.
There should be recognition as a part of any data sharing plans that a quality framework is established that supports continual improvement of the quality and accuracy of coding and recording information. It must also acknowledge the semantic differences across provider organisation and that work is needed to harmonise these differences.
What further tools are needed to support Whole Systems Integrated Care and how can they be prioritised?
In addition to the data warehouse and care planning, new analytics and front-end tools are needed to analyse and display data. A number of the capabilities and tools identified to support Whole Systems Integrated Care have been widely discussed in North West London in past years because they were desirable irrespective of our model of care. Therefore, the working group focused discussions on prioritising new informatics requirements identified during the course of the co-design phase and which have not been discussed in depth by decision makers before. These new requirements were identified as the new behaviours, activities and capabilities that will be needed to support Whole Systems Integrated Care were discussed. They are highlighted in the gap analyses earlier in the chapter as working group priorities.
What new requirements did the Informatics Module Working Group identify?
The Informatics module working group identified a short list of new analytic and frontend tools generated by Whole Systems Integrated Care:
1. Population analytics and grouping
- Ability to understand needs, activity and cost and outcome for population and to define population groups and understand population at group level (Relevant for both commissioners and providers)
2. Payment calculation (and tracking)
- Ability to calculate and capitation amounts and track usage
3. Funding flows calculation and tracking
- Ability to based on performance (Relevant for providers)
4. Performance analytics
- Ability to track performance on activity, cost and outcomes (relevant for both commissioners and providers)
- Ability to track performance on provider and network-specific service standards (Relevant for providers)
5. Care model resourcing/costing
- Ability to define resourcing levels and consequent costing for care models (Relevant for providers)
Request for Information (RFI)
In line with these priorities, a RFI was released at the end of January 2014, to understand the potential innovative systems available both inside and outside the heath care market. The RFI asked for plans and proposals of technologies to provide front end software tools to support Whole Systems Integrated Care in line with the requirements identified by people who use services and the Informatics Module Working Group.
The RFI does not commit North West London to using any particular supplier. Its main advantage is helping understand the range of potential options for existing, similar or bespoke tools that could be developed in partnership with early adopters. The results of the RFI are available on request to support and shape organisations plans.
What are the next steps for Whole Systems Integrated Care Informatics?
An informatics programme is continuing that cuts across individual expressions of interest and early adopters. This is because the high fixed costs of developing these new systems make it sensible to develop this enabler once for use and adaption across North West London
Next steps include:
- Continuing to manage the status and timeline for data availability from the Whole Systems Data Warehouse
- Developing an understanding about what funding is available to pay for new tools to support Whole Systems Integrated Care
- Working with early adopters and other stakeholders to develop specifications for informatics analytics and front end tools ready for procurement
- Are your systems ready to send and receive real-time data across organisational boundaries?
- What robust information governance arrangements have you prepared to support legitimate sharing of personal and sensitive information between organisations?