Secondary Care

Health Tech Predictions 2020 Part One

As 2019 draws to a close we asked members of the HTN community for their predictions for the health tech landscape in 2020, what will be big in the year and what will be some of the challenges.

In this part one of the series we have curated a series of comments from: Health Education England, InterSystems, Sectra, Northampton General Hospital NHS Trust, ORCHA, BJSS, CCube Solutions, Royal Marsden NHS Foundation Trust, Draper and Dash, Mid and South Essex Group, The Martin Bell Partnership, Dartford and Gravesham NHS Trust, Healthcare Gateway, Accenture, TPP and Allscripts.

Dr Dilshan Arawwawala, CCIO, Mid and South Essex Group

With the election concluded, I expect NHSX to take the lead and drive forward with mandatory interoperability and data standards. These are critical for all aspects of healthcare delivery and the use of data to benefit patients, clinicians and public health promotion.

For organisations yet to start on a digital journey, clarifying digital clinical visions and strategic roadmaps with c-suite and wider workforce buy-in must be a priority for 2020. Central to any vision should be the end-users- patients and staff, focussing on mobile working and transforming care pathways (e.g. digital outpatients). Defining and strengthening the digital infrastructure  is also an essential step before adding the layers of health information systems.

For most organisations this will be a year continued growth. There will be a wider uptake of solutions that deliver immediate value e.g. single sign-on, e-prescribing and NLP dictation. Rate limiting steps will be resources and the rate of change impact on organisations and frontline staff. Capital for investment is limited and properly trained clinical informatics staff and data scientists are in short supply! Two additional areas I would hope to see focus on this year are standardisation of core processes and digital education of the wider workforce. Both are required to build a robust platform with complete and accurate datasets to extend digital transformation and demonstrate value to all end users.

For Trusts further along the digital journey, increasing utilisation of data with predictive tools to proactively plan organisation care, use of clinical decision support systems are likely this year. Radiology machine learning is also a possibility. Gathering robust evidence of safety and value in the use of these tools will be necessary to drive a wider uptake in the future.

Kirstie Watson, Head of Clinical Systems, Northampton General Hospital NHS Trust

During 2020 the NHS tech landscape is going to focus on drawing organisations and information closer together, through more Local Health and Care Records (LHCR) and better capabilities to utilise this joined up data.  Hopefully during this year we’ll also start to see emerging interoperability between LHCR’s to offer better patient care across regional boundaries.  Some of the legacy clinical solutions in use won’t be easy to integrate but these issues aren’t insurmountable.  The biggest challenges will relate to breaking down cultural barriers to sharing rather than technological barriers.

For patients and communities, engaging with the NHS via electronic mechanisms will be normalised through Personal Health Records and E-Consultation, and the challenges will be to make technology accessible and usable for everyone.

James Freed, Chief Information Officer , Health Education England

The Healthtech industry is starting to recognise quite how important its people are – members of our digital professions, our leadership and our end users – staff and patients. The big thing will be how we make best use of our people, moving to service-based multi-disciplinary models focussed on delivering excellent user-centred services. The challenge will be culture, education and expectation but as more and more of us take steps in the right direction, the quicker we will collectively move.

Lauren Bevan Head of Healthcare, BJSS

Best-of-breed innovation will start to come to the fore in a big way. There are lots of innovators who have excellent solutions for a specific problem but they have, until recently, been quite sparse. Now that there is a critical mass with a good track record, it’s a less risky proposition for the NHS.

The challenge will be, how to effectively redesign services and integrate these solutions on top of delivering BAU.

Cash and capital funding will be an ongoing challenge although with a majority government this may not be as much of an issue as feared. Being able to prioritise technology funding when there are crumbling physical estates being paid for from the same capital pot will continue to be difficult to navigate.

Hopefully more integration with social care will be on the plan for the year, they have been long neglected and the cuts to council services have run far deeper than in health.

Lisa Emery, Chief Information Officer, Royal Marsden NHS Foundation Trust

We’re all watching keenly to see how NHSX develops and grows, to help us deliver on the Health Secretary’s vision for healthcare technology.

Looking forward there will be a strong focus on technology (bringing everyone up to the same level) and interoperability across whole healthcare systems being a priority.

At a local level, we are driving a comprehensive digital transformation programme across our Trust, and the key challenges here will be ensuring that the change is clinically-led, and driving engagement and adoption across all clinical and non-clinical teams (tech is the ‘easy’ bit!).

Matthew Stickland,  Senior Healthcare Analyst, TPP

Looking back, I think 2019 has been an important year for digital health. The establishment of NHSX has been a positive move; it’s great to see a common direction around national standards. This year’s breakthroughs on interoperability have been fantastic to see, especially the exemplar projects for the GPConnect and Generic FHIR Receive programmes.

Interoperability will continue to be a major focus for digital health in 2020. We all need to keep pushing to make sure we get the right standards and infrastructure to accelerate adoption. It’s clear what a difference interoperability makes to both patient care and clinical practice.

I think there’ll be two other major trends in 2020 – smartphone apps and AI. The NHS Login service has opened up, allowing suppliers new opportunities to develop in the patient-facing space. What innovations will we see here during the year? It’s also a make-or-break year for AI in healthcare. There’s lots of talk and lots of promise, but it’s time to see some real-world implementations.

Orlando Agrippa, CEO, Draper and Dash

I truly believe that the year 2020 will unleash some incredible opportunities for digital health technology. My prediction is that much of this will revolve around addressing the issue of data confidence within healthcare systems. Most hospitals still hold very little trust in their own data, and so a digital touch will be essential in paving the way to sounder hospital finances and better-quality patient care.

With the huge pressures our healthcare workforce currently faces, there will undoubtedly need to be a substantial digital overhaul within this arena. Providing stronger support to A&E departments and clinical teams working towards transformational goals is essential, and this will come from increasing partnerships between healthcare organisations and tech companies in 2020. I am confident such changes would be boosted by providing more freedom to executive teams from the centre, and will require substantial investment.

Cash will indeed continue to be one of the greatest challenges over the coming year. However, with new digital software and hardware innovations surfacing all the time from both the big tech players and rising SMEs, this is a hurdle that more and more healthcare providers will recognise needs to be jumped for optimised patient journeys and solid financials in the long run.

David Hancock, InterSystems

It is very difficult to make predictions right now, what with the election and promised funding not yet coming through for global digital exemplars or local health and care record exemplars. My main prediction would be (even) greater uncertainty.

However, we should see a more muscular approach to standards enforcement from NHS Digital as it appoints both a head of standards and a chief commercial officer. That could well allow NHSX to implement its statement that it “will not approve digital spend unless it complies with open standards”.

One reason that we need standards is to push forward on interoperability. I think we’ll see more work being done to integrate health and social care systems and also care/nursing home software. We’ll see a lot of this in INTEROPen Hackathons, like the one that took place in Leeds in October. We will see progress with GP Connect.

Even if funding does get back on track, as recommended by the Wachter review, I see little appetite or ability to take on a large-scale electronic patient record projects outside the largest acute trusts. A “Best of Breed” or more like “Best of Suite” approach may be better for the market that needs systems that can phased-in and implemented over a longer period of time; but there will be a need to define components and deliver real interoperability between them.

Finally, something for the longer term: once trusts finally move to Office 365, they will get access to Microsoft Teams, which is a unified communication and collaboration platform. It has an HL7 FHIR interface and can be used to build bots that can obtain information from back-office clinical applications and integrate it into clinical workflow. It supports Team-based working so well. University Hospital Southampton NHS Foundation Trust has made good use of this: and it may well become the shape of things to come.

Jane Rendall, Managing Director, Sectra UK 

The impetus for large scale regional NHS imaging technology procurements will continue to grow in 2020. This means that departmental systems, where imaging is locked in silos, and even single trust imaging procurements, will soon be consigned to the history books.

The future is very much one of cloud based regional collaborations across consortia of multiple trusts, allowing the NHS to harness economies of scale and collaborative working.

Covering far more than radiology, imaging platforms and enterprise imaging systems need to cover more than just shared working – they need to enable collaboration across a triple helix of industry, academia and healthcare, where innovation can flow to translate combined efforts for the benefit of patients.

We are starting to say goodbye to the days of a single organisation buying a single PACS system. And we are welcoming the dawn of an era where new blueprints are being formed that will reshape what diagnostic services in the NHS look like, and what partnership looks like.

In this new age technology vendors need to change from being suppliers to being genuine partners. They need to understand the complexities faced by professionals, individual departments, and trusts, and respond to those specialist needs and workflow requirements. This will mean partners integrating with third party systems, stimulating the growth and application of artificial intelligence, and integrating specialist user interface requirements into their own solutions so that end users face no disruption. 2020 and beyond will be an exciting time.

Vijay Magon, CEO, CCube Solutions

The national uncertainties are almost all over and there are good signs that progress in the NHS will be much more tangible and visible – specifically on digital transformation. There is no doubt that everyone now recognises that any service that relies on paper will be handicapped. The establishment of NHSX has been a positive move in this area and we hope to see the benefits soon.

The key areas of attention will include digitisation, standardisation, analytics including AI, and interoperability – not just for structured data but for all content. Use of standards like FHIR and disciplines like SNOMED will expedite sharing and efficiencies. We will hear more about AI in healthcare – this can only move forward if we continue with the digital healthcare directives and, specifically, the transformation from paper to digital. Use of smart Apps, smart electronic forms, workflows, and consumer devices along with standards that govern how data is collected, managed, and shared will help to ensure that during 2020, the progress to date is sustainable and, hopefully, sufficiently funded based on promises made.

Liz Ashall-Payne, CEO and Co- Founder, ORCHA

In 2020 we’ll see a far greater level of collaboration, with more information shared between patients and healthcare professionals, and data flowing from health apps into patient held records.  This will give healthcare professionals a more seamless view of each patient and allow them to gain a greater insight of a person’s health.  There will also be further clarity across the industry of what ‘good’ looks like for apps and with this, an increasing number of developers will achieve a sustainable commercial model, which is vital for the longevity of this sector.  Innovation and use of AI will continue to grow and clarity of standards and regulations for this technology will emerge.

The public’s adoption of apps has been dominated by fitness, followed by pregnancy and mental health.  Through 2020 we expect high growth in usage by other patient groups looking to better self-manage specific long term conditions, notably dementia, Mental Health and MSK.

Niamh McKenna, UK health lead, Accenture

In the next year, the health tech landscape will stop talking about digital technology as the destination and treat it as the enabler. With this mindset, we can focus on enabling positive and improved outcomes for citizens and clinicians. Initiatives around artificial intelligence will only increase, heralding an explosion of start-ups and new ideas.

Within this environment how we use data will be an essential consideration. Data is at the heart of everything in digital health. But data privacy concerns and the problems it may hide, such as biases, call for a renewed focus on establishing an ethical framework for data.

Neil Perry, Director Digital Transformation, Dartford and Gravesham NHS Trust

With Matt Hancock’s recent announcement of shifting focus to the digital aspirant Health Providers, I predict we’ll see a lot of tech innovations adopted by smaller Trusts and see wider spread adoption particularly around the Internet of Medical Things, wearables and health sensors for remote real-time monitoring will spread and assist in saving Acute bed days. Adoption of Artificial Intelligence for imaging will also start to spread by the end of 2020, regulatory bodies will be pushing for adoption of AI after early adopters prove the benefits and set frameworks for implementation and ongoing quality assurance processes.

The sea of AI startups will start to merge and be acquired by larger established companies creating rich multi-modality suites of AI. And multi-functional AI enabled phone apps will start to emerge, symptom checkers will move beyond question tree logic and start to use AI from audio to detect/diagnose respiratory problems and phones smart cameras to detect/diagnose wider health problems creating ‘a Doctor in everyone’s pocket’ solution – truly democratising healthcare.

There are going to be a number of challenges, namely cyber security for online medical devices and cloud based services – I’d anticipate a realisation and again regulatory bodies pushing for much more vigilance, secure by design approaches and proactive management of all networked medical devices. I wouldn’t be surprised to see some big news stories of medical devices being hacked to devastating effect across the US and Europe, which will create the focus to improve standards from suppliers and the importance by services.

But overall after many decades – real progress in digitalisation of healthcare services – driven by the sheer pace and capabilities of modern technologies used in other industries and by consumer technologies. 2020 will be the start of a transformative decade where the 4th industrial revolution changes up a few gears in health and care.

Peter Anderson, Managing Director, Healthcare Gateway

Looking ahead to 2020, here at Healthcare Gateway we believe we will see a reinvigorated drive in digital health technology.

We hope to see the Local Health and Care Records (LHCREs’) plans mature as they look to implement solutions to meet the NHS requirements.

The move to using FHIR profiles across health and social care will gain momentum.  We are committed to supporting our customers with this, progressing the work we have done with the real-time sharing of social care information with the wider health and care economy, achieving success in a number of hackathons using FHIR profiles alongside RESTful APIs.  As national FHIR standards mature and become more common place, we anticipate system suppliers being willing and able to share more data in a slick and efficient way. The use of RESTful services using FHIR standards will allow for more intuitive messaging, allowing pull, view, analyse, post, update all on the fly in real-time.

We anticipate better connectivity between health and care in a structured way. Use cases are all important, The Medical Interoperability Gateway (MIG) has been able to provide structured data for a number of years. The demand has been high, but the use cases not really formulated. We see these coming to the forefront as suppliers are mandated to share information in a structured format.

The challenges we foresee are the speed at which every supplier can meet LHCREs’ needs. Varying suppliers will be working more closely together to meet a demanding schedule of developments.  Healthcare Gateway are ready for this and excited to enhance the work we have been doing for the last nine years to support record sharing across health and social care organisations.

Richard Strong, vice president and managing director, EMEA, Allscripts

I hope that in 2020 we will see decision making freed up and money flowing back into NHS IT. The political turmoil around Brexit has made it difficult for central bodies to take strategic decisions and approve trust spending cases.

With the general election behind us, I hope we will get enough stability to move forward. There is a specific opportunity for NHSX, because its chief executive, Matthew Gould, has said that he wants to do something for the ‘digital have-nots’.

I hope that alongside a new focus on standards, NHSX will release funding into trusts to support projects that will make a difference and get them on the roadmap to 2024, which was the milestone for digitisation set down in the NHS Long Term Plan.

Even if we do see some momentum in the market, I don’t expect to see many huge deals for electronic patient records being done. Instead, I think we will see trusts looking for a way forward that is both more affordable and faster and easier to deploy.

I also hope that we will see action on the local health and care record exemplars next year; and not just the LHCREs. I’d like to see a focus on joining up communities in new ways, so they don’t just put in portals, but lay the data foundations for population health management.

Finally, I think that we will see some HIMSS6 and 7 trusts coming through next year, and that we will see some real use cases for genomics, precision medicine and AI. So far, there has been a lot of excitement in that space; next year, I think we will start to see some action.

Martin Bell, Independent Consultant – The Martin Bell Partnership

2020 marks the start of not just a new year, but a new decade. A decade, that across the whole 10 years, will see a significant rise in the usage of digital health services and health technology used increasingly in day to day patient care – but it’s not all going to happen in the year 2020!….for the large part it will be more of the same.

The NHS overall will face continued issues of workforce shortages in the year ahead. Governments in all UK nations need to get a handle on this.

Funding agreed from government is a “stand still” position, not a transformational change position. Operational pressures and performance challenges will persist.

Brexit will continue to overshadow, as it “doesn’t get done” at the end of January, it is merely the start, and it’s taken over 3 and a half years to get to that start line, whether you feel it’s a race worth running, or one to give a miss too.

Alongside workforce in the NHS, the biggest issue facing health and care is to come up with a sustainable, substantive and preferably cross party/across the country way of enabling social care to deliver what it needs to the most vulnerable in our society.

What this will look like, given years of delay so far, I cannot predict, but it will continue to dominate debate in 2020.

For digital health/health tech specifically, here are a few thoughts:

  1. Watch closely what is going on in the USA with the large tech giants in digital health. I believe over the next decade they will bring their increasing tech presence in the US to the UK, and it will be transformative.
  2. Continue to ignore the hype around Artificial Intelligence, but let’s all accept that AI will continue to mature and so will have a greater role to play as the next year, and the next decade progress.
  3. Clinical systems will become more mobile, more “in real time”, more “smartphone/device” based – those that don’t, will ultimately perish.
  4. NHSX needs to put the same effort into CareTech as it does into HealthTech and stop treating social care and care sectors as an afterthought (this is a hope rather than a prediction!).
  5. NHS technology procurement needs to take a serious look at itself if it wants to encourage startups and SMEs to bring innovation to market, rather than requiring the same hefty, unwieldy procurement processes to apply to them, as to larger, incumbent players.

Finally, we will see continued moves to share more patient data between clinicians and professionals, across the many shared care record projects across the country, which is great news for patient care and essential if integrated care is to become a reality.

We will, however, also continue to have the debate about the sharing of this data, in some kind of aggregated form, with organisations outside the NHS, as per the recent “Big Tech/Big Pharma” discussions, or the sharing of data with Amazon.

Whatever advantageous some may see in these relationships (and there may be some), forming them and offering vast amounts of valuable UK data without safeguards, assurances, commercials and – most importantly – patient consent and agreement in place, is a very dangerous path to pursue.