Beyond the technological gaps – Interoperability done right in workforce software
Dr Nicholas Andreou,
Locum’s Nest Co-Founder
The past year has seen numerous NHS regulating bodies (NHS Improvement, NHS Digital and NHS X) considerably ramp up their attempts in moving the healthcare tech market towards becoming a more connected and compatible environment.
For Locum’s Nest and workforce management platforms, our currency of choice is ‘shifts’. A shift will travel from rostering system to bank system and then end its journey with the vendor system which will distribute the shift to agencies.
Needless to say, it’s been a challenging journey and frustrations have, understandably, been high amongst the software companies, the customers and those trying to coordinate the effort.
It seems that interoperability - the ability of software to exchange and make use of information - has become a mythical ‘holy grail’ where competing companies are unsure of how data exchange between them becomes the seamless norm in order to make our healthcare system more efficient, from avoiding orders for redundant patient tests to helping specialists communicate quickly with referring doctors. The whole premise left everyone questioning if their revenue models need to change, and how to protect competitive advantage. Will their company and industry ever be the same again if or when interoperability becomes common?
Undoubtedly, these are tough questions to answer and perhaps explains why there’s been little to no meaningful progress despite the soundbites and best intentions – knowing users are crying out for this.
And then Covid-19 struck.
Suddenly innovation became a necessity, not a luxury.
In specific areas innovation has been adopted faster to respond to the pandemic, but we must have a balanced view of the whole landscape, looking at this tech adoption in the bigger picture. It has been the coming together and unified response of the NHS, independent sector and government that has driven innovation. Huge steps can be made quickly when all parties work together and constantly keep assessing ways of working, learnings, best practices every step of the way. We must keep this momentum going.
From the outside, it can be very easy to criticise the pace of adoption of innovation in the NHS – but this is often misguided. We are not working in the finance or retail industries, where innovations can be prematurely tested and adopted without major consequences. We are in the business of people’s health and livelihoods. Therefore, changes need to be built upon trust, and this takes time to nurture.
As expected, in this era of unity, disruptor companies, like us, with little ‘traditional’ influence but with enough agility to rapidly respond and develop interoperability solutions in a matter of days, have led the way. Locum’s Nest (digital bank management) and Rotageek (e-roster) is the first innovative example I know of to have a live integration between rostering and bank systems. We wanted to see what can be done better and together to help the NHS’ temporary workforce – which has proved itself a critical resource in the past months.
So, what lessons did we learn?
Integration between two systems needs to be done in a matter of weeks and should be led by engineers - the problem-solvers who can make integration work, to get a proof of concept up and running to give end-users the benefits.
Commercial interests should be benched. Above all, the commercial leadership needs to inherently believe that good integration will bring the desired commercial benefits down the line.
Our work with Rotageek has seen swift and total alignment between the commercial, product and engineering disciplines of each company. Of course, this was helped by the fact that both our platforms are technically very robust with gold-standard technologies such as APIs already in place. However, from the outset, we were determined that any technological gap would not hold back interoperability between our two systems. In the tech world, where there is a will, there’s a way.
As David Payne, Rotageek’s Chief Product Officer said to me,
“At such a timely juncture when hospitals and health services need it most, it’s been a real pleasure of a project for us, to accelerate something we had on our ‘roadmap’ anyway and give rota-makers the ability to access Locum pools and contingent-worker apps as a way to fill scheduling gaps seamlessly. Working with another app built to same API-ready standards as our own made it much easier to achieve, and working with an engineering team that also embraces Agile principles enabled us to do it in a fast, iterative way, building a workflow to handle the ‘core case’ first and adding ‘edge cases’ incrementally after.”
Both of us were bound by the duty of care towards our clients being at the forefront of decision making. Generally speaking, when it comes to technical work for healthcare interoperability, there’s a real inequality in the information and knowledge held by the companies when compared to their clients. As a result, clients have no choice but to place their full trust and faith in companies like us. For example, clients have to hope that the two companies will act responsibly with integrity and respect and when they say the magic words ‘we integrate’, they actually do! They have to trust that both companies will strive to give the best value proposition for the clients and cross fingers they won’t act for selfish or commercial interests.
A customer’s trust should be nurtured, protected and never exploited. This means not using key knowledge and expertise to delay, block or hinder integration work. To the contrary, it is our responsibility to provide a higher standard of service and provide a pathway for customers to take advantage of new technologies efficiently and effectively.
Total transparency means that tech companies don’t manipulate the speed of implementation when the ultimate goal is to bridge all tech gaps wherever possible to make the everyday lives of our healthcare professionals easier and safer, putting patient-centred care at the forefront.
Locum’s Nest subscribes to the principles set out in the WePledge initiative which we helped to write. Interoperability should not be an excuse to try and obliterate each other or absorb practices that can be done better by existing processes. Interoperability needs to unify and bind the strengths from each partner that generate a synergy that is far superior than the sum of individual parts.
If done properly, a partnership that is working creates an intangible ‘wow’ factor that far exceeds expectations for users and clients alike.
As Chris McCullough, CEO of Rotageek, puts it:
“As a former doctor, I know first-hand that it’s vital for organisations to work collaboratively with staff to help them manage their work/life balance and how great an impact getting this wrong can have on engagement and wellbeing. Through this integration we're offering them input into their schedules, allowing them to swap, change and pick up extra shifts, thus allowing managers not only to support their staff with demands like childcare or family commitments but also ensure patient care and safety standards are met.”
Part of our experience has shown that there is much more to gain than there is to lose, and that working with other ‘leaders’ within the sphere is a fulfilling and greatly enriching experience.