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Cranfield, UK, 21st November 2019 – October and November have seen Signify Research attend UK analyst/customer events held by two of the heavyweights of the global EMR market. InterSystems held its “Joined-Up Health & Care 2019” customer event in Birmingham in October, and Allscripts held its “EMEA Influencer Summit” in London in early November. Signify Research will publish its 2019 EMEA, Asia and Latin America PHM/Integrated Care market report this month and both events highlighted interesting developments relating to the UK integrated care IT market. We explore several of these below.
Drivers of Integrated Care
The integrated care agenda was the primary focus at the InterSystems event; little was mentioned of InterSystems’ Trakcare core EMR product, with the discussions, fireside chats and presentations instead focused on its integrated care offering, HealthShare. The event also included a presentation from one of InterSystems’ key UK integrated care customers, Lincolnshire STP. Although not the only focus, integrated care was also a key theme at the Allscripts Influencer Summit, particularly in relation to the rollout of Allscripts’ dbMotion and CareInMotion products across several acute trusts and Integrated Care Systems (ICSs) in the UK. The company is now well underway rolling out these solutions in Salford Royal NHS Foundation Trust, part of the Greater Manchester ICS, and Dudley Group NHS Foundation Trust, part of the Black Country STP (sustainability and transformation partnership).
Integrated care programs are forecast to be engines of growth for much of the healthcare IT market in the UK for several reasons, including:
- The NHS Long Term Plan
- The rollout of LHCRs
- The development of STPs, ICSs and ICOs (Integrated Care Organisations)
The NHS Long Term Plan (published in January 2019) has set the target that Local Health and Care Records (LHCRs) should be in place nationwide by the end of 2024. LHCRs will ultimately bring the healthcare data of patients across acute, community, primary and mental healthcare into one summary record that can be shared across agencies throughout a regional cluster. To realise this objective, healthcare providers require integrated care technology that can be used to bring together data from multiple agency EMRs and PAS into one record.
The development of STPs, ICSs and ICOs is encouraging healthcare providers to purchase IT that supports EMR data sharing/integration, shared care planning and shared patient communication. In the UK an ICO/ICS has many similarities to the US ACO model, i.e. it is a legal entity that brings together healthcare providers across a region or network to provide a more holistic, value-based care service. The STP and ICS status are steps along the road to achieving this model. As with the US ACOs, integrated care and Population Health Management (PHM) IT is key to supporting this transition.
A key focus throughout large parts of the NHS Long Term plan relate to implementing a “proactive population health approach” and for “local NHS organisations to increasingly focus on population health, moving to integrated care systems”. Again, to achieve a more proactive, predictive healthcare approach integrated care IT will be required.
Typically, the steps required to achieve the above are outlined in the table below:
However, a key takeaway from both vendors’ events was that this sequence was not being followed.
Buying PHM but not Doing PHM
Both events had customer presentations or vendor case studies that illustrated healthcare providers were jumping past the second step and going straight to the third and fourth.
Implementing Step 2, i.e. using the analytics, was often pushed to some distant and unspecified point in the future. Providers are implementing Population Health Management IT but not actually using it to manage populations!
At the InterSystems event, Lincolnshire STP presented its HealthShare implementation and explained its rollout so far. In a similar fashion to the above table it had broken the project into specific “modules”, namely:
- Care Portal – equivalent to Step 1 above, i.e. implementing a shared record
- Analytics – equivalent to Step 2 above, and partly Step 5
- Electronic Care Plans – equivalent to Step 3 and part of Step 4
- Patient Portal – equivalent to parts of Step 4
Significant progress had been made to Care Portal, Electronic Care Plans and Patient Portal. However, analytics was a lot less developed and with a relatively vague implementation timetable.
At the Allscripts event, an update of integrated care technology rollout at both Salford and Dudley NHS Trusts was given. IT to support providing primary and acute care users with a longitudinal view of the patient was partially implemented and live across parts of both networks. In Dudley progress was being made to roll out shared care planning tools using CareInMotion, with specific timetables in place for implementation. However, neither trust had set dates for implementing broader analytics or risk stratification programmes, and were either stuck at Step 1 or, in the case of Dudley, had missed out Step 2 and moved to Step 3.
This does beg the question, why?
Lower Hanging (and Still Highly Valued) Fruit
One reason is that the data aggregation tools are providing something that clinicians in the NHS have never had, a local longitudinal view of the patient. This is a huge step forward, that alone is a game-changer and makes cross-agency/multidisciplinary care planning at an individual patient level more realistic. Obtaining this longitudinal view also means that the provider is hitting its LHCR target and can be viewed as a significant milestone.
The size of the task to reach this point should not be underestimated. The volume of work for the provider and the IT vendor that is required to normalise data across multiple agencies is vast. Additionally, EU data protection laws indicate that there are many more data protection hurdles compared to other countries such as the US, and not all agencies in the network play ball when it comes supporting this.
This explains why several providers have not moved too far past Step 1. However, it only goes some way to explaining why step 2 is missed out or pushed back. Using analytics and risk stratification tools effectively means a significant change in care management operations. Often care management is a “tactical process” that focuses on individual patients and processes to best manage individual cases. Using risk stratification and analytics tools to manage cohorts and entire populations require a more “strategic approach”, with a change in the structure of care management, and more investment/additional funding. This is a major barrier to adoption and explains why it is easier and more valuable, in the short term, for the providers to instead jump to Step 3 and only use the new tools to improve tactical, individual patient care management.
Again, this is understandable. Having tools that provide a longitudinal view of a patient, with the means to plan care and communicate with the patient and other agencies in a structured fashion is a huge leap forward compared to existing processes. However, it does not leverage the wider population/cohort-wide improvements in care management that PHM can ultimately offer, or address many of the ultimate aims of the Long Term Plan relating to new models of care that leverage a more predictive approach. As previously mentioned, the required funding to take advantage of the tools is one element that could change this, but vendors also have an opportunity here to support providers through advisory and process reengineering services that will enable the transition to a more strategic care management process.
The Bigger Picture
The examples provided for Allscripts and InterSystems are not unique. Several other vendors such as Orion Health and Cerner have had success selling integrated care and PHM tools to Trusts and STPs across the UK, and for many the issues have been similar. LHCR objectives and obtaining a longitudinal view of the patient always drives initial deployment, and using this to support tactical care planning typically follows. But is this really offering new models of care?
In some ways it does. Cross agency healthcare provision can be vastly improved with such tools. However, addressing the more fundamental parts of the NHS Long Term plan will only be achieved when these tools are then employed to introduce a more strategic approach to care management.
Related Market Report
Signify Research is publishing its 2019 market report on the EMEA, Asia and Latin American markets for integrated care and population health management tools this November. For 20 countries and sub-regions the report provides a deep dive analysis of the drivers of integrated care technology deployment, such as government initiatives and healthcare organisation changes. It also explores which vendors (local and international) have had success in each country/sub-region and what product types are driving growth. For more information, please contact alex.green@signifyresearch.net