Secondary Care

HTN Digital Week: Day three in review

HTN Digital Week Day Three: Wednesday 22nd January 2020

On the third day of HTN Digital Week, we hosted three webinars and our prestigious HTN Awards 2020. The content so far from all of our presenters has been fascinatingly varied and has really shown what can be achieved across the health tech industry.

We also celebrated the HTN People and Partnership Awards 2020, the winners have been revealed here >  


Chris Reynolds, Head of Innovation and Product Development, NHS Arden & GEM CSU presented how healthcare organisations can make best use of cloud technology to improve productivity and collaboration’ 

“Our first ambition with cloud technology started in 2013. We currently support over 50 CCGs, with 900 staff, and we work across many locations. Our journey started 7 years ago with 365, and we have been continuously developing; always evolve what you do and make sure it is right for you.”

“Our approach is People, Process and Tech. Tech won’t solve everything and actually is the cheapest and easiest part, which is scary when you think about it; if you automate a rubbish process, it is an absolute waste of effort. In this regard, is has to be people that come first. Developing is based on the three aforementioned areas; Tech is the bottom. People come first!”

“The underpinning drivers are: increased agility, higher service level, cost reduction and reduced complexity. Solution options and suitability: how we leverage what we have, to give you what you need, to make your life easier.”

“Microsoft Teams has been evolving with the integration point of 365 services allowing collaboration and persistent chat. This in turn improves collaboration, removes barriers to working and reduces travel and does this by showing you what is happening. New team members can see what has been discussed and agreed through understanding what has already happened 6 months into the project for example. Travel is reduced through screen sharing and conference calls. There is also a feature for auto transcribing voice in to text which is remarkably accurate. We have so far saved 42k with a 10% reduction in travel required.”

“Office 365 fits with your workflow, where everything is in one place with Planner – tasks are RAG rated in terms of priority; it is basically a total visual single pane of glass.”

“Power BI (Business intelligence and data visualisation tool) gives you a dynamic dashboard, AI driven visuals with ML (machine learning), a natural language QA system amongst other features. Its output makes unknowns known; leverage what you have.”

“We’ve also been working with an ICS, looking at trends and analysis, cancer by type, location and time.”

“The program provides an overview of what is going on over time, what is occurring in your teams, how can you make something lower cost with lower effort but with the same output.”

“When it is time to move to new technology, technology grows through need, for example the growth within social media. Figure out your baseline – where are you currently now, why is this occurring and ask the latter 5 times; it allows you to move forward.”

“Aspirations – make everyone aware of your aspirations at the beginning. Long term goals – how will you get there, do your stakeholders agree, how can you work together.”

“What are the barriers – changing attitudes is hard, changing how people work is hard, you have to win hearts and minds.”


Quintonn Rothman, Senior Implementation Consultant & James Hardacre, Senior Implementation Consultant Rhapsody – How We Learned to Stop Worrying and Love FHIR

The session started with a quick introduction by defining what FHIR is.

“One of its goals is to facilitate interoperation between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems.”

“FHIR was developed by implementers for implementers.”

Quintonn showed us an example of a FHIR resource; a script of code composed of building blocks, resources being the basic level. Very few fields of FHIR are mandatory and is a minimalistic system. Profiles in FHIR are used to add context; to increase or decrease the number of elements required and so on.”

“HL7v3 was too complex, CDA is mostly for documents and HL7v2 does a great job but has limitations and flaws and there is no way to force compliance. HL7 is mainly focused on event driven and is a very nuanced format to understand and not very mobile friendly considering our usage of such technology in the modern world.”

“FHIR is the new version of HL7 and uses different formats – XML/JSON/Turtle. FHIR was built with modern web standards in mind.”

“Is FHIR better? It is very well documented, is fast and easy, has interoperability out of the box, validation is included, has structured data and is human readable, as in data is always clear in all fields.”

“It has real time support, supports many exchange paradigms, extensions built-in from the start, has familiar tooling and is very mobile friendly.”

After the overview, John Mitchell gave us a demonstration of how to create FHIR through Rhapsody and how FHIR works in real time – we have recorded the presentation if you wish to see the details of how FHIR works and what it looks like.”


David Wells, Head of Pathology Services Consolidation at NHS Improvement presented the role of digital technology as an enabler of pathology networks

This presentation was delivered with the support of our sponsor Dedalus UK. 

David said: “We have been working with the 29 identified pathology networks, allowing for the transformation of pathology services across the country. In 2017, we committed to consolidating pathology services in England by proposing 29 hub and spoke networks as analysis showed there is unwarranted variation in how NHS pathology services are delivered to patients because of how they are organised.”

“How will pathology networks improve patient care and outcomes, and deliver potential efficiencies?” According to the NHS Improvement website, pathology networks will deliver the following benefits:

For patients:

  • patients should receive quicker, more advanced and reliable screening test results for illnesses including cancer (under proposals aimed at improving how NHS pathology services are organised)
  • access to pathology services won’t change — core services will still remain in hospital labs
  • there will be an introduction of a new wave of genetics

Delivery of potential efficiencies:

  • under our proposals, the 122 individual pathology units within NHS Hospitals in England will join-up, and form a series of 29 networks
  • the new networks will bring together clinical expertise, ultimately making these services more efficient that deliver better value, high quality care for patients
  • enhance career opportunities for staff, whilst being more efficient, delivering projected savings of at least £200 million pounds by 2020-2021
  • early analysis shows that hospitals which have already started to implement their pathology network saved £33.6 million, with a further £30 million of savings predicted for 2018/19

Here are the key points from David Wells’ presentation:

“We have had a history of consolidation since 2006 talking about network pathology and this is still the case in 2020. 2006 saw the report of review of NHS Pathology services. 2008 saw the report of 2nd phase of review. 2012 saw the pathology services toolkit. 2016 saw operational productivity and performance in English NHS acute care.”

“When we talk about digital pathology, we are talking about an end to end process; from primary care to tertiary services. The links between primary and secondary care are not in the main in place; certainly not in the way we want to see them.”

“Being able to share images and large data sets is going to be really important. We are not talking about the operational delivery but the holistic delivery.”

“When we talk about working across all sectors, we need new ways of working and these meet stringent standards with accreditation; use of algorithms and digital technology, these services need to be ensured to be safe for our patients.”

“The 2016 Carter Report saw £5bn of value opportunity if unwarranted variation is removed. This £5bn is commitment around our long-term plan, which will be reinvested back into the NHS system. We are working very much on this is what you should be doing because this is better for patient care.”

“Where are we now? before the network, we had 122 pathology providers with a workforce of 27,000. It costs us 2.2bn per year to run these services. Pathology is essential in over 70% of patient pathways. Currently, there is national excess capacity in equipment, yet we are seeing local workforce shortages. We know networking delivers better value and commands better pricing.”

Digitisation and networking allow for consolidation across clinical financial and operational areas

“What does good look like? “Networks must benefit the NHS and have a patient focus, be clinically and scientifically lead, training and education is a key part of those networks with adopting new models of working. Advanced roles should be part of the future operating model. Active engagement with the workforce.”

“Some of the organisations that we’re working with include NHS England, Royal College of Pathologists, Equipment Suppliers and many others.”

“We are seeing an impact! When we started our programme, it was costing £1.95 per test, and now the test price is £1.81.”

The long-term plan is to revolutionise the NHS with digital and interoperability, pathology and cancer and rapid diagnosis. Some of the ways is to have straightforward digital access to NHS Services, commit to pathology networks, use AI with decision support, to link clinical genomic and other data, use predictive techniques to allow for earlier diagnosis, support and encourage a world leading health IT industry in England and others.”

“Digital technology can support the NHS to deliver high quality specialist care more efficiently.”

“Currently, we wait for patients to have symptoms before we take action – essentially reactive care; the future will be much more proactive with the analysis of healthcare data harvested from the wide population, using AI and ML to be predictive in who should be assessed earlier than when symptoms present. The data can be connected from outcome data to input data.”

“We must have equality of access – where all patients should be able to access their data in a timely fashion to facilitate their own care. With this in mind, there must be complete interoperability between systems in order for data to be compiled in one place so that both patients and clinicians can access data without restrictions.”

“Digital is a key part of what we do – networks will require a high degree of interoperability with standardised messaging and codes.”

“Digital pathology will need the ability to work anywhere for anyone.”

A couple of questions from participants towards the end of the presentation:

“What do you see as the main challenges to interoperability?”

“We have a lack of standards being the main challenge – we are working towards a universal test list but there is far more to it than that. If we don’t get on the front foot of it, we may end up working towards a future where we have different standards.”

“How do you see the patient being more engaged?”

“The patient as a single user needs to be able to access all the information available to them and we support patients if we speed pathways up. We need to make sure people are ok with their data being used to improve pathways and management of other patients. We need to make sure patients have the option to opt out of sharing data if they wish.”