1) The document discusses developing an open environment for information sharing to support new models of care through open interfaces, standards, and APIs. 2) It outlines current priorities like using NHS numbers as primary identifiers and electronically sharing discharge summaries. 3) The goal is to open up key national systems like the Summary Care Record through structured APIs to allow access and contribution of important clinical information based on industry standards.

1. Taking forward
Information Sharing
Health Insights June – July 2106
David Waller
Interoperability Engagement Lead, NHS England

2. Strategic context
Breaking down “interoperability”
What this means for professionals and citizens
Current priorities
Working in conjunction with localities and the market

3. The development of an open environment
for information sharing supporting
emerging models of care based on open
interfaces and open standards.
Open APIs
Open interfaces to enable information to flow
across a care pathway and to be accessed
across geographies
Local shared care records that
link health and social care as
main approach for delivering
local information sharing needs
Tight standards for key transfers of care
Local IDCRs Professional
Through my system I can
directly access and
contribute to summary and
detailed care information
Citizen
Using my PHR I can
access care information
about myself and
contribute information
PHR
Patient Record Index
Ability to locate patient record information that
can then be accessed through open APIs
Open interfaces from national
systems such as SCR to simplify
access and contribution.
Expansion of SCR for access by
additional care settings and
additional critical information.
Summary
Care Record

4. • Breaking down “Interoperability”
• Key priorities - NHS Number, Transfers of Care
• Focus on opening up key systems (Open structured APIs) for key
clinical priorities based upon industry standards - FHIR
• Working directly with localities and clinicians on needs and market on
solutions – the “Community”
• Not seen as national organisations in an ivory tower
• Supporting localities to be more “informed customer” in
implementing information sharing approaches
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5. 97%
Of localities using NHS Number as
primary identifier when sharing
information
66%
Of localities sharing discharge
summaries electronically
StandardsLevers Incentives Service change Technical Capability

6. Professional endorsed
standards
• Developed initially by the Royal
College of Physicians (RCP) and
published in July 2013
• Signed off as fit for purpose by
50 organisations that give
professional leadership to the
medical, nursing and clinical
professions
• Adopted by the Professional
Records Standards Body (PRSB)
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7. 7
Discharge summaries

8. Nov
2015
March
‘16
National Information
Board
Interoperability
Strategy published
Over 95% of hospitals
using NHS Number in
clinical correspondence
Launch Interoperability
Community bringing
together localities,
vendors and national
organisations
Over 70% of hospitals
sharing discharges
electronically
Use of FHIR
APIs for
workflow and
accessing
record starts
Discharges shared using
professionally endorsed
clinical structure
Key APIs Transfers of CarePrimary IdentifierFocus on key
priorities
Change the dynamic
Nov
‘15
Jan
‘15
Nov
‘14
Sept
‘16
Dec
‘16

9. End of life
care
prompting key
preferences
Vaccinations and
immunisations
history
Visual
comparison
of medications
Prescribing
alerts
Encounter
timelines
Long term
conditions
(trending and
recall)
Pre-population
of pre-operative
assessment

10. Clinical
Scenario Drivers/Benefits
Why Structured and
Real-time
Elements on GP
Record Needed Supplier Capability
1.
Visual
Comparison of
Medications
Drivers:
• Medication errors are the third most prevalent source of reported patient
safety incidents in England
• Prescribing errors are the most important cause of medication errors
Benefits:
• Reduction of safety issues on manual transcription
• Medication errors reduced as have up to date medication list
• Time taken to have to compare across tabs/systems
Cannot create a
consolidated list from sets of
information that are in
different read-only views.
Have up to date medication
information.
• Medications EPRs systems e.g.
Cerner, Orion,
Allscripts and shared
records already able
to provide functionality
2.
Prescribing
Alerts
Drivers:
• Medication errors are the third most prevalent source of reported patient
safety incidents in England
• Prescribing errors are the most important cause of medication errors
Benefits:
• Reduction in safety incidents due to lack of contra-indications
Cannot proactive prompt
from information that is in a
read-only view.
Have latest allergy, problem
information
• Medications
• Allergies
• Diagnosis
• Problems
EPRs/shared record
systems e.g. Allscripts,
Connecting Care are
already able to provide
functionality
3.
Long-term
condition
patients
(trending and
recall)
Drivers:
• Reduction in avoidable cost for long term condition management e.g. an
estimated 80% of the costs of diabetes come from the management and
treatment of avoidable diabetes-related complications
• Recalling people safely on time – e.g. repeat obs/test
Benefits:
• Proactive intervention in long term condition management
• Avoiding unnecessary drug administration
• Avoiding safety incidents where drugs administered incorrectly as have
real-time access to latest trend information
Cannot proactive prompt
from information that is in a
read-only view.
Have access to latest
readings and their trend to
manage intervention.
• Medications
• Diagnosis
• Problems
• Investigations
• Observations
Some EPRs/shared
records already able to
provide trending and
recall functionality
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11. Clinical Scenario Drivers/Benefits
Why Structured and
Real-time
Elements on GP
Record Needed Supplier Capability
4.
Prompting on key
preferences
Drivers:
• NICE guidance on improving end of life for people in their last days
• Improved efficiency in care provision – 111 workflow
Benefits:
• Enables patients to die in accordance with their patient preferences
e.g. in their preferred place of death.
• Efficient and appropriate use of services in co-ordinating care for the
patient e.g. sending ambulance to admit into hospital when patient wishes
to die at home.
Cannot proactive prompt
from information that is
in a read-only view.
Have latest information
on key preferences e.g.
preferred place of death.
Specific
preferences/flags
• DNR
• Preferred place
of death
111 service
EPACCS systems
(e.g. Adastra,
Graphnet)
5.
Encounter Timeline
Drivers:
• Safeguarding
• Improved efficiency in care provision
Benefits:
• Ensuring appropriate intervention based upon having holistic view on
patient’s touchpoints with the service.
Cannot create a timeline
from information spread
across a set of different
read-only views.
Need to have latest view
on all touchpoints in
crisis period.
Encounter
(including care
setting, encounter
type, clinician type
and associated
clinical information)
EPRs/IDCR Portal
already able to provide
this e.g. Connecting
Care portal
6.
Vaccinations and
Immunisations
History
Drivers:
• Avoid duplicate immunisations/vaccinations
• Aid recall system for children
• Aid frail and elderly who are immuno-surpresed
Benefits:
• Enables correct intervention based upon accurate history – important for
Digital Children's strategy
Cannot proactive prompt
from information that is
in a read-only view.
Have latest vaccination
information e.g. child
health.
• Immunisations
• Medication
• Allergies
EPRs systems e.g.
Cerner, Orion,
Allscripts already able
to provide functionality
11

12. Clinical Scenario Drivers/Benefits
Why Structured and
Real-time
Elements on GP
Record Needed Supplier Capability
7.
Pre-population of
Pre-operative
Assessment
Drivers:
• Improved patient experience of not having to repeat same information or
attend unnecessary appointments
• Improved efficiency in care provision
Benefits:
Reduction in administration burden leading to:
• Improved patient experience
• Improved productivity of clinicians
Cannot pre-populate
forms from a read-only
view.
Have access to latest
record information to go
onto the form.
• Medications
• Allergies
• Diagnosis
• Problems
• Investigations
• Observations
Hospital PAS systems
Example of alerting against allergies when prescribing Example of encounter timeline 12

13. Appointments
Manage appointments in order to co-
ordinate access to care
Access Record
Access a patient’s care record for the
purpose of direct care
Tasks
Manage tasks in order to work effectively
across care settings
eDischarge
Discharges from inpatient care back to
the general practitioner
A&E eDischarge
Information sent to the general
practitioner from an A&E attendance
Ambulance
Social Care
Referrals
Emerging needs

14. Creating a common and open set of APIs to support information sharing across health and care
Defining the key clinical information
sharing needs.
Prioritising the key APIs.
Group members e.g. CCIOs, CIOs,
Vanguard, Pioneers, PMCFs,
NHS England.
Outlining the accreditation approach
for APIs.
Group members e.g. TechUK, CIOs,
suppliers, HSCIC.
Defining the key underpinning components and
policies, e.g. security and authentication.
Group members e.g. HSCIC, suppliers, CIOs,
TechUK, NHS England.
Establishing and creating the required APIs
based on clinical information sharing needs.
Group members e.g. suppliers, innovators,
CCIOs, CIOs, NHS England, HSCIC.
Made up of the above organisations, the Project Board
is responsible for the assurance and governance process.
Links to existing
communities and
signposts tools and
products.

15. • The board will be made up of representation from across the
stakeholder community:
• Builds on models from other geographies e.g. Commonwell.
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