Talking about a shared care revolution
How health information exchange with HL7 FHIR®-enabled electronic health records can transform the NHS
By Dunmail Hodkinson, chief technology officer at Black Pear Software and immediate past chair of HL7 FHIR UK
Health information exchange can revolutionise shared care in the NHS, but only with a change in mindset and the use of modern tools such as HL7 FHIR. Without this, exchanging Electronic Health Records (EHRs) on a health information network is simply a better way of doing the same thing. As any clinician knows, the ability to share EHRs across different organisations gives immediate benefits. An A&E doctor won’t prescribe something to a patient that they are allergic to if they can see their GP record stating the relevant allergy. But these gains are limited if the records being exchanged are still those that were designed for the paper age.
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Once clinicians start sharing healthcare data there is suddenly a whole lot of information that it makes sense to record, while it made no sense to do so before. If a GP record is never going to leave the surgery the GP doesn’t need to think what might be worth noting down in case a paramedic is called out to the patient’s home – like where do they keep their medication, or spare key, or do their family members’ know how to use a syringe. Now if recorded it could mean the difference between life and death.
The challenge of getting that stuff to the right person is not a technical one; it is cultural. Thanks to technologies such as HL7 FHIR the content can be easily upgraded with live, read-write care plans built into the existing framework. It means the challenge of making health information exchange truly revolutionary is not one of finding groundbreaking new tools, but in defining what clinicians need from the powerful solutions that already exist.
A bold vision for smarter health information networks
We already have the technology to beam relevant data wherever we want, but to ensure it is picked up in the first place there needs to be a change in clinicians’ outlook. Going back to the GP, whereas before there was little point considering what patient information others might find useful, now they must understand that to do so is transformative for everyone. If the GP writes this stuff down the patient won’t get taken to A&E unnecessarily and the GP won’t get a call out of hours asking what medication they are on.
To nurture this change you need to talk to clinicians and understand what they actually need – and what they could do without. The information needs to be tailored differently to different services. A paramedic driving under blue lights to a critical situation has very different priorities to a hospice consultant dealing with an end of life patient or a nurse on a community visit.
Enabling new ways of working
It is also important to make sure the way the EHRs are presented fits with clinicians’ current workflows, otherwise they won’t be adopted. A GP is pressed for time, but modern technology means they can auto-populate a new care plan in less than 60 seconds. HL7 FHIR allows you to layer these plans onto existing electronic records. For example you can place a button next to patients’ names on their digital record; if a patient is on an end of life care plan this button will change colour. The clinician clicks on that button and gets a live snapshot of all their end of life plan with the relevant needs and preferences. When they add notes to this plan every other user’s view of the plan is instantly updated with the change.
The hard yards here are not in building the mechanisms, but in having conversations with those on the front line to ensure the digital transformation is actually useful to them. At Black Pear, these new ways of working have been our focus for the past ten years and we are working closely with our partners to realise them.
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