As Health, Social & Community Care Systems Embrace a Common Ground in Integrated Care Systems, an Agile Information Infrastructure is Called For

The power of linked data in care transitions from hospital to home is fundamental to improving the health of individuals, as well as that of health systems. EY’s new insights paper, titled How innovative infrastructure can power the purpose of integrated care systems, looks at the information architecture backbone necessary to join up the many threads of health, social and community services that keep people and populations healthier, independent and at home.

The paper discusses integrated care systems (ICSs), which are presently being introduced in England’s NHS. However, the insights are relevant for any health system that is contemplating better coordinating care between health, social, third-sector and local government delivery channels. Joining up services is a long overdue recognition that, working together, rather than in fragmented silos, achieves better outcomes. And ICSs tick all the right boxes, ideally providing equitable, well-connected and coordinated care across all aspects of a person’s health and social needs for healthier populations and more sustainable systems. 

Infostructures, or information systems that can create, connect and share data, leveraging a semantic standard, at scale, are key to modernizing health systems. As data becomes the core asset of health and care, it will be used by thousands of people for different purposes across time and space. Unlocking the power of ICSs as coordinated and collaborative ecosystems requires a new approach to health information architecture. This is one that not only spans the health and social dimensions of an individual’s life journey, but also realizes the immense value of health data availability in accelerating novel approaches for better and more efficient health and care. 

Joined-up care means working differently 

The richness and variability of health and social care encounters demand information infrastructures that are sufficiently agile to accommodate the heterogeneity of many different existing systems. Such infrastructures also need to act as platforms of exchange. This means allowing the easy flow of data within and between systems and analytics capabilities that support the use of data for local needs, safely and securely. 

At a minimum, modernizing the operating environment should integrate the vast amount of health-related information about an individual into an integrated shared care record. Spanning complex care pathways across many different organizations, this should drive interorganizational information exchanges that prevent errors, avoid inefficiencies arising from duplication, and support primary care and health at home care models.

As organizations such as the NHS move toward integrated care systems, there is a timely opportunity to build an information backbone with the entire system in mind. In the paper, we discuss why an open platform environment would allow sufficient flexibility to benefit from emerging technologies (e.g., artificial intelligence, augmented and virtual reality, hyper automation, decentralized identities and digital twins) and to deliver digital-first consumer and workforce experiences. 

As major investments, health information systems need to stand the test of time. For decision-makers, this means not being constrained by elements that hold back system modernization and taking steps to avoid future burden from technical debt. Although the NHS points ICS decision-makers toward consolidation and enhancement of existing EPR assets, we have suggested in the paper that an alternative approach warrants consideration. This includes weighing whether existing monolithic EPRs in use in the acute health system can extend to satisfactorily meet the information needs of the community, mental health and social care domains, as well as in providing an experience desired by both the individual and the clinician. 

Infostructure: The essential foundation for new models of care 

Sharing organized and complete data to generate insights for better health outcomes is the driving force behind joined-up care in ICSs. This demands an information architecture that supports a longitudinal health and care record, shared services between different resources and the easy exchange of structured data across systems. 

Health systems need to plan with a long-term view of the future. Beyond immediate need, strategic considerations must revolve around the vision for a modernized health system. Technology enablement is key to modernization, and the primacy of data liquidity is beyond question. The tools to deliver such liquidity must enhance, not impede, the permissioned sharing of complete data that gives rise to service model and operations innovations for better health outcomes. ICSs are a perfect example of the importance of considering the needs of all information users and ensure that a sufficiently agile system underpins the model. 

Open platform systems will produce significant value as a result of seamless data flow across the entire health and care value chain – from primary and community care through to hospital systems.

Integrated shareable care records replete with good-quality data are the backbone for any future health and care system. This is too important to get wrong. In this early stage of transition to ICSs, opportunity exists to weigh alternatives carefully. If information infrastructure is viewed through a different lens, that of open platforms and systemic design, the building blocks of a truly transformational change become clear.