Only connect: Microsoft’s Connected Health Framework

The end of big-bang IT projects in healthcare is dead. But what is going to take their place? To help chart the future, Microsoft has created the Connected Health Framework Architecture and Design Blueprint. Nick Saalfeld finds out more.


As the old saying has it, the only sure things in life are death and taxes. Somewhere near the top of the less-sure things that make up the rest of life on our planet is IT implementation in healthcare. "Our ambition for the next 25 years is a patient record tied to the individual- from cradle to grave- and all the interlinked instances of data transfer that will involve.”

Technology specialists in the NHS have to deal with far more uncertain factors than their counterparts in business. For a start, the healthcare landscape changes constantly. Policy changes, as do demands – the datasets required to map the most basic healthcare episodes today would have been unthinkable 15 years ago.

Meanwhile, there is no single “product”, no “end” to the delivery cycle – and no downing tools at 5pm. And different sites are at different levels of IT maturity. The vast majority must integrate legacy systems as well as new applications and services - and find clever shortcuts to make budgets balance.

All these issues make designing and building resilient IT systems that can be shown to deliver improved outcomes a mighty challenge.

 

A policy turning point

We also happen to be at an interesting juncture in policymaking. Murray Bywater, managing director of healthcare IT analysts Silicon Bridge, believes we are at nothing less than an epochal moment.

“We are coming to the end of an era,” he says. “For the past 25 years, patient records, for example, were defined at an institutional level. Even departments like radiology and pathology held their own records. Our ambition for the next 25 years is a patient record tied to the individual- from cradle to grave- and all the interlinked instances of data transfer that will involve.” “Because the NHS has traditionally been centralised, we’ve been slow to recognise this move away from giant-scale IT towards more local and incremental thinking.”

In England at least it is not, perhaps, entirely clear at the moment which elements of this undertaking will receive national leadership, and which should be pushed locally. However, it is clear that the best solutions to emerge will involve both approaches to some degree.

Introducing the CHF blueprint

To address some of these challenges, Microsoft is one of a number of vendors producing best practice advice and documentation to make IT rollouts easier to plan and execute.

At the forefront of Microsoft’s efforts is the Connected Health Framework Architecture and Design Blueprint (CHFB); a collection of processes, assessment methodologies and strategic advice assembled across the best part of a decade of working with healthcare organisations around the world.

That experience is of significant value. For starters, Microsoft has worked with healthcare providers globally to gain a birds-eye view of the needs of the industry from many perspectives. Healthcare provision in many parts of Europe (for example Spain and Sweden) is highly devolved to regional government bodies. In the US, of course, it is led by the private sector.

And these different systems have taken radically different approaches to digitisation. Mr Bywater says: “Most of the developed economies accepted naturally that it was simply unrealistic to replace a bunch of heterogeneous systems with brand new IT.

“Because the NHS has traditionally been centralised, we’ve been slow to recognise this move away from giant-scale IT towards more local and incremental thinking.” With CHFB, Microsoft has aimed to put together advice which meets the demands of all these varying structures without compromising delivery.

Secondly, where much of IT ten years ago tried to cram every customer into a one-size-fits-all system, today’s best-practice is all about flexibility. CHFB is vendor agnostic, platform agnostic and infrastructure agnostic. It understands that the future will be built on service-oriented IT architectures.

The idea is that whatever your supplier list, your IT maturity, or your resource availability, the guidance in CHFB will remain valid.

Ilia Fortunov, Microsoft’s lead on the CHFB project, says: “We have stepped back from specifics to see the bigger picture, and offer a set of guides which are not predicated on a particular model. The advice comes from Microsoft, but you can take it and use it with whatever technologies you like.”

In this way, the Blueprint is not a “cookbook” for delivering an IT system (a shopping list of hardware and software). Rather, it is what you need to think clearly about when architecting an IT system – strategies, priorities, essential questions to answer, and key decisions to make.

“I think it fits very well with the reality in NHS trusts”, says Mr Fortunov. “They have lots of systems already in place performing to various degrees of optimisation. They may not be ideal, so a lot of emphasis in the guidance is on how we enable what you already have to participate in this new world of knowledge-driven health.” “The Blueprint is not a “cookbook” for delivering an IT system. Rather, it is what you need to think clearly about when architecting an IT system.”

Tailored to health

Mr Fortunov is at pains to point out that CHFB is also specifically tailored to the healthcare business. “What’s interesting is that security, privacy and scalability present unique challenges in the healthcare field, so we have tried to tackle them very much in the context of this business.”

The CHFB guidance therefore includes advice on implementing codes like the globally recognised HL7 medical messaging and clinical document standards.

What about tomorrow?

Mr Fortunov says that CHFB is also as future-proof as possible: “This is one of the big advantages of a service-oriented approach. New functionality, new services, new applications and new participants can plug in using defined and scalable processes.”

This means that even legacy systems can be used to deliver services far beyond the limits of their original design, unlocking innovative new approaches to healthcare delivery.

Mr Fortunov continues: “We’re excited, for example, about devices which individuals can take home to monitor their own health. The patient is saved unnecessary journeys to a hospital, which massively improves their quality of life. The NHS saves resources, yet with online submission of data, any worrying results can immediately be flagged up to the consultant.”

These are the sorts of functionalities which provide great benefit (and sometimes even gratitude) from the public, yet require relatively little work or expense - provided the IT fundamentals are locked down correctly.

Service-oriented IT is not just a fashion; indeed many experts rather suspect that only open systems can cope with the huge and varied data flows required to deliver modern healthcare.

As Mr Bywater says, “This is the end of the road for “Big Bang” solutions to healthcare IT needs”. And CHFB is there to help all healthcare organisations move towards a more flexible and agile IT platform.

Find out more about the Connected Health Framework blueprint