Researching barriers to interoperability in health NHS England and Improvement

An ambition to make health and social care interoperable was proving difficult. We gathered evidence to help shape a national strategy.

The challenge

In March 2021, the Secretary of State for Health and Social Care gave a speech about the critical importance technology has played in the coronavirus response.

He highlighted how interoperability - joining up IT systems to allow instant data-sharing - has the potential to transform health and social care.

We were engaged by NHSX (now NHS England and Improvement) to carry out a discovery phase into a digital solution that could move the government closer to its ambition of an interoperable health and social care system.

A workshop plotting out types of interoperability standards

Identifying the problem to solve

Over 4 weeks carried out a discovery that explored:

• the user groups and their role in building, commissioning and enforcing interoperable health tech
• their needs and pain points
• the extent to which NHSX’s proposed standards catalogue would meet their needs

In total we carried out 28 sessions with users, identifying over 60 user needs and 9 high level problems that need to be solved for interoperability to be achieved. These are:

1. Difficulty finding standards - standards are published by multiple organisations and there’s nowhere to see standards by care setting or use case.

2. Low levels of understanding - interoperability, standards and the benefits they bring aren’t well understood.

3. Lack of mandation and enforcement - users want the NHS to decide which interoperability standards to use and then mandate and enforce them.

4. Issues with contracts and procurement - contracts don’t always list the correct standards or stipulate that data must be owned by care settings.

5. Standards development can be slow - early adopters are happy using experimental standards but others are waiting for them to be finalised.

6. Uncertainty around funding - there’s no funding to align health care providers’ existing solutions to minimum standards.

7. Healthcare providers have competing priorities - with many other problems to solve it’s important to win hearts and minds.

8. Difficulty accessing central data services - this includes services such as the Patient Demographic Service.

9. People find it hard to get support - this is a niche area so connecting people working on similar problems can help drive adoption.

A section of the board used to capture all user needs identified in discovery

A clear way forward

NHS England and Improvement now has a rich source of clear evidence with which to inform their overarching strategy.

To help them move forward we produced:

• a user ecosystem map visualising the 50 different user groups and their relationships to one another
• a user needs board with the 60 identified user needs, categorised into themes that can be taken forward in separate work streams
• a list of prioritised user needs to inform the design of the standards catalogue in Alpha
• communication materials to help inform and engage stakeholders

Feedback from NHSX’s senior leaders has been extremely positive.

“I just want to say: amazing work all! Thank you. Really impressed with [your final] report” Irina Bolychevsky, NHSX Director of Standards and Interoperability

More on this project

Designing solutions to join up health tech

Building the NHS Data Standards Directory