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EMIS Group CIO: Breaking down NHS patient data silos by going all-in on AWS

EMIS Group CIO Pete Malcolm is in the throes of a sizeable revamp of the healthcare provider's flagship software system for GPs that will see it go all-in on AWS, while addressing the government's push to make NHS data systems more open and interoperable

Enabling patient data to be safely, securely and efficiently shared across the entire National Health Service (NHS) in the interests of improving care quality is a top priority for healthcare-focused tech firm EMIS Group.

The organisation is in the midst of a major revamp of its flagship product, EMIS Web, which is used to log details of the ailments, treatments and advice given to patients within a primary care setting, and is reportedly used by 56% of GP practices in the UK.

Its development is being overseen by EMIS Group CIO Pete Malcolm. He joined the firm just over a year ago with a focus on extending the data-sharing capabilities of the platform to make it easier NHS healthcare practitioners to monitor the wellbeing of the patients in their care.

“The whole UK healthcare system, right across the board, is not joined up and each organisation [a patient engages with] in the NHS maintains a medical record for you,” he tells Computer Weekly.

“If you are unlucky enough to get hit by a bus and end up in A&E, the chances are they won’t be able to see your GP medical records.

“So they have to ask you what your medical history is, what drugs you’re on and all that kind of thing, and you might not necessarily remember it all, so not having access to all this information actually puts patients at risk,” he says.

Sharing is caring

The next-generation of the technology, known as EMIS-X, is due to start rolling out to GP surgeries before the end of 2019, and aims to breakdown these disparate patient data silos through interoperability and open standards.

Both concepts, incidentally, that health and social care secretary Matt Hancock championed in his October 2017 “technology vision” for the NHS, as he works towards realising his vision of creating the “most advanced health and care system in the world”.

While there is pressure from on-high for NHS healthcare providers to embrace interoperability, it makes good commercial sense for the supplier community to build products that play nicely together, says Malcolm.

For one thing, he says, there is unlikely to be one product or provider whose offerings are universally favoured by all or whose functionality can meet the needs of healthcare professionals working in every different type of clinical care environment.

“We’ll never get everyone to agree to put everything in one bucket, and it would be a disaster if we tried,” he says. “The health secretary has made it very clear that he wants interoperability between the various providers and we support that, but – to us – interoperability means a bit more than that.”

It is EMIS Group’s view that breaking down the patient data silos will also require providers to build systems that enable patient data to be selectively, as well as securely, shared.

“This is where our model is a bit different,” says Malcolm. “We are selectively allowing an organisation to share data, and determine who it is going to be shared with, and that sharing has to be legal, ethical and authorised.”

The system will achieve this, he adds, by checking the qualifications and credentials of the person attempting to access it, to ensure they are registered with the British Medical Association, for example.  

“EMIS-X is designed to join all these things back up and create a system that allows all of the organisations to retain ownership of that record yet allow sharing by letting each organisation decide what it is they want to share,” he says.

“If we just take GPs, for example, one of the reasons they have been resistant to sharing data is for 30 years they have been writing little comments about you. They can write free text comments [on your records] and they don’t want all that exposed.”

There are obvious efficiency benefits to be gained from enabling such sharing within a clinical setting, but also from an appointment administration standpoint too.

“Today, if you need an appointment with a consultant, the GP chooses one for you, they send off a referral letter, a week to 10 days later they send you back an appointment time which may be entirely inconvenient for you,” he says.

Pete Malcolm

“We want to cut out all the paperwork, make it easier for the patient and quicker, more efficient and cheaper too”

Pete Malcolm, EMIS Group

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“At the end of it, your GP isn’t aware of what is going on with you and that consultant until the consultant sends back a written report that gets posted, scanned in and all that stuff. It is bonkers, as far as efficiency is concerned, and it costs a fortune.”

This convoluted and disjointed process is one EMIS is aiming to eradicate through the inclusion of its “federated appointments” functionality within EMIS-X, which will enable clinicians to seek out and book treatment sessions while they wait at whatever time and location is most convenient for them.

“It’s the ability to say, ‘I need to make an appointment for a patient to have a particular type of procedure, and I want to search across all of the providers of that procedure and tell the patient I can book them in for that now and remove all the time that usually takes’,” says Malcolm.

“We want to cut out all the paperwork, make it easier for the patient and quicker, more efficient and cheaper too.”

Moving medical data to the cloud

In preparation for EMIS-X to start delivering all these things, the company has – in conjunction with the system’s revamp – been preparing to shutter its two datacentres, and move 40 million of the NHS patient records stored there to the Amazon Web Services (AWS).

“We have 2.5 billion documents we manage for those 40 million patients, which include referral letters, blood reports, X-rays and everything single thing you can imagine, and we’re moving all of it to the cloud,” says Malcolm.

The technology tie-up between EMIS Group and AWS began in May 2018, with the former party going public with its plans to go all-in on the latter’s public cloud platform in November 2018. To date, more than five million patient documents have been migrated as part of the move.

“Thirty years ago [when EMIS first started], there was no such thing as the cloud, and now we have providers like AWS which has systems that are massive, and provide massive economies of scale in a way we could never hope to,” says Malcolm.

“We would like to get on with the business of developing our software, rather than operating datacentres, because it is horrendously expensive and the security requirements are increasingly going up, and [now] we get to leave all that to our friends at AWS .”

Ramping up the resiliency of its systems was another reason for the move to the cloud, with Malcolm pointing out that using AWS’s London region means its data is now backed up in three availability zones, rather than the two datacentres it currently operates.

There are also economic benefits to be had, in terms of catering to the “peaky” nature of the workloads EMIS plans to run in the public cloud.

“If you look at utilisation on a Sunday afternoon, there is almost nothing happening, and then first thing Monday morning, it goes berserk. We don’t want to be putting in [on-premise] compute power just to deal with that,” he says.

Growing confidence in public cloud

In the early days of public cloud, the very notion of using it to store data as sensitive as medical records was scoffed at, but attitudes have softened. So much so that the NHS issued guidance in January 2018 confirming the public cloud as being a safe place to store patient data.

Even so, Malcom says the firm went into a “great deal of detail” with AWS during the selection process to ensure it was the right provider to entrust its data with.

“There is probably nothing more sensitive than your medical records. Maybe, perhaps, the nuclear codes, and all of us have probably had some medical thing in the past we hope people don’t find out about that could be used against us,” he says.

“Statistically, we’ve probably got half of the Cabinet’s medical records, so the security of that is of paramount importance.”

Amazon’s assurances that any data entrusted to its cloud servers is encrypted when at rest and in motion were another tick in the box for EMIS when deciding which of the big three cloud providers to go with.

“It was very clear to us early on that AWS was the preferred vendor for a couple of reasons. Their platform was by far the most mature and we wanted examples of very large-scale organisations running very large databases, as ours is,” he says.

“We use thousands and thousands of virtual servers today to run this on, and we need someone who can really do scale. AWS could demonstrate that with real customer scenarios that the other vendors couldn’t.”

With the cloud migration part of the EMIS-X remodelling process underway, the next priority for Malcolm is ensuring the roll-out proceeds with minimum disruption. 

“What we can’t say is, ‘We’ve built this thing and now we’re going to have a giant switch-over of one system to the other’. The litany of projects that have tried to do that in the past is long,” he says.

The one luxury GPs don’t have is the opportunity to take a week out and learn a new system, as there is a queue of patients out the door
Pete Malcolm, EMIS Group

Instead, the firm is going to – essentially – run the two systems side-by-side for an unspecified period of time so users can gradually acclimatise themselves to the different interface and functionality.

“We will embed a browser inside the existing Win32 app and we will progressively migrate functionality over from one to the other. On the back end, they will share and mirror data, and on the front end we will have new, replacement functionality integrated into it,” he says.

“In that way, we can give users a migration between the two, and allow them to learn the new system, because the one luxury GPs don’t have is the opportunity to take a week out and learn a new system, as there is a queue of patients out the door.

“This way we can allow both methods to be there in parallel, and – when you have five minutes – you can try the new way and there will be significant advantages to doing it the new way.”

It will be “progressive migration path” and no-one will be forced to move before they are ready, as EMIS Group plays its part in helping the NHS make better, more efficient use of its data.

“That is the goal – learning how can we make this whole thing more efficient, so GPs can spend more time on the patient and less time on the technology,” he concludes.

Read more about NHS data and the cloud

This was last published in March 2019

Read more on Infrastructure-as-a-Service (IaaS)

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