Breaking down patient data silos in UK healthcare with serverless cloud technology
Healthier Lancashire and South Cumbria Integrated Care System (ICS) looks after the health and social care needs of a population of 1.8 million citizens across the North West of the UK. The ICS is an initiative directed by the National Health Service (NHS) in England to centre care delivery around citizens, to better support social needs, physical health, mental health, and well-being across a geographical region. One of the main goals of the ICS is to work collaboratively with all partners involved in care delivery for their geography. To this end, the ICS recognized that using cloud technologies allows for better data sharing to improve patient outcomes.
Breaking down patient data silos to create a holistic health history
As the ICS began to organise care around their citizens throughout Lancashire and South Cumbria, it became apparent that data was being stored in multiple silos across different organisations. The process of obtaining the information to treat a patient with all the necessary information from multiple healthcare sources was lengthy and time consuming. For example, if a patient moved from one trust to another, a medical secretary would have to telephone another healthcare provider for the patient information, which could often take hours; in some scenarios, the patient file would be printed and handed over to the patient. To address this issue, a team of three people within the ICS created a shared care record called the Lancashire Person Record Exchange Service (LPRES). LPRES is built on top of International Standard of Healthcare Exchange (IHE) technology, provided by Tiani-Spirit UK. The team built a web application that pulls clinical information into single view regardless of which of the nine ICS organizations it is stored in, to support the holistic clinical care of patients.
Initially, LPRES required a local installation at all nine organisations across the region including three local councils, five acute provider trusts, and one mental health trust, where each local IT team had a dedicated server to the application. Whenever the central LPRES team wanted to issue an update due to developmental improvements, there would be a lengthy change process of requesting each of the nine organisations to update their application, and then waiting for the updates to be installed, which could take up to two weeks per update. This kept the LPRES viewer from iterating quickly enough to keep up with changing health and social care needs.
Cloud flexibility helps LPRES stay dynamic and expand reach for patients
In November 2021, the ICS moved the application into Amazon Web Services (AWS) so the LPRES team could manage and run it centrally, instead of hosting locally at individual organisations across the ICS. The ICS chose to work with AWS for this project because they wanted to work in an agile manner and focus on developing the core application instead of worrying about the underlying infrastructure.
Since moving to the cloud, the nine local IT teams were able to free up a dedicated server, and instead of issuing one developmental release a month, the LPRES team can complete multiple releases a day. The team integrated the datasets that the original monolithic application was accessing in silos, including connections to the Enterprise Master Patient Index (a central service based on international open standards implemented by Tiani Spirit which links and matches patients across disparate databases or organizations); nine provider repositories of clinical data including three councils, five acute trusts, and one mental health trust; and connections to local charity Change Grow Live, as well as connections out to the Nexus population health platform within the ICS.
The team focused on leveraging cloud concepts such as microservices and serverless technologies. The application now uses an AWS Lambda function for each data source and communicates via an internal load balancer to the Amazon Aurora back-end database. The LPRES viewer keeps logs of usage and patterns of usage, and also uses Amazon Cognito to authenticate all users coupled with two-factor authentication (2FA). The team made sure that they followed an internet-first approach in their design, which means that all new applications be made internet-facing so that that staff can access the application from their tablets and phones wherever they are, and also means the application can be offered to non-healthcare organisations, including care homes and hospices in the future.
Before moving LPRES to AWS, clinicians would only use the LPRES viewer on an ad-hoc basis, but the workflow systems have since been redefined so that a clinician starts off with the regional bigger picture view of a patient before drilling down into more minute issues. Now, clinicians use the LPRES viewer as their first application for a single source of truth on a patient’s medical history. Currently the web application serves over 1.6 million requests per month and is used by more than 8,100 clinicians.
LPRES leads among ICS shared care records with microservices architecture
Adopting a microservices approach and being able to issue developmental updates as and when they happen has allowed the LPRES viewer to outperform in care provider views of the platform over other ICSs in the UK. The more clinicians view a shared care record, the more citizens benefit from their care provider accessing a more unified account of their health history. Compared to other ICS’s in the UK, the Lancashire application is being utilised the most by clinicians.
Figure 1. The number of views for regional healthcare records within the ICS. The Healthier Lancashire and South Cumbria shared care record, LPRES, leads among these views in February, May, August, and September of 2021.
LPRES has already been making a huge impact across the ICS. A clinical service lead from East Lancashire Hospitals NHS Trust said, “Having access to LPRES saves an estimated 10 to 15 minutes per patient.” Based on an average of 3,000 admissions per month, this equates to savings of 750 working days, or over £90k per annum in this hospital pharmacy department alone.
The ICS are open to collaborating with other NHS trusts and sharing the blueprint of the LPRES viewer to enable other regions in the UK to benefit from this technology. The most recent development is the capability for patients to upload videos and images for clinical review into the LPRES system in a secure way. This development has been architected in an open source manner so that any other ICS in the UK can plug and play into their own architecture.
Paul Bradley, technical systems development manager for LPRES, said, “By leveraging Lambda functions and serverless architectures where possible, we’ve managed to reduce costs while increasing availability and uptime. The move to serverless has allowed us to quickly iterate, introducing new capabilities to the shared care record platform. For example, we’ve just introduced the capability for patients to upload videos and images securely to their regional patient records, so that clinicians can quickly diagnose issues.”
If you would like to understand how you can also benefit from adopting cloud-based technologies to enable holistic care, contact the AWS for Healthcare team directly.
Read more stories about AWS for healthcare:
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