July marked the official launch of NHSX, a new organisation to oversee digital, data and technology.
The organisation recently set its mission to reduce the burden on clinicians and staff, so they can focus on patients, giving people the tools to access information, improve productivity and ensure clinical information can be safely accessed, wherever it is needed.
The focus is first to be on interoperability, standards and platforms, with an aim to keep the centre as ‘thin’ as possible, in a very similar way to how the internet works. It’s hoped this will open up opportunities for innovation and development. Standards are the common technical and semantic rules that everyone agrees on in order to participate in a system.
We asked the industry for comment and opinion following the recent announcements from NHSX and what needs to happen to deliver on these objectives.
Contributors include: CCube Solutions, iPLATO, Echo, Isosec, TPP, BridgeHead Software, Difrent, Allscripts, Dem Dx, Airedale NHS FT Rotherham Doncaster and South Humber NHS FT, Norfolk and Norwich University Hospitals NHS FT, East Midlands Ambulance Service, , Patients Know Best, OLM, Change Healthcare, InterSystems, Inhealthcare, Radar Healthcare, IMS MAXIMS, Enovacom a subsidiary of Orange Business Services, InfoFlex, Civica, X-On and Ingenica Solutions
Vijay Magon, CEO, CCube Solutions
The announcements from NHSX have been really positive and have been largely accepted by the industry. I think we all agree that interoperability and open standards should be a main priority for the NHS, and when delivered it will reap significant improvements and cost savings. The NHS is still largely reliant on paper, and that needs to change. It restricts the flow of information and creates huge administration costs. Once organisations are digital then we can start to explore really making the most of data, structured and unstructured content, but we need to make this information available at the point of care first in a quick, efficient and cost effective way. We have helped a few Trusts achieve paperlight healthcare delivery and clearly demonstrated that careful application of available technologies really does work in terms of financial savings and improvements in patient care and safety – systems must be interoperable and share data that complies with established standards.
Stephen Bourke, Echo co-founder and NHS Innovation Fellow
Gould has wasted no time in shifting the NHS’s focus back to fixing the basics, a hard, long road that is absolutely essential if we want to deliver the long term plan. He has brought a sense of pragmatic optimism and quiet urgency back to Skipton House and done a good job in listening to the HealthTech community. But he will only be as good as the team around him, so identifying, nurturing and retaining talent within the NHS needs to be a priority.
Michael Latimer, CEO, Isosec
It’s obviously early days for NHSX, but we are looking forward to seeing how this pans out. For instance, how will NHSX and NHS Digital work together in the longer term and who will ultimately lead?
We welcome the statement by Matthew Gould “We don’t want to build many digital services ourselves”, this is something we have been advocating and for NHS Digital to focus on the role of guardian rather than building new technology themselves. It’s early days but we are excited with the prospect of some real progress which will allow great software to be more easily adopted within the NHS.
Marc Warburton, Chief Executive, InfoFlex
Interoperability needs to be mandated by NHSX and suppliers should not have the choice to decide when it will be made available. Similarly, clinical IT solutions procurements should no longer be looking for solutions that are limited to the clinical department silo, they must include interoperability (not just interfacing), ease of sharing data across the community and require the solutions to be easily extendable beyond the immediate requirements. www.InfoFlex.co.uk is designed to overcome these barriers but the focus of the implementations often precludes the benefits of a shared care solution to be realised. The Living With and Beyond Cancer stratified pathways program is an ideal example of how InfoFlex can easily be extended to support care across the community.
John McCann, Senior Director of Marketing, BridgeHead Software
To solve the current interoperability issue, NHSX need to think about the flow of patient information – allowing it to ‘travel’ with the patient and not get held up in data silos.
The reality is that many hospitals are still running multiple applications, supplied by different vendors across various departments, often with little or no integration. It’s BridgeHead’s strong belief that the focus of interoperability should not be on ‘system interoperability’, but ‘data interoperability’.
Unfortunately, many vendors simply do not want to embrace open standards. On the one hand, it might be costly for them to change their systems; on the other, they may fear losing the control or ‘lock-in’ they have with customers.
If Matthew Gould and his team can ensure that everyone works towards the nirvana of a truly integrated and standards-based NHS, only then will we NHSX be able to achieve its 5 missions and create the efficiencies needed to provide patients with the sustainable, high quality care they deserve.
Rachel Murphy , CEO, Difrent
The flow of money from a commissioning perspective needs to change and a move to a truly agile working environment, thus releasing some of the shackles of antiquated waterfall financial processes. The old way of working has really hindered us at NHS Digital before and prevented delivery at scale across the portfolio. Pockets started to motor ahead under progressive SRO’s like Sam Shah and Juliet Bauer but the internal process to release funds, effectively wooden dollars, really needs an overhaul. Matthew and team are making all of the right noises about understanding the user needs, it’s a really encouraging start.
David Hancock, Healthcare Executive Advisor, InterSystems
NHSX rationalisation of previous priorities is welcome to both increase the focus and eliminate duplication of efforts across programmes. That is still a lot of focus areas and NHSX have, very helpfully, stated unambiguously that the most important focus area is interoperability – in my view this is clearly the right one. This is because the highest risks of poor quality care and gaps in care occur, at its simplest, in three scenarios:
- When care is handed over from one Provider to another who use different systems
- Where patient care has to be delivered by a Multi-Disciplinary Team made up of workers from different organisations, who use different systems.
- Where patient care has to be delivered inside a single organisation using multiple systems – for example E-Prescribing and Pharmacy Stock Control
NHSX’s vision is brilliant – the focus is on open standards using tried and tested internet architecture and public cloud, something we are all used to in our use of the internet over the last 20+ years (even if we are unaware of it). Taking health and social care from where it is today into this brave new world will undoubtedly be challenging that will need a “carrot and stick” approach. One of the sticks already evident, is if a vendor doesn’t meet certain open standards, they will not allow the NHS to purchase that solution. Understandable, and it does highlight the requirement for IT suppliers to have clear sight of these standards and intended use, allowing them to plan their development roadmaps and commit to that development. The service, NHS Digital, NHSX and IT Suppliers all suffer from the problems on interoperability, so working together we can effectively solve it. INTEROPen plays a key role to supporting these ambitions and are actively working to define and drive adoption of interoperability across health and care organisations (and individual patients)
Going forward they must be clear that measurement is not limited to the definition of interoperability standards but also on adoption. Otherwise we run the risk of failing to learn from our experiences over the last 15 years of Healthcare IT in the NHS where we have achieved so little in interoperability. Fortunately NHSX appear to not only recognise and encourage co-production of these standards, but also appear to have an open door policy to IT Vendors – long may this continue and I look forward to seeing the resolution of interoperability issues across the NHS.
Mike Lewis, Executive Chairman, iPLATO
We agree with the need for interoperability so that the patient receives joined up care. The patient should be at the centre of their own information sharing it in real time with their care providers whilst using intuitive tools that the patient wants to use. We have developed an app that is being used by a million patients – and those one million patients have chosen to use it over other methods for booking their GP appointments among other features.
The system should be digitally capable, be digitally aware and focus on delivering care. The system shouldn’t build apps or technology just like they don’t make pharmaceuticals, MRI scanners or operating tables. To paraphrase Matthew Gould ‘startups….can do a much better job of designing new services than we can at the centre’.
Our view is that we should have a digital first healthcare system, powered by clinicians but with the patients at the centre. We have one million people regularly using our app to manage their care, because it works for them and is centred around their needs. It works because it wasn’t us “dreaming up grand digital projects from the centre” as highlighted in the NHSX blog, and has already delivered digital inclusion, accessibility and been deployed to over 10 times the number of patients for 10% of the cost to the taxpayer of the NHS App.
Richard Strong, Vice President and Managing Director EMEA, Allscripts
In the blog post that Matthew Gould wrote to set out his priorities for NHSX, he emphasised that it is not looking to launch a revolution, and that it has a lot to build on.
I think that is right, and I think the priorities that he has set, in terms of ‘giving patients and staff the technology they need’, and improving patient safety while supporting productivity, are the right ones. I also think it is interesting that he has put an emphasis on being able to measure progress.
We have not heard much, yet, about how NHSX is going to do that, but it is something that has been missing from previous IT programmes. Being able to measure outcomes should build the credibility of NHS IT, and address Treasury scepticism about finding the necessary investment.
Matthew Gould has said, since he was appointed, that NHSX will focus on standards and interoperability. I am delighted to see that he has reiterated that, because Allscripts believes that use of standards and interoperability enables clinicians to provide safer care, so we’re really committed to both. But what is really interesting in his blog is the way that he talks about ‘joining up data across population and place’.
As a former ambassador to Israel, we believe that he has kept in touch with developments in that country’s health system, and one of the things he will have seen is one of our solutions, dbMotion, because it is used to connect almost all of Israel’s HMOs, public and private hospitals, and military healthcare facilities.
Information is shared in the dbMotion central solution, in a consistent format, which means that whatever system a clinician is using, they see if there is additional information about a patient that has generated elsewhere, and then access that, or even pull it into their workflow.
Two of our UK customers are already using dbMotion: Salford Royal Hospital NHS Foundation Trust is using it to enable local GPs to access data such as test results, while Dudley Group NHS Foundation Trust is using it to enable hospital clinicians to see GP information. But in Israel, 8.5 million citizens are covered, so it has also been able to push ahead with the population health management agenda.
NHSX is now focused on ten work programmes, and it’s good to see that they will include the global digital exemplar programme, with a new focus on less digitised trusts, and the local health and care record exemplar programme, which was set up to support exactly this kind of information sharing and analytics agenda. Overall, I think NHSX has made a positive start, and we look forward to working with it as its ideas develop.
Matthew Stickland, TPP
We’re really supportive about the creation of NHSX and it’s fantastic news that Matthew Gould has now taken up his post as CEO. It’s great to see that Matthew has been visiting services up and down the country and to read his thoughts in the blog post. The programmes that NHSX are supporting have the capacity to improve the experience of patients and clinicians across the NHS. We are particularly pleased to see a focus on standards, interoperability, citizen-centred care, and deeper integration of social care into the digital health agenda.
There is also a clear focus on the community designing their own digital services and innovating on digital platforms. As an organisation we see this happening on a day-to-day basis and are very supportive of it. Most recently, we’ve seen the clinical community develop their own digital innovations in safer prescribing for elderly patients and in a programme which is delivering significant efficiency benefits for pre-operative assessments. Of course, these digital platforms need to be fully interoperable to support innovation and to allow for flexible ways of working across the country.
Dr Lorin Gresser, CEO and Founder, Dem Dx
NHSX has been charged with the mission of optimising service provided by the NHS using digital support, from communication between medical teams, to communication with patients, in order to help clinicians and staff be able to give patients the best possible care.
At Dem Dx we agree with NHSX’s aim to ensure interoperability in systems although not at the expense of forcing complexity on products or of stopping the roll out of stand-alone systems that work. For example, in our current partnership with Moorfields Eye Hospital NHS Trust we are being used initially as an isolated support to their Advanced Nurse Practitioners as they triage patients before we integrate into their electronic medical records systems. This gives their staff immediate access to and value from our product without having to wait for the significant complexity around systems integration to be completed.
We applaud NHSX’s intention to focus on creating the platforms upon which innovators can build services and we hope that this focus will help bridge the gap for innovative solutions as they look to move from successful pilot programmes to broader, system-wide implementation.
Justin Tuggey, Chief Clinical Information Officer, Airedale NHS FT
We are delighted to hear the narrative from Matthew Gould on behalf of NHSX. The aspiration to address silo systems is already being realised at Airedale NHS Foundation Trust where we are progressively utilising the benefit of a fully shared record between care providers, supported by HSLI funding. Interoperability through shared standards and platforms is key to making patients’ and our staff’s experience as seamless as is possible as they navigate through multiple organisations and care providers. Information technology needs to support, not hinder care delivery. We work with our local acute Trusts to ensure that information is accessible when and where it is required, and this will be further enhanced as we develop the Yorkshire & Humber Care Record as part of one of the national LHCR initiatives.
Richard Banks, Director of Informatics, Rotherham Doncaster and South Humber NHS FT
We are developing our first digital strategy which has a key focus on innovation and partnership working to enhance the care we provide to our patients and service users.
Working with our partners we will ensure that our strategy is aligned to local, regional and national requirements while meeting the aspirations of this Trust.
Anthony Lundrigan, Chief Information Officer at Norfolk and Norwich University Hospitals NHS FT
We support and welcome the main aims of NHSX, which we hope will work towards ensuring clinical information can be safely accessed, wherever it is needed to help improve patient safety across the NHS.
Our own Digital Strategy reflects this ambition. We support the team in place at NHSX and look forward to them visiting and discussing how NNUH can support their ambition for the health service.
Will Legge, Director of Strategy and Transformation at EMAS
We welcome the advancement of the digital agenda due to the benefits it will bring to our patients and the opportunities it provides to our staff.
Having a geographically spread, mobile workforce presents challenges when attempting to access timely patient-level information, and therefore improvements to the infrastructure will have clear benefits.
We also welcome the advancement of the prevention agenda and recognise the possibilities which data can provide this area. With the right resource and capability, we see this area providing relief to the entire system.
Dr. Mohammad Al-Ubaydli, CEO and Founder, Patients Know Best
We completely agree with NHSX’s goal of ending the silos. This has been PKB’s focus for over 10 years; one patient, one complete accurate real-time record, for the patient, around the patient, owned by the patient. Past NHS programmes have focused on silos by institution, disease, region, transaction or device. Even focusing on the NHS itself makes for a silo that excludes social care, third sector and the private sector so, it was great to read Matthew Gould’s vision.
Oli White, Sesui
It was great to see Matthew Gould set out NHSX’s mission to reduce the burden on clinicians and staff by providing the tools to access information and improve productivity. However, it is vital that we do not just focus on back-end systems, and address some of the fundamental issues associated with how we connect patients to clinicians at the start of the process. Outdated phone and communication systems are limiting our ability to offer truly integrated care; the patient experience is suffering, and overstretched clinicians are tied to legacy modes of operation and/or physical locations.
Sesui believes that a digitally capable NHS can happen, supporting the establishment to evolve. With GP and clinical staff already over stretch, their core service is being disrupted by new entrants offering digital first operations, forcing them use resources outside their Practice and breaking the ‘integrated care’ approach. Sesui believes it can help make the NHS digital by providing patient demanded technology, such as video consultation, directly to GPs and clinical staff, in an interoperable way to existing communication services, in a form that does not require massive investment in money and time, allowing them to be effective – while continuing to delivery top quality and joined-up care directly to their patients.
Mark Denton, Chief Product Officer, OLM
We applaud the direction of travel that NHSx is headed in with regard to detailing standards and will back them in their mission of updating the legacy tech used in the sector. They have a clear message to focus on the areas that will have the biggest impact first:
- Interoperability; the need for modern open systems
- Usability; systems that are easy to use
- Productivity; systems that reduce unnecessary administration
We welcome this as it is our direction of travel. We are dedicated to ensuring that person-centred care is met through reducing unnecessary administration.
Richard Turner, Executive Director, International Operations, Change Healthcare
The blog that Matthew Gould wrote to outline his priorities for NHSX is very interesting and our headline response is: we get it, and we are very supportive.
His focus on connecting lots of different systems, and getting them mobile, so information can be used by staff and patients at the point of care, is absolutely the right one. The challenge is that while it is simple in principle, it is very hard to do in practice. The blog talks about the importance of standards, and standards are key, but at the moment some of the standards we need do not exist.
If we are going to make progress, I think three things need to happen. First, we need an answer to the first question that Matthew Gould sets himself: ‘what are our priorities for technology in the NHS?’ The health service needs to set out the scope of what it wants to achieve, at an operational and at a technology level, so that suppliers can work with it to deliver them.
Second, we need to know which of those priorities need to be addressed in the short, medium and long term. We need a roadmap, so that suppliers plan their product roadmaps against it; and then we need all that to feed into tenders.
Procurements need to be outcomes based. Instead of saying: ‘can you deploy this?’ They need to say: ‘we want to do this, and this is where we expect image solutions to fit, and the prime supplier you will be working with is going to be…’
That would encourage innovation, make sure there is a prime contractor in place to ‘hold the ring’ on issues like standards and interoperability, and define benefits that can be measured. If we did all that, then some of NHSX’s work might look very different.
To take just one example, Matthew Gould’s blog says the Citizen ID programme will continue as a standard for patient identification. But is citizen ID a priority? There are already any number of ID tokens that people can use. Perhaps NHSX should sit down with suppliers to make sure their systems can accept different tokens, while still accurately identifying a patient, and releasing the data and images relating to them.
So, we welcome NHSX, and we fully support its mission to transform digital services, to make sure information is delivered to clinicians in a seamless manner, to focus on the patient, and to work in collaboration. What we need to know now is what its priorities are going to be, so we can translate them into our product roadmaps, and see those picked up by the NHS. We look forward to working with NHSX on that.
Bryn Sage, CEO, Inhealthcare
We welcome the Government’s increased commitment to technology through the launch of NHSX. Creating an open delivery vehicle for innovation is good news for patients, clinicians, taxpayers and our growing health tech industry.
As the UK grapples with post-Brexit challenges, we have an international opportunity to be at the forefront of the fourth industrial revolution, which can generate growth and jobs in the regions of the UK which have strengths in the life sciences, such as Yorkshire and the North East.
Early signs suggest NHSX could be the catalyst for the large scale and meaningful uptake of proven technologies. A key measure of the new organisation’s success will be its ability to speed up time to market for proven technologies.
Paul Johnson, CEO, Radar Healthcare
The drive to create a core level of digitisation to support the delivery of good quality health and care is an important task ahead for NHS X. We have seen how the adoption of technology at pace and scale within independent health and care services has delivered efficiencies and positively impacted patient outcomes, and these best practice approaches can be applied to the NHS. Digitisation is often associated with potentially ground-breaking innovation that will disrupt services. But there is also a need for technology to be applied to support more operational requirements; to reduce the burden on front line staff, underpin best practice, improve productivity and offer truly informative data to facilitate decision making which ensures a safe and effective healthcare system. All systems should be interoperable, future-proofed, adaptable and easy to use in order to encourage adoption.
Shane Tickell, CEO, IMS MAXIMS
We welcome the delivery missions set out by NHS X, as technology can make a huge difference to reducing the staff burden and improving patient safety. Interoperability and common standards will be essential, as will be engaging with end users in the design and delivery of tools that will help enhance care. There is a real opportunity to use available technology to transform care, but we need to do so in collaboration – not just within the NHS, but with others involved in providing health and care.
Mark Smith, Business Development Director, Enovacom a subsidiary of Orange Business Services
With both the recent announcement by Matthew Hancock, and a subsequent presentation delivered by Will Smart NHS X CIO last week at the iLINKS conference in Liverpool, I am encouraged by their message that innovation will no longer be stifled by “clunky” technology systems, that clinicians have been complaining about for years. Indeed some influential groups in America for instance, such as FORTUNE are challenging their own health system leaders decisions of adopting software solutions that were hurriedly developed to join in their words the “gold rush” gifted by the government. The article they published is called “Death by a thousand clicks”, that was introduced to me by the hugely impressive Professor Shafi Ahmed when he referenced the report at the Yorks&Humber AHSN event in Leeds. In fact some camps are suggesting that as little as 30% of clinical data is captured in an EPR system for example, with the remaining 70% being administrative data. If you then also consider that over 95% of clinical data from medical devices is not captured, I see a massive opportunity of creating more value to the clinicians with the right technology, from wherever that maybe around the world, that will ultimately benefit patients.
Their ambition of expanding the GDE Programme is welcome for us, a relatively new UK market SME entrant, as we are actively involved in this initiative and proving value quickly with simple innovative software solutions that can be scaled and spread rapidly. There does appear to be a feeling of “blowing away the cobwebs” with NHS X and an ambition of embracing new innovation that is created and managed locally and sourced from all corners of the globe.
The clear message that interoperability is the number one priority is something that I think everyone accepts, the difficulty lies where software providers are asked to share patient data with their competitors for instance, and there needs to be some way of brokering the relationships perhaps through NHS X that is satisfactory to all parties involved.
I am also in complete agreement that recognised open standards are essential to ensure that interoperability flourishes in the future, it will make it so much more beneficial for software providers, the care givers and the supplier community.
Paul Bensley, Managing Director, X-on
Using technology to ease the burden on clinicians and staff is much in evidence in primary care; we have seen ourselves how advanced telephony can achieve such a goal, as well as reduce costs and underpin a better patient experience for many GP surgeries. Interoperability and standards are important, as NHS X suggests. Just as vital is the need for those involved in technology planning to decide which systems will be able to support the future of health and care, whilst which also meet current needs. The majority of patients, for example, rely on the telephone to engage with healthcare professionals. This will evolve over time, but we should be mindful that place-based, integrated care will require both strategy and infrastructure that will support the needs of multiple stakeholders. We look forward to seeing how NHSX embraces this integration challenge; the signs thus far, with community and social care explicitly mentioned as areas for transformation, are positive.
Steve Brain, Deputy Executive Director, Health & Care, Civica
For some time now, leaders of NHS Trusts have been vocal that the Global Digital Exemplars programme has created an imbalance that saw those who were less advanced on their digital journey, further disadvantaged. The approach that NHSx is taking is a good move and is providing some much-needed clarity. Matthew Gould’s intent to add focus to bringing everyone up to a minimum standard will benefit NHS employees, in turn having a positive impact on patients’ treatment. Digitisation of care and administrative processes is essential for an NHS that is under ever-growing demand and simultaneously facing unprecedented resource and financial challenges.
However, we must acknowledge that the level of change involved is substantial and given the constraints of resource and funding, this will take time. A successful digital approach won’t happen overnight so roadmaps to transformation must take place in stages, where solutions are implemented in consumable pieces, each providing benefits that will help to fund the next. It’s essential that systems share data to enable this modular approach. Top of mind for leaders of NHS Trusts are the gaps in the workforce, the consequential need to drive ever improved productivity, while improving the patient experience and maintaining a strong grip on cost management. Providing tools that make it easier, quicker and safer for those who work in the NHS to deliver care will help organisations to both retain their best people and continue to attract new talent.
James Ormonde, Director of Sales, Ingenica Solutions
Ingenica Solutions are delighted with the formation of NHSX, the world’s largest digital and social care transformation programme. It supports the work we undertake with our NHS customers through the implementation of our GS1 certified inventory management solution (Ingenica Solutions’ 360 IM); for instance helping NHS trusts to track and trace products, and undertake product recalls quicker to ensure patient safety, whilst also reducing clinical time spent on managing and ordering supplies. Lancashire Teaching Hospitals NHS Trust has made great progress here, saving more than 7,000 clinical hours which is the equivalent of four FTE; which can be reallocated to patient care.
