Dylan Roberts, Leeds City Council’s digital chief, tells Gill Hitchcock that other public services could benefit from the local authority’s open source integrated care record programme, Ripple.

Leeds council aims to set the standard for integrated health and care systems – Photo credit: Wikimedia Commons

The team behind Leeds City Council’s programme to deliver the integrated health and social care services demanded in NHS England’s Five Year Forward View is working to ensure it can be used anywhere in the country, according to its chief digital officer Dylan Roberts.

“The idea of the Ripple programme is to take what has been done through the Leeds care record and ultimately shape an approach by which that is simplified and standardised, so it can be shared and acquired in other areas,” says Roberts.

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The programme, which started around a year ago, is based on Leeds’ existing open source integrated care records system.

“That integrated system is used across all the care organisations in Leeds,” says Roberts. “So it is used within all the wards of our teaching hospital, GP surgeries, community and mental health organisations, and in adult social care.”

As part of the NHS’s push for integration, the Ripple project team – which also includes the Local Government Association, the Health and Social Care Information Centre and NHS England – has received £1.35 million in pump-priming funding for two years from the NHS Integrated Digital Care Technology Record fund.

The local authority has three in-house staff working on Ripple, with further capacity and skills brought in as required. Most of the development work has been carried out by external providers, Roberts says.

“One of the things we are keen to do is to build a community of development companies that can then support not just Leeds, but other health and social care providers too,” he says.

He adds that the project’s partners– Answer Consulting, XML Solutions and Lockheed Martin –can develop the capabilities and support people in doing this.

“From our point of view, we are developing it and pioneering it in Leeds, but in such a way that it can simplified, standardised and shared in other areas,” he says.

Six guiding principles

Ripple – named for its potential to spread across the country – works on six open principles.

The first of these is open requirements: a standard set of common needs based on feedback from health and social care organisations about the key information they and their partner organisations require.

Second is open governance, which aims to set standards for good practice in information governance, particularly when it comes to information sharing.

“One of the massive challenges that people face in relation to integrated care records is the information governance,” says Roberts. “So we have developed ratified, open governance documents.”

A European standard developed by the Royal College of Surgeons, OpenEHR (electronic health record), is the basis for the third principle of open architecture.

“This means that whoever is developing anything around care records – and we have people who are developing apps and services for citizens, sometimes unique to individuals – is working to the common OpenEHR standard,” says Roberts. “The result is that services interoperate with each other more easily and, more importantly, they can interoperate with a professional care record system.”

The fourth principle of open integration has seen the development of open application programme interfaces to support system interoperability.

“For example, if you are implementing Ripple in south Tyneside, the hospital might have a certain system, the community health organisation another, and so on,” says Roberts.

“The important thing is that, with open APIs, you can add them to your back-end systems when you are creating a care record.”

He says that the group has worked with Endeavour Health Charitable Trust to try and encourage a set of proprietary vendors to work with open APIs.

The fifth principle is that of open viewer – a care record user interface framework that has been co-designed with clinicians to common standards. This, says Roberts, will provide health and care professionals with a view of care records, regardless of back-end systems.

He says that the final principle, of open citizen, is the least developed. But, given the NHS’s commitment to give citizens access to their medical and social records within five years, it is likely to be crucial. Its aim is to create a standard specification for an open source personal health record.

Joined-up commitment

As the team wants to expand Ripple’s reach, Roberts says there is a need for people to be better educated about the benefits of open standards and a platform-based approach. Then, says Roberts, you need a cultural shift needed to allow user adoption and business change.

But one of the biggest challenges is, he says, “boundaries of control” and broad support for the programme.

“In Leeds, we are blessed with a strong partnership across the city,” he says. “I work hand-in-glove with information governance chiefs in the clinical commissioning group, the hospital, and the community and mental health trusts. We are really committed to a joined-up approach across Leeds.

“For this sort of thing to work, you have to have that joined-up commitment.”

Ripple is being gradually being introduced across Leeds, and in May it was introduced in South Tyneside’s council, as well as the region’s GP surgeries and hospital.

And Roberts says that health and care systems in Liverpool, Warwickshire, Newham, Havering and West Yorkshire are interested in the initiative.

“To be honest, I think the biggest issue we’ve got at the moment is having the capacity to be able to deal with all that.”