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Signify Premium Insight: InterSystems and the great PHM cultural shift

This Insight is part of the Signify Premium Insights (SPI)-Digital Health service, which will launch on 9 January 2023. From that date, this and all SPI-Digital Health Insights will be available only by paid subscription. Click here for a free one month trial of this service. 

In theory, recent contracts that data technology provider InterSystems has secured with two Integrated Care Systems (ICSs) in the UK lays solid foundations for forays into embryonic European PHM markets. But they also raise wider questions on where exactly the UK PHM market is heading, how fast and, ultimately, where the likes of InterSystems fit in. 

The Signify View 

The two recent deals for InterSystems will consolidate data from siloed systems in the North West London and West Midlands ICSs. This is part of a broader drive by ICSs in the last few years to put in place ETL and shared care record solutions, bringing together EHRs from GP/primary care practices, social care councils, hospital trusts, mental health trusts and other hospitals.  

The five-year North West London contract, in partnership with Amazon Web Services (AWS), will enable social care, mental health and community trusts, local authorities and third-parties, to migrate their on-premises workloads to InterSystems’ HealthShare Health Connect Cloud on AWS. Ultimately, it will provide a better view of the health records of around 2.1 million people. Similarly, the West Midlands ICS deal will bring together around 400 health and social care providers from six local authorities in that region.  

While both deals further affirm the success of InterSystems’ HealthShare solution, they should also now be viewed in the wider context of the UK PHM market. 

The PHM Maturity Model (see below) shows the market’s expected evolution over the coming years. Currently, it is still in its formative years, with investment concentrated on data consolidation. Most of this investment has already taken place, thereby limiting the upside potential for the likes of InterSystems in this space going forward. 

Next Steps 

The focus will move to ICSs, Primary Care Networks (PCNs), acute trusts and other primary/community NHS providers examining how to leverage new harmonised patient data pools to support integrated care, and upscale a care management process that is, at present largely manual.  

To date, funding has concentrated on data aggregation tools that give a single view of the patient across different settings. A nice view to have, but not one that will save money for the NHS. The real savings will be in predictive, preventative tools for risk stratification, better care management workflows and clinical decision support. This is where we expect more funding from the likes of the Unified Tec Fund. 

In this regard, vendors and the ICSs say the risk stratification technology (developed by the likes of InterSystems, Oracle Cerner and Orion) is now in place to support the move into predictive analytics. 

Furthermore, PHM lies at the heart of the NHS Long Term Plan, which was launched in 2019. PHM is a critical building block for ICSs, and as a result government IT investment in this area should largely escape the expected swathe of cuts the NHS will be forced to make in the coming months and years. 

But, at last month’s InterSystems conference, we attended presentations by the West Midlands and Cumbria and the North East ICSs. While both insisted they had all the building blocks, and the integrated care records in place, they were unable to confirm when they would, or could, move on to the analytics and predictive phase. We published an insight following the InterSystems 2019 conference (see Insight here), and the narrative does not seem to have progressed much since. 

The Bottleneck

The barriers to progress appear to come from within the NHS at this stage. Achieving the first phase of the PHM journey was relatively easy for the provider, because it did not require healthcare professionals to fundamentally change the way they work. Using aggregated data is a similar process to that which preceded it. With overlay systems, healthcare professionals simply get a better, bigger picture of a patient’s history. The problem now is that, to make use of the more sophisticated tools now being developed, the NHS will have to undertake a cultural shift. It will need to move on from platforms, and invest in people and processes to proactively make use of the tools. This change will not come easy for the NHS. 

The UK healthcare infrastructure at large will also need to adapt to move this process forward. It will not be solely the ICSs responsible for driving change: PCNs will increasingly take the baton to make use of the predictive analytics tools at their disposal, and unlock the market. Given this, it will be PCNs that must be the focus of funding if the PHM market is to move forward at any speed.  

Hand Holding 

So, what is the role for the likes of InterSystems, Oracle Cerner, Graphnet, Patients Know Best and Orion in this PHM evolution?  

In the UK, these vendors have the analytics, care management and health insights-type solutions for PHM available to sell to the PCNs and ICSs when they are ready. In the meantime, however, the vendors will need to identify opportunities to drive new revenue streams. There are two potential ways this could happen. 

First, during last month’s InterSystems conference, we got the sense that the PCNs, ICSs and other stakeholders in the industry need some sort of guidance from vendors on how to take the next steps on this journey. The vendors therefore have an opportunity not just in analytics solutions, but also to becoming more embedded with the PCNs and ICSs to consult on and navigate IT strategies. 

Second, as the various PHM stakeholders work out how to move forward in the UK, Europe could still prove to be a happy hunting ground for data aggregation solutions vendors. Value-based care is in its infancy in Europe (especially compared to the US), and France, Germany and the Nordic countries are all embarking on journeys in this regard. The proven track records and experiences of Oracle Cerner, InterSystems and Orion in the UK could be a welcome springboard for them into new geographical markets.  

Leap Of Faith?

The UK ICS network is establishing a more connected, predictive, preventative healthcare system. This is paving the way for a transition to analytics, which is where the NHS will have real opportunities to save money. 

However, despite many of the ingredients being in place, this process has hit a roadblock. This roadblock will only be overcome if the NHS can overcome entrenched ways of working (and it is very much in its interests to do so), and if all stakeholders in the industry can find new ways to work together to drag the PHM market into a new era.  

The industry is talking the talk, but it is not clear if it is yet ready to walk the walk.

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