Article

Andy Atkins
Andy Atkins 31 January 2017

Digital Embassies – The Hero To The Rescue

The purpose of digital embassies is to provide a demarcated data safeguarding area under the full sovereignty of the data owner.

Back in December 2015 NHS England announced the introduction of Sustainability and Transformation Plans (STPs) which have created a number of challenges for healthcare providers. The challenges – though very complex – are surmountable. The amount of data organisations have to manage however is increasing year on year alongside the need to keep the data safe and accessible. STPs only add further complication to this picture.

In October 2016 STP management teams were required to submit a preliminary business case and now the onus is on further refining and implementing strategies to make the rollout of the STP structure a success. Going forward, these teams will need to be acutely aware of the risks posed by how the STPs are organised.

The Challenges

One of the major challenges around the implementation of STP is the need for data to be shared between multiple service providers and the need furthermore to provide controls over multi-stakeholder access to archived data. It is essential then that health service providers reach a clear understanding of how they will be managing their data over the long term from the outset of the plan if they are to be confident in meeting key objectives such as targets for cost-savings. In other words, health service providers must be able to describe with confidence their long-term information lifecycle management strategy while simultaneously making their near-term technology choices.

Information Sharing Agreements help by enshrining the principles involved, but the real challenge rests in operationalising these principles and in rolling out the infrastructure and methodology across an STP footprint that reconciles the issues and constituents.

Data sharing and control is one issue but simultaneously organisations also need to deal with the problem of effectively archiving an ever-growing volume of data. Providers should carefully consider what their data growth rates are likely to be over at least the next five years. Of equal importance, given the pace of change and difficulty in accurately estimating future capacities, is that providers should also ask themselves what is the likely cost impact of either under- or over-estimating growth rates.

A critical part of the Five Year Forward View which is underpinning the thinking behind the STP is the need to deliver cost savings and increase efficiency. The solution to the challenge of data preservation and archiving therefore is not to pour an ever greater amount of money into out of date solutions, but to work out exactly what processes and solutions will work best in order to keep organisations and teams compliant and efficient.

This leads on to another problem. Traditional backup regimes are not designed to support the search functions, retention policies and audit trails that are critical for regulatory compliance. Additionally, the episodic nature of patient diagnostic data naturally lends itself to a hierarchical storage management approach involving some form of archival storage. However, all too often this type of solution is not implemented.

On the financial front, the solutions adopted need to provide value for money coupled with cost transparency and predictability. Too frequently pricing is opaque and provides poor value for organisations. Providers should nonetheless ensure they clearly understand the predictability and transparency of the costs involved for storage of their data over the long term. For example, an underlying requirement will almost certainly exist to retrieve aged records from time to time for either clinical or legal/regulatory reasons.

This may involve the search and retrieval of individual patient records or larger datasets over a period of time. In such instances it is vital to be aware at the outset of the costs for the data egress involved. More seriously, it should be apparent at the beginning of the procurement process what the cost impact of significant change would be, either in migration of a front-end system, or where the provider may wish to terminate the contract for whatever reason and requires return of all datasets. In other words, what is the exit cost?

Digital Embassies – the hero to the rescue

The consolidation of health services across STP footprints which has already been alluded to earlier, means that data will need to be shared securely between multiple organisations. This is complex and risky. Data security and sovereignty have become paramount concerns amid the emergence of new models for data retention, such as cloud and hybrid storage strategies, and the need to provide controls over multi-stakeholder access to the archived data.

The digital embassy model has emerged as a new way of defining these requirements and creating an appropriate technical architecture and methodology to satisfy them. The purpose of digital embassies is to provide a demarcated data safeguarding area under the full sovereignty of the data owner.

In the digital embassy, data access by third parties is negotiated within controlled conditions, access policies and protocols in order to ensure compliance with the relevant privacy, clinical access or data governance guidelines. Due to legal and clinical best practice guidelines, it is important that the prime data owner is always in control of the data and has confidence that the data is preserved and protected with chain of custody processes to prove that the record of what has taken place is accurate.

In conclusion, STPs are necessitating increased planning around sovereignty of data. Healthcare organisations need to plan for the changes and the numerous challenges they will create. Fortunately there are ways to deal with the problem, especially with proper planning and expertise. A greater focus and awareness of how digital embassies are the hero that can come to the rescue of embattled STP implementation teams will go a long way to helping make the transformation a success.

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