Interweave’s use of FHIR for enhanced health and social care data sharing

In this in-depth use case, see how Interweave, a platform designed to facilitate data sharing between health and care providers, has successfully applied Fast Healthcare Interoperability Resources (FHIR), the global standard for exchanging healthcare data.

FHIR supports organisations to improve the efficiency and accuracy of information exchange across Integrated Care Systems (ICS). This case study highlights how Interweave has harnessed FHIR to address health and social care data interoperability and standardisation challenges.

Context

Interweave began as the Yorkshire & Humber Care Record (YHCR), part of NHS England’s Local Health and Care Record Exemplars (LHCRE) programme. The success of the YHCR in supporting data sharing drew attention from various regions, prompting the development of Interweave, which has become a modern shared care record platform that supports six ICS’s using a partnership model.

The Interweave platform is NHS-owned and managed by Humber Teaching NHS Foundation Trust, with FHIR now as its backbone which is central to its support for data sharing between health and social care organisations.

Why FHIR?

Interweave aimed to tackle several common challenges that impact data sharing for health and social care:

• Data interoperability: how do you ensure smooth data exchange between disparate systems, including legacy technology?
• Standardisation: how do you establish a common language to represent health and social care data?
• Security: how do you protect sensitive patient information?

Having looked at several potential approaches, Interweave looked to FHIR for a modular, customisable, and open standard to support its objectives and provide a foundation for collaboration and innovation.

FHIR provides a well-defined framework that supports data consistency, interoperability, and secure data sharing. Interweave’s Exchange product fully implements the FHIR standard and allows for the exchange of data using a federated data model.

Organisations providing data via the Exchange also need to be FHIR compliant. To support this, Interweave offers a solution called Connect. This FHIR-compliant server, following data mapping procedures, serves FHIR resources to the Exchange, ensuring data consistency.

Challenges in integrating health and social care data

ICSs are tasked with integrating health and social care services, and data sharing presents several challenges.

Social care now routinely record NHS numbers which enable patients to be matched reliably across settings. However, with social care professionals performing a highly responsive person-centered practice, they rely more heavily on capturing rich narrative rather than structured data. Sharing data held in this way can be difficult.

With multiple organisations involved within an ICS, determining what data needs to be shared in a unified care record and finding common ground between the differing systems across a region can be a significant challenge.

Terminology often differs, and the lack of nationally defined coding systems for social care can make standardising data more complex. In addition, FHIR is primarily designed for healthcare, and there is no direct equivalent for social care.

How Interweave tackled health and social care data sharing

The first step in addressing these challenges was establishing a working group that included health and social care experts, FHIR specialists, technical experts, and representatives from both consumers and providers. Stakeholders, suppliers, and inter-regional representatives also participated.

The group started by developing a Minimum Viable Dataset (MVD) to identify the essential data for sharing in a care record, as shown in the diagram below. Defining consistent terminology and approaches was critical, as inconsistent naming conventions between healthcare and social care often posed challenges. Once such terms are agreed upon, the team can establish their attributes and relationships.

Interweave found that, whilst there is some commonality between terms, there are differences that must be considered. A flag on a patient record or a team resource are comparable between health and social care, for example. However, what constitutes an episode of care differs between health and social care.

To overcome this challenge, Interweave created a separate Episode of Care profile for social care and changed its description to explain things accurately, whilst also staying FHIR compliant.

Using and adapting FHIR profiles to meet social care needs has seen Interweave working with professionals to ensure alignment with real-world scenarios. Specific use cases have been developed to demonstrate how people can apply FHIR resources in practice, and a supporting implementation guide is available to aid deployment.

How Interweave customers are sharing data to support health and social care

As a result of this work, Interweave’s partners are integrating health and social care data to meet specific requirements in areas that could have wider applications across both sectors. For example:

• Humber and North Yorkshire ICB – data sharing across health and social care services simplifies information flow and reduces administrative burdens. Key benefits include less reliance on third-party information in adult social care and hospice services, reduced emergency department admin time through digital ambulance transfer of care, and fewer unnecessary hospital admissions and ambulance conveyances by making patients’ end of life wishes easily accessible. Interweave also speeds up the exchange of information between primary care and acute services via GP Connect, while easing the administrative workload in primary care. These improvements boost efficiency, reduce delays and promote more coordinated, patient-centred care.
• Leicester, Leicestershire and Rutland ICB– Delivery of Social Care information as a priority workstream.  Initial deliverables relate to representing adult social care service provision but data maturity work is progressing to include flags, assessments and social care needs information.  This data provision has been aligned to regional discovery work to ensure benefits are maximised and new opportunities for sharing information are identified.  Close relationships have been fostered between social care and health stakeholders to ensure that the provision of data meets with the needs of consuming organisations. A key to this success has been the development of information architecture groups, including different organisations to ensure that business rules and models are appropriately represented in FHIR data standards.

The potential for broader sharing of data between the two sectors is significant. If a clinician needs information about a patient’s social care interactions or care plans in an emergency department, this data can now be easily accessible. The patient would get the right care, at the right time, and the hospital may avoid an unnecessary admission.

A bold, pragmatic and repeatable approach

Interweave’s use of FHIR for health and social care data sharing showcases the power of standardised approaches to solving complex interoperability challenges. Interweave has enhanced data quality, interoperability, and security by using FHIR, ultimately improving patient care and outcomes.

The project reflects the shared values of Interweave and FHIR: bold, pragmatic, and repeatable. Interweave and FHIR are well-positioned to support the broader use of technology to create safer, more integrated care systems as the health and social care landscape continues to evolve.

Next steps

Interweave plans to expand its social care dataset further, guided by its partners’ needs. Progress is ongoing, with continuous development of health- and social care-specific profiles.

The platform is also planning an upgrade, migrating from FHIR’s STU3 to the R4 version, which offers enhanced functionality and stability. This migration will involve creating an adapter to convert STU3 to R4 and developing reusable components at the central and provider levels. Once in place, these converters will streamline the upgrade process for future version increases.

Further information

If you would like to know more about the work, please contact Sophie Lowsley at Interweave at sophie.lowsley1@nhs.net

Social Care MVD for the Shared Care Record

Notes:

• This list shows the resources which were newly defined for phase one of sharing social care data in the shared care record.
• Patient, Practitioner, Practitioner Role and Organisation resources – which have relationships with these entities – are not included in the list. They were previously defined during previous health data sharing exercises and needed little to no work to enable their usage within Social Care.
• Hierarchy and relationships left out of the diagram below for simplicity.

Social Care Shared Care Record Data Model

Real-world scenario

Patient with no previous services presents to ED and requires reablement

FHIR UK Core Release 2.0 (STU2)

HL7 UK are pleased to announce the release of FHIR UK Core release 2.0 (STU2)

https://simplifier.net/guide/uk-core-implementation-guide-stu2?version=2.0.0

This is the second release of UK Core and is a standard for trial use. It is ready for use, and recommended for use, but we will continue to gather experience and improve it based on implementer feedback.

Key updates and improvements can be found here:

https://simplifier.net/guide/UKCoreVersionHistory/Home/STU2-Sequence?version=current

See also some background to the process: https://confluence.hl7.org/pages/viewpage.action?pageId=175611042

This was a substantial effort, with a lot of editing support, and many comments raised and reviewed. Many thanks to all of those involved, who made this release possible.

Those who want to implement UK Core may be interested in UK Core Access, which outlines a REST API for accessing UK Core resources:

https://build.fhir.org/ig/HL7-UK/UK-Core-Access/index.html

UK Core Access IG Initial Draft

HL7 UK are delighted to share the initial draft UK Core Access Implementation Guide (IG). UK Core Access describes how organisations can provide read-only access to health and care information within the UK, not only for direct care given to individuals but also for subject of care access. 

Ben McAlister, Chair, HL7 UK said “This publication builds upon the recent release of base profiles in the UK Core IG and represents a major milestone towards defining a minimum set of FHIR API capabilities for health and care systems to target. Implementation of these capabilities across health and care systems in the UK has the potential to transform the delivery of direct care to individuals across a wide range of settings.  Implementation also gives subjects of care the ability to actively participate in putting their own health and care data to use.”

Providing a common baseline will benefit organisations that provide health and care services as well as suppliers of IT systems. Through common information exchange, the IG also allows for innovative applications within health and care that can be more widely and efficiently developed and deployed. 

David Hancock, Chair, techUK Interoperability Working Group, said “The work that HL7 UK has done on creating the UK Core Access Implementation Guide is a vital part of driving open interoperability standards across Health and Care.  Despite all the work being done on the definition of the content of UK Core, what has been missing is the definition of standard methods of accessing the UK Core content, and this has undoubtedly slowed down adoption of UK Core.  I hope the UK Core Access Implementation Guide will be adopted by all EPR and other healthcare software vendors, as through this, we will drive the adoption of HL7 FHIR and UK Core across the UK.”

Both the development build of UK Core Access and the source files are available online for you to review today. We would welcome your feedback on the draft implementation guide before it is further developed. You can provide comments as issues on the repository or by email. For each comment, please include the page address and section number, a description and a proposed change. 

We would like feedback on or before Tuesday 30th May, after which we will use these comments to improve UK Core Access.

FHIR Implementation Guide – Australia

As you may recall, HL7 UK is currently balloting a FHIR Implementation Guide for the UK.  The processing of the comments received on this is now nearly complete and we hope to issue the final version very soon.

In the meantime you may be interested in what is being done elsewhere in the world.  For example, in Australia they are currently balloting a very similar specification: the Au Base Implementation Guide. This guide specifically supports the use of FHIR^®© in an Australian context however it’s really interesting to see the approach.