Thread by @DavidHancock6

1/16 So, a long weekend to reflect on @DHRewired last week. After a couple of dog-walks and marathon poo-picking sessions, plenty of time to think. I keep coming back to the #frontline #digitisation programme. I offer this constructively. If you want to discuss, contact me

2/16 The session with the biggest impact was #Tim #Ferris. He talked about his experience in Boston at Mass Gen and he stressed that once they’d put a single system in across 8 hospitals, all staff were part of one team and they were all on the same page for every patient

3/16 What greatly troubled me is that there was no acknowledgement in the world of ICS where we are driving vertical integration, we cannot be working on a single system

4/16 Acutes, Mental Health, GPs, Community and Social Care will not be using the same #EPR. What we need to be talking about is all of these Providers using the same Data Set. We have to focus here on sharing data across systems, not having a single system

5/16 A shared data set that also needs to be shared across ICSs as geographic boundaries are very porous and patients will always flow across ICSs, and indeed across separate health jurisdictions (Wales, Scotland, Channel Islands, IoM etc.)

6/16 So how do we square this circle and help everyone in NHSE/I who have the £2bn to make sure it is spent wisely and does what we need? I have some suggestions below

7/16 #frontline #digitisation programme has to include requirements for #interoperability. #EPRs must be able to consume information from the shared Data Set and provide data to it too. We must prioritise what that data is and define where and how data is consumed and provided.

8/16 What EPRs need to be able to do regarding #interoperability must be written in black and white in any #frontline #digitisation RFP. To support the #clinical #decision #support objectives of #Tim #Ferris #EPRs must consume structured and coded data from the shared Data Set.

9/16 The shared Data Set is vital. To do this effectively requires a strategy for managing data at rest. However, an ICS also needs a strategy for managing data in motion. This is both a strategy for routing and transforming data and also integrating workflow across providers

10/16 This is really important where we have heterogenous applications – and we will always have huge variability in end points even after this #frontline #digitisation programme completes as it will not replace every system

11/16 We must tackle how we share data across ICSs and for that we need a published strategy and roadmap with dates on the National Record Locator – especially how it is to become an aggregator. With no guidance, ICSs will struggle achieve anything meaningful x-border.

12/16 We have to tackle issues such as not all Shared Care Records are equal – what is the scope of the data they hold and can they serve it up using #HL7 #FHIR? Therefore different ICSs will access items of shared data from different places, many will need help to define this.

13/16 A toolkit to help understand patterns, options and art of the possible is really important in a way that non-IT people understand. We need a diagram that shows how everything fits together, including NRL and the options for accessing a shared data set.

14/16 What I am also describing requires huge change but as with all #transformation, the biggest issues will be social and organisational. How do we prepare and help our ICS leaders implement this kind of work?

15/16 There have been huge steps forward taken, but we are entering a new age. Are the enablers in place and suitable? We have to ask, does #DTAC work? (Spoiler alert, No!). Does onboarding to NHS Platforms work, such as #GPConnect? (Spoiler alert, No!). Let's sort out together

16/16 This is not sniping from the sidelines. Myself and other suppliers are in the frontline and want to make sure we succeed this time. My plea is that everyone understands this and we work together based on the reality to get it right. You know how to contact me…..