Integration and Interoperability in Healthcare Information Systems

Graphnet is fully interoperable and is specifically designed to build on investments the NHS and local government have already made in IT systems. We connect to all the major health and social care IT systems being used in the UK, including the leading GP systems.

We are a signatory to TechUK’s Interoperability Charter and our Technical Director, Adam Hatherly, is a Vendor Representative on the Board of INTEROPen. Graphnet Shared Care has attained official accreditation as an ITK Client Application with content ITK readiness, and was also one of the first systems to integrate with the National Record Locator to allow ambulance services to rapidly identify patients with mental health crisis plans in place, and provide them with contact details for a crisis team.

In addition, Graphnet Shared Care can be embedded into third party systems and can open views into those systems with single sign on and within patient context. Third party systems can also be embedded directly into the Graphnet Shared Care record. This is a key feature in the widespread acceptance of the integrated care record across a clinical community. Graphnet Shared Care is available on the cloud (Microsoft Azure). This provides a secure, scalable and resilient environment and gives us a more open platform for interoperability between systems.

Contributing systems flow agreed data to Graphnet Shared Care, which is pre-configured to collect data from a broad range of solutions in use in the following care settings: primary, community, acute, mental health, social care, and from other specialist systems, such as Out of Hours and Electronic Document Management.

This data is stored in a single clinical data repository, which enables data to be sorted and filtered from multiple sources quickly. From here, Graphnet Shared Care links the data from multiple systems, using the NHS Number as the primary identifier, and presents it to end-users in a unified manner within a single care record for that individual.

Graphnet Shared Care is a complete integrated care record platform, employing a combination of a repository with asynchronous feeds, and real-time updates/access. This approach builds comprehensive, up-to-date records which include a wealth of care history supplemented with event-driven, real-time data, enabling prompt notifications to be raised and pro-active actions taken as the record is updated.

High levels of connectivity means the number of systems sharing data is maximised, which in turn makes the care record richer and more useful.

Accreditations and compliance

Graphnet is committed to complying with all relevant national standards and guidance, as well as legal and legislative requirements to ensure the safety and security of data. These include: continually striving for compliance with the Data Protection Act 2018, GDPR, ISO 27001:2013/9001:2015 certificated, Data Security and Protection Toolkit, Cyber Essentials Plus, DSB0129 and pending ISO27018 assessment.

We are also compliant with PRSB standards and EPaCCS SCCI180 for our Integrated Care & Support Plans and End of Life planning.

We are a member of the PRSB Partnership Scheme which connects the PRSB with digital system software suppliers to support them to develop, adopt and implement PRSB information standards within their products for social and health care.  

APIs

The System C & Graphnet Care Alliance announced a major adoption of the FHIR interfacing standard to make easier the sharing of health and care information and to stimulate digital innovation. This is being built on a cloud-based platform which offers customers and authorised third parties a package of open APIs using FHIR-based standards. The APIs will be available in a rolling programme right across all Care Alliance products – including shared care records as a key capability in the delivery of Local Health and Care Record (LHCR) platforms.

INTEROPen has defined a set of FHIR profiles for the NHS in the UK and the profiles are published by HL7 UK and INTEROPen.

In addition, INTEROPen, working with NHS Digital, have created an implementation guide which outlines how these profiles should be used to deliver ReST APIs for the NHS.

We have committed to develop our FHIR APIs in-line with these requirements through our programme of open API delivery. This will ensure that the Graphnet shared care record is as interoperable as possible, and form the basis for sharing of Local Health and Care Record (LHCR) longitudinal records for patients within LHCR regions using the Graphnet Shared Care record.

We are delivering support for each of the CareConnect profiles and interactions in a rolling programme –the initial package of API will include four FHIR resources: Patient, Practitioner 1 (registered GP), Medication Statement (GP Medications) and Immunisations (from the GP record).

Subsequent releases will introduce other resources and data from other sources (Acute, Community, Social Care).

Graphnet API Developer Portal

This developer portal also allows developers to sign up, and test API calls directly against a sandpit environment. This environment has sample data in it, so no patient information is exposed to developers testing in this way.

This portal shows the APIs currently offered – which fall into two broad categories:

• Shared Care APIs - These are our own ReST APIs for Shared Care, which can be used to read and submit data into the shared record (via the separate Data Submission product, available to logged-in users only, subject to approval).
• FHIR APIs (STU3) - These are the CareConnect-compliant ReSTful FHIR APIs delivered to-date, based on the STU3 version of FHIR. We are in discussions with INTEROPen about the timetable for moving to FHIR R4 and will adopt that once agreed.

The steps required to test an API in the portal are described below

1. Create an account on the developer portal
2. Request access to an API "product"
3. Explore the APIs in the API catalogue
4. Authenticate
5. Send the API request - You should also be able to see the exact HTTP request including the URL and headers that were sent - this is very useful when replicating that call from a local system

Another way to try out FHIR API calls is using a free API client application called Postman. A full sample postman collection, and step-by-step instructions on using it to call a FHIR API are provided on the developer portal.

We are also building support for other FHIR Paradigms within the platform, which will allow us to produce and consume FHIR Clinical Documents, as well as real-time event flows using FHIR Messaging over channels such as MESH.