Inside e-health thumbs through the ASCC catalogue

There are two main ways to achieve interoperabilty. You can either standardise on a single system; or you can opt to use many systems that share standards and so are able to work together. The NHS IT programme now appears to have a foot in both camps, says Jon Hoeksma.

NHS Connecting for Health (NHS CFH) recently announced Additional Supply Capability and Capacity (ASCC) contracts for sixty-one suppliers of clinical systems.

It covers everything from patient administration systems to e-prescribing, pharmacy, order communications and dentistry. And it may be the final call on the idea that a single, wall-to-wall solution can meet all the needs of an enterprise as complex and varied as the English NHS.

The pros and cons of ruthless standardisation

Standardising key systems has a lot of attractions, including - potentially - much lower cost. It has worked in other industries that are based on standardised processes. And it is the approach that the National Programme for IT in the NHS (NPfIT) has been pursuing for its key systems.

However, it would require much greater standardisation of clinical practice than tends to exist today; which is just one reason that IT-enabled reform of healthcare is proving a long-haul.

The idea of a framework catalogue to help fill specific gaps of unmet need in clinical software appears both pragmatic and sensible, and NHS CFH has now created one. But it does seem to mark the end of the idea of a single, integated care records system to be used by all clinicians across a particular region of the NHS.

Gordon Hextall, NHS CFH’s director of informatics, said the ASCC framework contracts will “ensure that the NHS has access to a range of suitable IT supply routes to respond flexibly to new and future business needs as they arise.”

“This may be the final call on the idea that a single, wall-to-wall solution can meet all the needs of an enterprise as complex and varied as the English NHS.”

And of a wider choice of suppliers

The tacit endorsement of best of breed can be seen as NPfIT 2.0. Version 1.0 heroicly said “we’ll do it all.” Version 2.0’s position appears to be that its local service providers (LSPs) will deliver core, detailed care record service applications, but a lot of specialised clinical applications will come from niche, expert suppliers.

The move doesn’t mean a free for all – yet. But the framework contracts will - in theory - enable NHS organisations to plug specific clinical requirements by allowing them to buy from a much wider range of vendors.

The caveat is that they will have to pay, instead of getting centrally funded software from NPfIT. And a more heterogenuous range of applications will create additional work for NHS trusts.

Rather than just planning to take and integrate one “strategic” application from their LSP, many will now have to locally integrate a wider range of systems than previously anticipated. These may include existing installed systems, one or more LSP provided systems and ASCC applications.

“In reality, a move to best-of-breed has been underway almost since the programme began.”

Straws in the wind

How radical a step is this? In reality, a move to best-of-breed has been underway almost since the programme began. The pressure came first in primary care – historically the most digitised part of the health service.

In March, after two years of negotiations, initial contracts were signed to provide GPs with a choice of practice systems. This recognised the fact that many GPs were pretty happy with their existing systems and reluctant to change unless they saw something a lot better offered.

London’s LSP, BT, has been pursuing what it calls a “de-risked” best-of-breed startegy since 2006. Rather than offer one, fully integrated clinical software system to run in hospitals, clinics and GP surgeries, it has been offering a series of different software packages together with high level integration.

A similar approach is being followed by Fujitsu in the South, where the LSP is using niche suppliers for areas such as child health. CSC in the North has also shifted to using a nominally “interim” supplier for community applications that many trusts are now planning to use long term.

Most NHS staff – the people who will actually have to use these systems - will not give a hoot about ASCC. They just want modern information tools to do their job well, without having to constantly re-enter or chase down missing patient information.

For them, it will be results that count, rather than how heroic the strategy used to be or is now. In other words, they don’t care how the NHS achieves interoperability. They just want the NHS to do it, one way or another.

About the author: Jon Hoeksma is a journalist specialising in public policy and IT. He is co-founder and editor of the industry portal, E-Health-Insider, and its Euopean sister site.