A focus on technology and data
Better use of technology and data is a prerequisite for reshaping the health and social care system, and NHS England has recognised this as a driver in its pursuit of interoperability – the ability of disparate IT systems and applications to meaningfully exchange data.
Developing new models of care, implementing Sustainability and Transformations Plans (STPs) and their local digital roadmaps, as well as improving integration between the NHS and local government, all focus on seamless care delivery across traditional organisational boundaries.
The latest iteration of the Five Year Forward View, the NHS’s operating plan, made a commitment that by 2020 there would be “fully interoperable electronic health records so that patient’s records are paperless”. Clearly this is an area that is at the top of the NHS’s agenda and rightly so.
What are Global Digital Exemplars?
The high level of national policy interest in leveraging technology is demonstrated by The Department of Health’s commissioning of an independent review ‘The Wachter Report’.
The review’s aim was to be the catalyst for the digitisation of the secondary care setting and learn from previous high-profile failures such as the National Programme for Information Technology, which was abandoned at an estimated cost of £10bn in 2011.
Authored by Robert Wachter, an American health IT expert, the report was published in September 2016 and proposed a number of recommendations, including the delivery of a phased digitisation programme for Trusts in England.
NHS England obliged and launched the Global Digital Exemplar (GDE) programme to fund England’s most digitally mature Trusts, with a view to organically stimulating digitisation across secondary care via the design of blueprints for follower trusts to adopt. NHS England identified sixteen initial sites as GDEs, each is due to receive £10m over the course of the programme.
So far so good?
Any hope of evaluating the impact of the programme has been thwarted by 9 months of delay to the provision of funding for the original GDE sites. While funding was originally promised by NHS England in September 2016, it was only in the final week of June 2017 that NHS England confirmed the selected GDEs could finally begin to draw down the funds.
The seven mental health GDEs, announced this spring, are still without access to the funds. They are currently subject to a due diligence process.
What does good look like?
GDEs have the potential to bring about fundamental changes to the relationship between patients and health professionals. The programme should drive improvements in care quality and revolutionise patient experience.
Early priorities for GDEs must include empowering patients to take a more active role in their healthcare by giving them access to relevant and high quality information. Electronic patient records will obviously play a key part in this.
A paperless NHS promises improvements to care coordination through the secure exchange of data between healthcare organisations. This will be a big tick in the box for the NHS’s pursuit of interoperability.
For clinicians (doctors, nurses, midwives and allied health professionals) to benefit from the programme, efforts must focus on reducing the time taken to access patient information. This should be supported by alerting apps, such as Streams by Google’s DeepMind, and remote monitoring methods giving clinicians access to important real time data.
According to a recent survey of Acute Trust Chief Execs, only a minority of Trusts have systems in place for telehealth and telecare delivery. The GDE programme must focus on addressing this.
GDEs should also focus on advancing medical practice through analytical techniques, such as machine learning, to support clinical decisions. Babylon Health is developing Artificial Intelligence (AI) clinical diagnosis capabilities which will support clinicians by providing a diagnosis of routine conditions.
As part of a trial, Babylon is already powering NHS 111 with an AI bot that answers inquiries from more than a million Londoners and triages them based on reported symptoms. GDEs need to build on this work to make life simpler for stretched clinicians.
The success of the GDE programme will be judged on the extent that knowledge is dispersed across the NHS as a whole.
As one of the world’s largest workforces, a key challenge is ensuring that examples of good practice are shared and not ‘stuck in silos’ (i.e. directorates, divisions, hospitals and CCGs not exchanging learning with one another). The programme will be jeopardised if the learning, software, IT teams, methodologies and processes developed by the GDEs do not reach the fast follower trusts and beyond.
The voices of the GDEs need to be loud and heard. This is particularly salient given that NHS England is promoting a bottom-up approach to the digitisation of secondary care via the GDE programme.
A bottom-up model is in stark contrast to the failed National Programme for IT which ran from 2002 to 2011. Overly centralised decision-making, combined with a lack of local engagement, meant that end users’ needs were poorly understood and Trusts were instructed to implement systems they had little say over. It is obvious and encouraging that the GDE programme is designed to avoid past mistakes.
However, the programme’s bottom-up approach makes it extra important to align with the NHS’s wider system transformation. The STPs’ local digital roadmaps, as well as new care model vanguard sites, are independently targeting improvements to digital technology in secondary care and there is a massive risk of duplicated workstreams here.
Another critical issue is maintaining public buy-in. The information generated by the NHS is inherently sensitive. Digital technology makes it easier to capture and share data, which is brilliant from an analytics perspective. However, any lack of trust on the part of patients or staff as to how data is handled may impede the progress of GDEs and restrict analytics potential.
Getting consent right is crucial. The NHS has unique national data assets which present invaluable research opportunities for patient benefit. But clearly the move towards using new data and technology will challenge traditional approaches to information governance.
A case in point being DeepMind’s collaboration with the Royal Free London NHS Foundation Trust, which was investigated by the Information Commissioner’s Office (ICO). Their collaboration has been embroiled in controversy since it was reported last year that the trust inappropriately shared 1.6m patient records with DeepMind.
In early July the ICO ruled that the Trust failed to comply with the Data Protection Act (DPA) when it provided patient data to DeepMind. The price of innovation shouldn’t be the erosion of legally ensured privacy rights. Innovation and privacy needn’t be mutually exclusive. Striking this balance is key to obtaining consent and sweating the NHS’s data assets.
Transforming secondary care from a group of organisations reliant on thick paper files and fax machines to one with a more digital infrastructure is going to require investment and careful monitoring. The transition will be disruptive, but achieving the aims of the Five Year Forward View in a non-digital NHS will be far riskier.
The digitisation of secondary care presents a wealth of opportunities for improving their service and it is exciting that key stakeholders have recognised this. The GDE programme will clearly be an instrumental driver in this transformation. In order for the programme to work the NHS must:
- Ensure alignment between the GDE programme and wider system transformations
- Maintain momentum with the GDE programme and avoid further delays to implementation
- Provide GDEs with a suitable platform to get their voices heard
Engage the public in the programme to build trust and confidence
This article was written by Charlie de Montfort from Capgemini: Business Analytics (UK) and was legally licensed through the NewsCred publisher network. Please direct all licensing questions to firstname.lastname@example.org.