Reasons to be cheerful: Andy Kinnear on UK digital health

Shared care record pioneer Andy Kinnear believes that UK digital health has many reasons to be cheerful at the moment – and suppliers that take the right approach to sharing information and working together are central to making the most of this opportunity.

After over 25 years in the business, Andy Kinnear is one of the UK’s leading lights in digital health. And this light shines ever more brightly as the prospects for digital health in the UK look ever more promising.

The lead for shared care record programme Connecting Care, and new head of BCS Health, echoes the belief held by life sciences minister George Freeman and Andy Williams of HSCIC (now re-branded NHS Digital) that the ‘stars are aligned for health IT’ as national and local bodies look to deliver on the potential for digital health, supported by national investment and a more supportive environment than previously.

“I don’t think the morale around digital health has been as high as it is now,” says Kinnear, who has progressed through the ranks to be one of the most respected health IT leaders in the country, and won plaudits for his work on the Connecting Care shared care record programme in the South West.

After years of frustration and failure for digital health to realise its potential, the tide has turned. “Now we can be masters of our own destiny,” the director of digital transformation at NHS South, Central and West CSU says.

The digital health landscape is looking much more promising from days of old, with NHS England setting strategy and providing investment, the HSCIC providing standards and systems, local CIOs such as Kinnear doing the delivery, and suppliers and vendors providing the NHS with the software and products to deliver that future world.

“NHS England and the HSCIC are fundamentally unrecognisable from the organisations they were two years ago. Culturally, they are heading in completely the right direction. This is making it far easier for people at a local level to engage with them, which is making it far easier for suppliers to engage with all three of us. You have this virtuous circle that gives cause for real optimism.”

Not only is the investment from NHS England a welcome boost; it is also an endorsement of what we have delivered and what we are expected to deliver going forward, argues Kinnear. The Wachter review of health technology also promises much.

“I think [Bob Wachter] will set up an agenda around professionalisation of digital health leadership in CCIO, CIO and CEO spheres the likes of which we have never seen. If you harness the enthusiasm of clinical CIOs, for example, and support them with a professional development programme that can see them stand alongside their CIOs, I think we have a real adrenaline rush for digital health,” he states.

“And if at the same time you are lining up your chief execs to recognise the potential digital technology has to change their organisations, then these are serious reasons to be cheerful. Certainly when you compare it with history, it is incredibly different.”

Award-winning health technology
Kinnear’s own history with the Connecting Care programme, which began in 2011, gives him his own reasons to be cheerful. The real-time patient information sharing initiative was the overall winner at the EHI Awards in November last year, and also picked up the prize for the best use of IT to support integrated healthcare services.

“The award was a career high for me on a personal level,” says the CIO. “But once the dust had settled, what we as a team enjoyed most was that it was a vindication of our approach. We had received plenty of challenges along the way. The award showed that what we were trying was right.

“The other aspect that for me and my team was to be acknowledged by our peers. Connecting Care is not at a point of full maturity yet, nor has it got to a point where it has thousands of users using it. It is yet to be absolutely embedded in the life of the health and care system in our city.

“But is has got to the point where it has proved it is technically possible to build shared records across a complex environment like this. We have proven that you can bring 17 organisations together, work out a shared record programme, and you can build a real live system that doctors, nurses and other care professionals can use. You can actually measure benefits from that, to such an extent that 17 organisations invest the best part of a million pounds a year in it.”

A boost for programme growth
As well as a boost for Kinnear and the Connecting Care team, the EHI accolade has given credibility to the programme locally, which is helping to engage a wider range of organisations that can benefit from the programme over the coming years.

“Such bodies may not have engaged at the beginning because they could not have conceptualised what the ‘thing’ was. Now they can see it for their own eyes, it has galvanised an enthusiasm in those organisations that we might not necessarily have got in the beginning.”

Plans include growing the number of organisations and groups accessing the shared record, as well growing the number of users that actively use the record. The breadth and depth of the information is set to grow, with added functionality and mobile access also on the cards.

“In the urgent care space, we would like to get 111 and our ambulance trust more involved. We are also talking to local authorities about extending out into education, particularly with children’s social care coming on stream.”

“We are also looking for it to be outside out of the professional only domain, so it moves to a place where patients can contribute to the shared record.”

Benefits starting to be realised
Such organisations will also be encouraged by some of the early benefits being felt by its 1,600 users across the South West. Operational efficiencies have been quick to emerge.

“For example, waiting for information from various GP surgeries for a pre-operative assessment would have taken around four hours. Now the process is being done in less than two minutes,” says Kinnear.

“Reduced duplication of effort is also in evidence. Previously, when an elderly person was referred for occupational therapy (OT), they would have been referred to both health and local authority OT teams. This could mean two different OTs would do an assessment. Now they are both double checking that the other party is not involved, and have ended up coordinating that only one of them does the assessment.”

Benefits realisation for Connecting Care is central to the programme, and is being supported by work with the local academic health science network, as well as expertise brought in from the HSCIC. “We get access to their expertise, and they get access to a relatively mature shared record programme to begin to understand what types of benefits they can extrapolate, and realise in other parts of the country.”

Selecting the right kind of supplier
Part of realising such early benefits is working with the right kind of supplier; Connecting Care is well known for working with Orion Health and NextGate.

So what does Kinnear look for when it comes to looking to those vendors that can support the drive for digitally-enabled integrated care?

“I think there are some hard and soft factors,” he says. “For the hard stuff, you need contractual elements that ensure software suppliers are willing to share data out of their systems in a format that is structured and usable for other purposes. You would want performance guarantees on the system that meant you could share data without impacting the day to day running of the application. You would also look for a product roadmap initiative that looked to support that going forward, for example through the adoption of FHIR standards, or open APIs.

“But actually, the more important is the softer stuff. Personally I warm to the vendors that recognise that, whilst they have got a piece of software that sits in a particular niche for us, they are not going to be the whole software house that does the whole end-to-end lifecycle for health and social care.”

Kinnear feels it is naïve for suppliers to think they can do everything on a single platform.  “If the National Programme for IT didn’t teach us anything, it was that we shouldn’t put everything on one platform.

“One of the trusts in Bristol, for example, has got 300-plus separate electronic systems using patient identifiable information. If you applied it across all other organisations you are probably getting on for around 9,000 separate clinical and care systems with such information. The idea that one software vendor is going to provide you with a replacement within one suite anytime soon is naive at best.”

Information governance holds no fear
The use of patient identifiable data is a perennial source of concern for those involved in this space, with the latest Caldicott Review (‘Caldicott 3’) into information governance in the NHS promising some change in approach. However Kinnear is confident that the review will take an approach he can deal with.

“The changes from the Caldicott reviews so far have been good, and been supportive of the ‘duty to share’. They generally recognise the need to create an environment where sharing information about people is for their benefit and for their protection. I am massively confident that what we will see in the next review will continue that ethos, and continue that journey.

“Firstly, we have made safe secure controlled information governance rules, policy and approach, an absolute lynchpin of this work, right from day one. Whatever Caldicott 3 comes out to say, in many ways it doesn’t hold any fear, as this is at the heart of our programme.”

“Second, the danger of being relatively early into this world is that we might end up having to do some retrofitting of that policy. However I am relaxed about it; the reality is that we have had this live for a couple of years and we are realising benefits. If we might have to spend a few quid to reverse engineer, then so be it.

“Otherwise, you could wait until you got an entirely safe, secure, robust information governance environment in which to develop a shared record. It might make your life easier, but it would mean you have missed out on 10 years of other benefits you could have realised.”

Do something sooner rather than later
A real exponent of the ‘just do it’ mentality, Kinnear urges other areas to be proactive in sharing information.

“I have said the only wrong approach to interoperability is to do nothing. Start connecting something together to begin that information sharing journey. Then the benefits can be realised.”

Healthcare is often perceived to be many years behind other industries when it comes to exploiting the potential for digital. With the stars such as Andy Kinnear put there, the future might be as bright as is promised.