National-Scale Clinical Information Exchange in the United Kingdom: Lessons for the United States
by Thomas Payne, MD, FACP, FACMI
Medical Director, IT Services, UW Medicine
Exchange of clinical information between sites of care can potentially reduce inconvenience and risk to patients, conserve healthcare resources, improve care coordination and inform decisions made by practitioners and patients. Many believe that reducing unnecessary duplication of tests and services will be an important component of future US efforts to reduce health care spending. One study estimates savings from health information exchange to be over US $77 billion per year. Yet in the US today, most health information is exchanged using mail, fax, telephone, or is not exchanged at all. Though inadequate data exchange standards are often cited to explain this, the reasons are likely more complex.
The UK has a history of health IT initiatives over decades that have contributed to its progress in clinical information exchange. The most widely known are within the National Program for IT (NPfIT) which had as one of its goals to permit exchange of health information throughout the United Kingdom. (One portion of NPfIT--implementation of clinical computing systems in acute care trusts--has received intense scrutiny because of the initial implementation strategy and delays.) NPfIT and earlier programs are not well known to US policy makers, health care practitioners or even to health care IT experts.
During a 2 month sabbatical in the UK I conducted 35 interviews with practitioners, academics, NHS leaders, Connecting for Health staff and others and reviewed published and unpublished literature to better understand the UK experience with clinical information exchange. I found that the UK has made progress establishing a national framework to support information exchange which may inform US efforts to contain costs and improve quality through use of health IT. It can be described in 3 layers:
- Foundations. Through national policy on protection of confidential health information, technical infrastructure, and public discussion about patient information exchange the UK has created a foundation on which clinical exchange can occur. A secure network and strong identification mechanisms for UK practitioners are in use today. The National Information Governance Board addresses questions surrounding protection of automated health information.
- Incentives. There are strong incentives directed at clinical computing system suppliers to adhere to detailed national standards for information exchange. Practitioners have strong financial incentives to exchange clinical information which also benefits patients and national goals. Acute care trusts have incentives to communicate discharge information to GPs.
- Applications. A collection of nationally-used applications used today to exchange clinical information. Examples are GP2GP, PACS, electronic discharge letters, and regional repositories.
These efforts permit and encourage clinical information exchange on a regional and national basis in a manner that supports national acute, chronic, and public health initiatives.
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