Duncan Allen, sales manager, InterSystems outlines why the era of digital NHS necessitates that medtech start-ups place interoperability at the core of their solutions.
The reshaping of NHS digital organisations could be good news for the medtech sector, placing renewed emphasis on data-driven innovation. NHS Digital and NHSX are to merge into NHS England and become part of the NHS Transformation Directorate, with the aim of providing a single coherent centre and consistent leadership on digital transformation.
If this works, it should increase digitisation across acute and social care and help facilitate the Integrated Care System. Yet given that waiting lists in England have gone up from 4.24 million at the start of the pandemic to more than six million now, innovation needs to be significant.
The government has, however, agreed to inject £36 billion into the NHS over the next three years, to alleviate the relentless pressure on waiting lists. In the budget, the chancellor also announced £2.1 billion for NHS IT upgrades and digital health technology, which from a medtech perspective, is encouraging.
And at the beginning of last year the government issued its MedTech Funding Mandate for NHS commissioners, providing guidance as part of the NHS Long Term Plan so patients have access to “cost-saving devices, diagnostics and digital products more quickly.” Although this was only for devices and solutions approved by NICE (the National Institute for Clinical Excellence) in five specific clinical areas, it shows there is a measure of momentum.
The continuing problem with data interoperability undermines innovative excellence
From the medtech side, the momentum for innovation has continued during the pandemic, helping provide new digital tools to connect patients with clinical staff. However, despite all these developments, medtech start-ups continue to face a distinct set of challenges around data when it comes to achieving adoption in the NHS.
Too frequently, medtech companies with highly effective or ground-breaking devices that enable a new level of treatment, care or new monitoring capabilities are themselves incapable of allowing data to flow quickly and reliably with NHS healthcare systems and solutions. This is a critical barrier to uptake and expansion since integration with the masses of clinical data that already exist is a necessity.
Remote monitoring providers use some smart technology to overcome barriers
Within the NHS, start-ups need to achieve interoperability with mandatory data standards HL7 V2 and FHIR, to which any applications must adhere. A good example of the challenges is exemplified in the use of remote monitoring technologies, which increased during the pandemic. Having open standards-based interoperability built into a remote monitoring product from the start is important so it can run on shared infrastructure. This is especially true with an interoperability standard such as HL7 FHIR, the use of which is hugely advantageous as it follows modern internet standards.
To increase uptake and give confidence to clinicians, data from remote devices should be interoperable with clinicians’ systems and with third-party electronic medical record (EMR) systems. Yet since an EMR is a medico-legal record, how data is entered requires great care. A medtech company could seek to resolve this by working on integration with individual EMR vendors, but given the number in the market, this is hardly feasible.
A more innovative way for remote device companies is to use SMART on FHIR, an open, free, and standards-based API, which provides a straightforward means for third-party apps to authenticate and integrate with other healthcare applications, including EMRs. If the remote monitoring software aggregates the data for each patient into an application that supports SMART on FHIR it will be able to seamlessly work with other EMRs enabled for SMART on FHIR.
This is just one facet of the challenges facing medtechs with remote monitoring devices. But today’s healthcare is increasingly driven by data with digitisation initiatives on many fronts. Any solution incapable of full interoperability is likely to falter when it comes to achieving acceptance in an organisation of the scale and complexity of the NHS.
Medtech companies need outside help to resolve data interoperability problems themselves
Medtech companies must resolve the data challenges themselves because the NHS is focused on improved patient outcomes, higher levels of efficiency and reduced costs. Like all healthcare providers, the NHS wants solutions that optimise the healthcare professional’s work. Whichever provider they want to form long-term relationships with, start-ups need to become familiar with standards bodies such as HL7, ASTM, DICOM, and IHE, and build compliance into their solutions.
Achieving interoperability quickly and cost-effectively is however, beyond the resources of most start-ups. The solution lies in building applications on a third-party data platform which encompasses interoperability, the ability to orchestrate multiple interfaces, high-speed data storage, and “in-flight” data transformation. A specialised health integration platform allows start-ups to address a far greater number of interoperability use cases, particularly if they combine them with real-time analytics such as insight into usage patterns and performance.
Additionally, a unified platform eliminates the need to integrate multiple technologies and toolsets. This not only reduces the amount of code start-ups need to develop, test, and maintain but can also accelerate time-to-market. In-house developers are free to focus solely on getting the product or service offering to the level required. This is important when research suggests data scientists at start-ups spend as little as a fifth of their time on analysis.
Interoperability remains one of the most serious barriers for medtech companies. It is one they need to tackle as early in their evolution as possible. Yet with such high levels of pressure to achieve launch and to keep within tight resource constraints, start-ups aiming for implementation in an organisation as vast as the NHS need outside help. The most likely way to achieve and maintain critical interoperability is through a unified data platform built for the purpose, providing full integration with NHS health systems and standards.
