At Blueberry, we have extensive experience working with NHS APIs to build solutions that enhance healthcare delivery and improve patient experiences. Here we share our insights and highlight the unique challenges in this field.
NHS Bulk
We’ve used the NHS Bulk interface for several customers. It allows us to securely obtain bulk patient data from consenting GP practices. The interface makes it possible to request a complete extract of all patient information stored within the EMIS Web and TPP SystmOne back-end systems, allowing analysis on patient data.
One application of this API is our call centre solution for GP practices. When a call arrives, we leverage the NHS Bulk API to download a compressed data file containing patient information. This data includes phone numbers and GP details. The NHS also provides daily updates in the same format. We integrate both the initial download and these daily updates into a local database. This local database serves as our primary source for retrieving patient details during calls, allowing doctors to access patient notes directly. This approach significantly improves workflow efficiency for both call centre staff and doctors.
It's important to note that the Bulk API is restricted to GP software applications that have been granted proper authorisation to access it. It does not provide unauthorised access to NHS data. Instead, it augments existing GP software and streamlines processes. For example, the Bulk API could simplify identifying patients with a specific health condition and sending them appointment reminders compared to using other NHS APIs.
Transactional APIs
Transactional APIs are a suite of APIs that provide real-time data access within GP systems, offering a significant advantage over the Bulk API, which may only update data every 24 hours. However, it's important to note that Transactional APIs only deliver small data volumes, making them a completely different use case to Bulk APIs, which are more appropriate for stats and reporting. Transactional APIs are used for applications where immediate data retrieval is essential, such as in emergency healthcare settings or active call centres.
The Transactional APIs consist of two main components: APIs that act as extensions to the existing GP software (EMIS Web and TPP SystmOne) on the same PC - to allow a patient record to be opened directly from EMIS Web or TPP SystmOne during a call centre interaction - and APIs that communicate with the server to access and update patient data within the GP system. This functionality allows for more personalised and swift healthcare responses, such as verifying information or updating notes.
For the first of the two use-cases, Transactional APIs require the installation of software on each GP's computer. This requirement, while seemingly old-fashioned, is currently necessary to ensure secure and controlled access to sensitive medical data. The software acts as a bridge, connecting the GP's local system to broader network applications, ensuring that all data interactions occur under strict security protocols.
Note that these APIs are limited to individual GP surgeries. Each GP practice must set up a specific role within their chosen system, either EMIS Web or TPP SystmOne, to enable this integration. While this may seem cumbersome, it's a safeguard to ensure that each practice retains control over who can access their data.
While this is not a significant hurdle if a GP expresses interest, there is an additional wrinkle: the Transactional API is an official NHS API, while the Partner API offered by EMIS is a variant with slight differences, though both serve similar purposes.
The issue with the Partner API is that pricing and licensing models aren't always straightforward. It seems that if you're using the Transactional API for a service operated on behalf of GPs, you may be able to use the Partner APIs free of charge in certain cases. But, if these APIs are integrated into a commercial product you sell to GPs, EMIS might charge a licensing fee for using their Partner APIs.
TPP SystmOne also has the equivalent of EMIS's Partner API, which may be easier to use. However, a key difference is that EMIS's Partner API allows server-based interactions, simplifying integration across multiple platforms without needing client-side software, whereas the TPP SystmOne Client Integration API can only be used from software running on the GP PC. This difference affects the feasibility of creating a uniform solution across different systems without involving local client software.
For both Partner and Transactional API integrations, we develop a Windows executable specifically designed for easy installation on GP computers. Whilst not a trivial task, we have gained a lot of experience in this area and can create new EXEs to meet new customer requirements. They then collaborate with their installation companies to deploy it across the relevant GP practices. This approach has proven successful for several of our customers.
NHS Login
Alongside Transactional APIs, we’ve also been actively working with NHS Login and IM1 APIs. NHS Login, as the name suggests, allows patients to log in and verify their identity.
NHS Login is one of the easiest integrations to implement. Whilst it provides basic biographical details, email addresses, and NHS numbers for authenticated patients, it's specifically designed for use in web and mobile apps where patients are present and can directly log in. A potential hurdle is the video-based registration process, which, although increasingly common, can be challenging for some older individuals who are more likely to be frequent NHS service users.
Implementing NHS Login typically takes a month, but the NHS approval process can extend to a couple of months or more.
The latest requirement from the NHS is that if both NHS Login and IM1 integrations are being implemented, they will only approve the NHS Login integration after the IM1 component is completed, so they can see exactly what the login is being used for.
IM1 API
Once a patient has logged in via NHS Login, we use the secured token provided to access the IM1 API, allowing us to retrieve the patient's data with their explicit consent. Unlike Transactional APIs and TPP SystmOne APIs, which allow clinicians to access patient information directly without patient interaction, the IM1 patient facing API requires active patient involvement. Patients must authenticate via NHS Login, ensuring that data retrieval or interaction with their health records is fully consensual and secure.
The Approval Process
Unlike many commercial APIs, integrating with NHS APIs involves a rigorous approval process to safeguard data privacy and ensure appropriate use. Before development commences, a detailed use case outlining your intended functionality must be submitted for NHS approval. This initial step, which is essential for accessing patient data, can take 3-6 weeks.
Following initial approval, it’s necessary to implement a preliminary version of the solution using the NHS's test APIs, which contain simulated patient data. The NHS will then conduct "witness testing" on this preliminary version to verify that the implementation aligns with the approved parameters.
Case Studies
Enhancing Receptionist Workflow in GP Surgeries
A leading provider of Voice over IP (VoIP) phone systems for general practices faced the challenge of integrating their systems with existing patient management software platforms, specifically EMIS Web or TPP SystmOne, to enhance receptionist efficiency and patient experience.
The goal was straightforward: automatically display patient information on the receptionist's screen when a call comes in and allow them to open the full patient record with a single click.
This seemingly straightforward task presented challenges, so a customised solution was required. The Bulk Extracts API for EMIS provided delayed bulk access to patient data, sometimes up to 24 hours, and while both EMIS and TPP offered Transactional APIs capable of accessing patient records, these required local execution on the GP surgery's PCs.
Blueberry’s solution involved a dual approach:
- Data Collection and Storage: We utilised the Bulk Extracts API from EMIS to gather the required patient data in bulk, which was then stored in a central repository for rapid access when needed.
- Real-time Data Interaction: We developed a specialised helper application that acted as an interface between the surgery's web-based phone system and the local installations of EMIS Web or TPP SystmOne. This application, installed on each GP's computer, responded to incoming calls by activating the appropriate API—either the Transactional API for EMIS or the Client API for TPP—to show the relevant patient record on the screen.
This strategic approach successfully addressed the inherent limitations of the available APIs, streamlining receptionist workflows significantly. As a result, receptionists were able to access patient information more swiftly and effectively, enhancing patient satisfaction by reducing wait times and improving service quality.
GP Practice Optimisation
A leading group of GP practices sought to enhance their operational efficiency by integrating their proprietary software with EMIS to streamline various GP surgery operations, including appointment bookings, patient interactions, and enhance overall service delivery.
Blueberry harnessed the capabilities of the EMIS Partner API to develop a comprehensive Triage system designed to manage the full lifecycle of appointments—requesting, receiving, and rebooking. This system greatly facilitated the handling of appointment bookings within the group’s practices.
A key advantage of using the Partner API was its ability to operate directly from a cloud-based server, thus eliminating the need to manage data flow through individual GP surgery computers. This allowed for a seamless integration, enabling the practices' software to effectively utilise EMIS functionalities like appointment bookings and patient information retrieval.
The project delivered two substantial benefits:
- Operational Efficiency: By automating several functions within the software, GP staff were able to operate more efficiently, significantly reducing manual tasks and focusing more on patient care.
- Patient Experience: The system enhancements made appointment scheduling simpler and quicker, significantly improving the patient experience by streamlining their interactions with the practices.
About Blueberry
Blueberry is a leading software expert on NHS integration with online pharmacies and provides a full range of software development and technical consultancy services for healthcare organizations. With expertise in the NHS Digital's IM1 GPSoC program, Blueberry creates software that interfaces with the principal clinical systems developed by their accredited partners.
The company's solutions are hosted within the Health and Social Care Network and can integrate with nhs.net e-mail systems, ensuring seamless integration and accessibility. Furthermore, Blueberry's apps work across all devices and are designed to integrate with the NHS Electronic Prescription Service, making it easier for healthcare providers to manage and track patient information.
All of Blueberry's software is designed to integrate with other healthcare data sources, such as PAS, GP address data, and drugs databases, allowing for a more comprehensive and efficient healthcare system.
