Within the NHS, two elements hamper the implementation of novel technology: the questionable veracity of source data, and the lack of interoperability among the many electronic health record systems (EHRs) currently in use.
There are multiple and varied objective data items involved in clinician-patient interactions. The simpler examples of these include patient demographics and date/time of encounters, or specifics such as tests requested, results recorded, actions initiated and drugs prescribed. More complex variables can relate to the technical specifications of procedures performed or equipment used.
The coding systems used to capture much of this information are arcane and antiquated. The input of these data points into ‘the system’ is most often performed at a clerical rather than clinician level, conferring another level of inaccuracy at best and error at worst.
The profusion of in-house and corporate-driven EHRs is a significant barrier to data interoperability. While most clinicians have – regrettably – become inured to this inefficiency, the frequent impossibility of two-way communication between systems creates even greater challenges for the health data innovator. Technology is hamstrung by the inability of the pre-existing parts of the puzzle to communicate with one another.
Devising a clinical photograph tool for diabetic foot wounds in a London teaching hospital, for example, necessitated access to four different system interfaces to correlate blood test results (CERNER), ultrasound arterial scan findings (IRRIS), angiographic pictures (PACS, Picture Archiving and Communication System) and previous clinical correspondences (OpenText) prior to annotating the relevant summary into the mobile image.