The Cheshire and Merseyside e-Xchange project
The Cheshire and Merseyside e-Xchange project
In the United Kingdom, the NHS is investing heavily in transformational technology to support healthcare as we advance into the 21st century. Forcare is working with the NHS Trusts across the Cheshire and Merseyside regions, and in collaboration with the Lancashire Healthcare Interoperability Exchange, to provide an open standards information highway for sharing healthcare information across the region.
As populations grow, and with an aging population, the challenges of healthcare are every increasing. If we are to meet these challenges, then we need to use technology to help us. Two key elements of the NHS strategy for technology are to allow patients to participate more in their own healthcare, and to empower health and social care organisations with patient focused information. The information is used in support of healthcare provision, and also in service planning (population health). The NHS has identified interoperability as a key technology enabler - connecting people and populations to their healthcare providers. In 2019, the NHS is funding 7 Interoperability Hubs across England to be exemplars and show how Interoperability can become a foundation for change and improved healthcare practices in a regional basis.
Forcare is working with the NHS Trusts across the Cheshire and Merseyside regions, and in collaboration with the Lancashire Healthcare Interoperability Exchange. The region has a population of over 2.5 million. There are 21 healthcare organisations providing care (including 12 secondary care Trusts). Forcare’s IHE and FHIR interoperability is providing an open standards information highway for sharing healthcare information across the region.
Alder Hey children’s hospital: a key centre for referrals
Forcare’s work in the region started with Alder Hey NHS Trust. Alder Hey is a children’s hospital in Liverpool with a global reputation for healthcare excellence. Being a children’s hospital, it is a key centre for referrals. Being able to safely and securely share healthcare information is extremely important for Alder Hey as they received referrals, not only from the whole region, but also from neighbouring regions, Lancashire, Manchester and North Wales. Together with six other hospital Trusts across the region, Alder Hey planned a Health Information Exchange (HIE) with the objectives
- To develop and use a single information sharing agreement across the region
- To put in place a regional HIE to support shared healthcare practices across the region
- To ensure a unified interoperable approach between Primary and Secondary Care providers
Alder Hey chose Forcare as an Interoperability technology partner to help them fulfill their vision for healthcare information sharing. Working in partnership with Alder Hey, Forcare is able to provide the technical know-how that compliments the organisation’s drive to shared working.
Specialists understand the need to use open standards for sustainability
Why did Alder Hey choose Forcare? Without doubt the main reason was due to the need to use open standards in the solution. Across the region there are several teams of integration specialists working in the NHS Healthcare organisations: they understand how open standards interoperability opens a channel for communications that is sustainable into the future and lines up with the NHS England strategy for interoperability. Forcare is the foremost supplier of XDS/FHIR software and as such was a natural fit. Forcare’s ambition to contribute to the success of interoperability in the UK, with software and expertise, added to the attractiveness of Forcare as the right partner for this work. And so the Cheshire and Merseyside e-Xchange project was born.
One of the exemplar Interoperability hubs
The ambition and scope of this project is large: providing a “vendor neutral healthcare network” to share all information for the region. This links together the Electronic Health Records in each of the 21 healthcare organisations (across Primary, Secondary and social care, and encompassing the Ambulance services). Such a large project needs to be taken step by step, and there are many complex challenges to overcome. But careful groundwork has meant we can work steadily, and we are already providing integration of care records across 7 NHS hospitals.
So far, the 7 hospitals are exchanging summary care records, discharge summaries and laboratory results. The solution also links with the regional radiology solution provided by Carestream. On key step made was to link to the neighboring Lancashire region, because the ambulance services for Cheshire and Merseyside are also shared with Lancashire. Lancashire has an existing IHE XDS network, so it was a simple step to hook these two networks together using IHE XCA. The practical necessity of connecting up the networks to provide information to the Ambulance Services then resulted in Cheshire and Merseyside joining together with Lancashire in obtaining addition NHS funding as one of the exemplar Interoperability hubs.
True bidirectional exchange of information
The next stage is to tie in Primary Care. Connecting General Practitioner information systems in the UK is notoriously difficult, mainly due to the contractual obligations of GPs and their GP systems providers: one of the more protracted elements of NHS healthcare governance. We are on track to achieve a ‘first cut’ GP connectivity by the end of this year. This will simply provide a view of Primary Care data within the e-Xchange. But we are also planning a much more ambitious interoperable working with the GP systems, with true bidirectional exchange of information. This is an important element of the NHS England interoperability strategy. Here NHS England and NHS Digital are working in a FHIR based framework for GP systems’ interoperability, called GP Connect. On our current track we are working towards being one of the early implementers of GP Connect.
Additionally, the next stage, through 2019, will see us rolling out to the rest of the healthcare organizations across the region. As more organisations come on board, we will continue to add more information and documents, and develop new use cases.