In 2014 I helped to facilitate a number of workshops set up to support the development of Better Care Fund plans. A key objective of these workshops was the identification of barriers to greater Health and Social Care integration and agreeing how to overcome them. Unsurprisingly shared IT systems were regularly highlighted as key enablers for integration, but all too often the only step that could be agreed upon for meeting this requirement was to increase the use of NHS numbers on different systems. Last month the Community Independence Service (CIS) in Hammersmith & Fulham began using a single shared IT system set up to meet the needs of the service. From an integration perspective this is an important step and should deliver significant improvements to both the co-ordination of patient care and the productivity of the service. The project to deliver this system highlights some important lessons that should be of interest to anyone else looking at integrated systems.
Given the widely recognised benefits of shared Health and Social Care IT systems it may seem surprising that so few examples exist. There are a number of reasons why they have yet to materialise.
· Cost is an obvious concern at a time when budgets are under significant pressure, and we all know that IT projects are notorious for exhausting the available budgets.
· The lack of suitable technical solutions is another issue. One day an ‘all-singing, all-dancing and affordable system’ that can replace current Health and Social Care systems may emerge, but in the meantime people have been asking for a level of interoperability between existing systems that software developers seem extremely reluctant to provide. In this situation playing a technological waiting game can seem like the best approach.
· Information governance is another concern. Organisations understand the reasons to share, but fear the legal requirements in relation to IG and the potential for partner organisations failing to have compliant processes in place.
· There is concern about who controls the data held on the integrated system and how the performance management requirements of all stakeholder organisations will be met.
· Finally, there is a general fear of change and the impact that change can have on processes that are already known to work reasonably well.
For the CIS project it was essential that these concerns were addressed head on. After exploring the available options, the decision was taken to build the new functionality required by the service into the existing SystmOne Community Unit used by the CIS Health staff. This solution offered what the service required whilst also delivering cost benefits, benefits in relation to staff training and benefits in relation to alignment with other SystmOne developments locally. Information Governance concerns were addressed by bringing in external support to work with IG Leads to deliver what was required. A new information sharing agreement, including a revised consent process, was developed and a comprehensive training programme was put in place. In order to respond to Local Authority concerns in relation to the ongoing integrity of data on their key systems an MoU was agreed and new standard operating procedures were adopted.
Delivering an integrated data system is by no means an easy task. In moving forward on the CIS project, we learned some key lessons:
1. Engage with all stakeholders early on in the process to ensure that they buy into the chosen approach and are given plenty of opportunities to highlight their concerns.
2. Work closely with staff delivering the service to understand the functionality that they require rather than replicating the functionality that they have been given in the past.
3. Develop a robust governance structure so that issues can be escalated appropriately.
4. Ensure that your budget has taken into account costs beyond simple development costs. There may be additional costs associated with providing training, infrastructural changes, changes to agreements with external support providers, Registration Authority requirements, data migration, project management, administrative support etc.
5. Modernising an existing system can be cost-effective and deliver a timely solution for a service which has immediate needs, even if it does not offer everything that the service has identified as a requirement.
6. Information Governance should not be an afterthought. Ensure that any IG issues are identified and addressed early on by working closely with IG experts from partner organisations.
Integrated IT systems, such as the CIS system, have the potential to transform how services are delivered, in a patient-centred and cost-effective way. Identifying key barriers and using best practice to respond to these are key to driving success.