Trust Integration Engine
A Trust Integration Engine (TIE) isn’t the most well-known of terminology but they are an important part of modern healthcare, specifically relating to digital solutions.
Integration engines are used across different industries and more common non-healthcare related engines are applications like Microsoft BizTalk. NHS Trusts, directed by NHS Digital guidelines and frameworks, use specific Application Programming Interfaces (APIs) to communicate information between software. This allows for connectivity within a hospital setting, but more importantly it supports nationwide communication and coordination of care and research.
This poses a problem when you have as many solutions and tools as an organisation the size of NHS England does. Invariably you need additional support to onboard these solutions and integrate them with existing software, to ensure a smooth introduction and continual service provision. Anything less than this risks patients and their care.
In this article we will explain what healthcare integration engines are, why the NHS uses them (particularly NHS trusts in England), and how they differ from interface solutions. We’ll also expand on basics such as what an API is, and more specific information such as the HL7 requirements for these APIs. To conclude we will showcase some of the NHS Trusts using a TIE and explain why you – like the NHS – need these tools.
What is a Healthcare Information Exchange?
Often abbreviated to HIE, a Healthcare Information Exchange is a software solution that fast-tracks the onboarding process of new software solutions by combining datasets from multiple systems and presents them as a holistic view of a patient records across different domains, e.g. Social care appointments alongside hospital ones.
HIEs are used by NHS Trusts to connect new software with a system that combines views from all different Trusts and national or regional systems in use across the health and social care economy. They are commonly also referred to as trust integration engines or healthcare integration engines, but they all deliver the same functionality.
What is the difference between an interface engine and an integration engine?
An integration engine works like an old telephone exchange in principle; it’s a central hub to receive internal or external messages. Healthcare Integration Engines can handle text, images, XML documents and other secure file types within the realms of clinical, financial or operational data. It then categorises these files and sends them to the necessary systems such as electronic patient records (EPR) or electronic prescribing (EPMA). A TIE can also enhance connectivity with outside facilities, such as labs or research centres.
An interface engine is purely the surface level interface that users will access information with, rather than a tool or solution that is managing the communication like the HIE does within the Trust Integration Engine.
What is HL7?
HL7 stands for Health Level Seven, which is a messaging standard for healthcare data communication. The model, unsurprisingly, tackles seven different aspects of communications:
- Physical (the connection)
- Data link (the agreements of data nodes to relay files)
- Network (the pathways to communicate)
- Transport (end-to-end coordination)
- Session (things not related to communications)
- Presentation (the language conversion)
- Application (arrival of data to the clinical program)
The name refers to its creators, Health Level Seven International. They are an international not-for-profit organisation that serve as a global authority for standards of interoperability in healthcare technology, with a remit around data sharing and messaging standards.
Health Level Seven operates around the world, including the UK. The current standards framework being promoted by them and used by NHS Digital is FHIR: Fast Healthcare Interoperability Resources. This is an evolution of previous guidelines based on modern technology standards and the demands of software to integrate into existing systems.
NHS Digital works using HL7 as the standard and FHIR as the framework when it comes to assessing the interoperability of software solutions bidding for business with NHS England. This is why trust integration engines can sometimes be referred to as an HL7 trust integration engine.
The popularity of the FHIR messaging format comes from the common data language it uses. It’s almost a universal translator; it takes in information from a source or solution, and converts it in a way that can be communicated or exchanged quickly and without any misinterpretation. Through a common data dictionary comes a common vocabulary, which allows for small regional changes, like UK-based FHIR, but otherwise shares most standards globally – thus ensuring ease of communication.
Why do you need an integration engine?
The principle is that by doing organisational work, a Trust Integration Engine optimises workflows for healthcare software, so that clinicians have a smooth user experience and there’s little to no impact on patient care.
Interoperability and the NHS quest for joined-up care are both huge goals but with huge benefits to patient care, but the software ecosystems in place in hospital settings aren’t up to scratch, nor are the connections with community care, mental health services, and other private providers. More and more solutions are getting brought in to enable these connections and optimise services, but then what links them all? How do they coordinate?
If these solutions are an orchestra then the trust integration engine is the conductor; dictating who does what and when. Without this guidance, solutions will just operate independently, but with it there’s consistency in communication. This is why you need an integration engine: there’s better access to information and data, and automated attribution or communication of details to a desired software solution.
The testimony to the benefits comes from seeing which NHS Trusts use a trust integration engine. The following NHS Trusts in England all have TIEs; confirmed via Freedom of Information requests:
- Alder Hey Children’s NHS Foundation Trust
- Wye Valley NHS Trust
- Dudley Group NHS Foundation Trust
- Leicester Partnership NHS Trust
- University Hospitals Birmingham NHS Foundation Trust
- Maidstone and Tunbridge Wells NHS Foundation Trust
- Bedfordshire Hospitals NHS Foundation Trust
- Royal Devon University Healthcare NHS Foundation Trust
- County Durham and Darlington NHS Foundation Trust
- University Hospitals of North Midlands NHS Trust
We also came across a confirmation of an in-house health integration solution from the Aneurin Bevan University Health Board, under NHS Wales, showing it’s not just England’s devolved NHS that recognises the important role a healthcare integration engine has amidst the ongoing digitisation and evolution of modern healthcare services.
This concludes our guide to the Trust Integration Engine. Hopefully it has been insightful as to how these integration and interface solutions act as the command centre for the myriad of healthcare software solutions enhancing modern healthcare within NHS England.
At The Access Group we provide a full ecosystem of NHS Software for a wide range of functions in a variety of settings. Our effective healthcare software offers integrated solutions for the management and delivery of Acute, Community and Mental Health, Primary Care and GP services. We understand how important interoperability and integration are for NHS Trusts and the wider healthcare community, so why not speak to us today to see how we onboard our solutions and if we can meet your needs.
