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Three Black and disabled folx (a non-binary person in a power wheelchair, a femme leaning against a wall, and a non-binary person standing with a cane) engaged in conversation. All three are outdoors and in front of a building with two large windows.

BY Leo Hynett


Why Isn’t Interoperability Commonplace?

Interoperability has been widely heralded as vital for the future of healthcare, so what’s stopping it from becoming common practice?

DECEMBER 17  2021


Over the past few years, extensive coverage has been given to the importance of interoperability in healthcare. With the emergence of Integrated Care Systems (ICSs), it has become clear that the government supports a connected care continuum, and many NHS trusts and collaboratives are adopting interoperable solutions. Indeed, a modern hospital could not function without the ability for systems to be automatically sharing data through messaging – interoperability.

However, despite the clear benefits of interoperability, there are still barriers. Distilled Post discussed this phenomenon with Cambio UK, exploring the challenges the NHS face when trying to integrate a new system into their existing IT estate.

Building an interoperable system

Cambio have built their Patient Flow Manager (PFM) with the goal of providing an affordable solution that supports interoperability with other systems by sending and receiving HL7/FHIR messages.

‘The HL7 FHIR (Fast Healthcare Interoperability Resources) standard defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. It allows healthcare information, including clinical and administrative data, to be available securely to those who have a need to access it, and to those who have the right to do so for the benefit of a patient receiving care.’

Recognising the significant financial and operational pressures that the NHS is currently under and the benefits that interoperability brings, Cambio provide this aspect with the same affordability/value for money model. However, what Cambio are hearing from some NHS trusts is that some suppliers charge significantly more for similar interoperability services.

If true, why are these suppliers making interoperability so expensive to implement? And, perhaps a more controversial question: how do they continue to get away with it?

When you set your own prices, the sky’s the limit

To truly dig deeper into this issue, we need to address the elephant in the room: cost.

Interoperability may not be cheap, but it is not inherently expensive. This situation may have been created by a structure that enables suppliers to charge whatever they want. (If true, some suppliers will, unsurprisingly, want to charge a lot.)

Imagine a contract to build a solution that enables information to flow smoothly between points A, B, C, and D. A supplier accepts the contract, creates this system as requested, and delivers something everyone is happy with. Later down the line, the trust wants to integrate with point E: a new third-party solution. To do this, the trust will in all probability need to get a quote from their existing suppler for work to integrate with the new third party.

And this is where the problem can occur, as the contract may not provide a mechanism for setting these costs, leaving it to the supplier to charge what they wish. The outcome is that if trusts wish to add in an additional point – be that a solution such as Cambio’s PFM or a new provider in a collaborative – they have no choice but to pay these fees. Or, alternatively, the price may be so high that trusts simply decide against this extension to the detriment of the overall solution.

Furthermore, if you are not familiar with the systems, interoperability sounds like it could be complex and expensive to implement. Subsequently, suppliers may be able to convince organisations that these costs are necessary, but are they?


From cost-prohibitive to cost-effective

Some suppliers charge considerably more than Cambio does, and while this says a lot about the affordability of Cambio’s solutions it perhaps says more about the system at large. Some variations in prices are understandable but, when the solutions are filling the same role, this drastic difference in prices raises questions:

Is it truly wise to be putting cost-prohibitive barriers between NHS trusts and solutions that could support them, at a time when they’re already stretched so thin? Are taxpayers getting value for money when suppliers charge far more than is necessary? And, dare we even ask, what is the order of priority between providers, patients, and profit?

These are not questions that are easy to answer, but they are certainly questions that need to be raised. From Cambio’s perspective, it is not a difficult activity to undertake the mapping of data with another system and then, once mapped, configure it. Their stance is that if an activity is not difficult, it should not be expensive.

The success of digital medicine and the overall future of data-driven healthcare hinges on successful data sharing and interoperability, and Cambio proves that this does not have to come at an immense cost to providers. Interoperability is an incredibly worthwhile investment that needn’t cost the Earth.

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