Today we were delighted to open HTN Digital Week June 2020, sponsored by CCube Solutions and Alfresco, where we saw five insightful and detailed presentations.
In this article we have curated what we think were the key pieces of information from each live webinar. We would like to say a huge thank you to the presenters and organisers, the quality of content was extremely high.
Session one, the first session of the day, we were joined by Morgan Thanigasalam, Clinical Lead for Digital Innovation and Transformation and Philip Harper, Associate Director of Strategy at Sherwood Forest Hospitals NHS FT.
The session first started to take us to the point of strategy creation, through detailed research and understanding of stakeholder needs.
Morgan explained a survey that they launched to garner insight into what could be done better in terms of digital strategy at Sherwood Forest Hospitals.
“The questions asked our colleagues and internal stakeholders to prioritise ten key themes of digitisation to improve patient care.”
The ten priorities that came back according to Morgan were: Speed and performance of connectivity, a move towards EPR, replacing IT equipment that is becoming out of date, reduce the number of system logins, more portable equipment for frontline staff, collaboration to share information across the region, improving trust intranet, improving internal communications, more electronic communication with patients, and more training and development.
“The top four of the ten priorities had significantly more weighting than the others – they are very IT heavy. The general theme was the majority of the comments related to things that had already been ranked – nothing came up that was really new.”
Morgan went on to describe a ‘Big Bang approach’ to implementing digital strategy, with the potential to realise the full benefits sooner. The main constraint to this approach is it being more expensive, as well as it has to replace existing systems and the peak risk being higher.
“We need to make sure we have the right tools and right skills to support our patients and colleagues. It is about building on progress we’ve made over recent years in a more widespread way.”
In summary, Morgan explains that in essence, “digital strategy needs regular evaluation where there is no such thing as too much engagement, there are risks whatever you do or don’t do – focus on what is right for your organisation.”
“Also, there are costs whatever you do or don’t do, decisions have to be right for your organisation. Finally, make sure you involve and invest in people!”
Session two, Sam Shah, Global Digital Advisor and NHS Clinician, focused on AI, inequalities and health tech
Sam took us through the impact and inequalities in digitisation and the socio-cultural factors that affect population when it comes to being digital. He started by describing how the UK population is dense compared to other countries and how inequalities can be masked due to this.
Sam speaking on the internet in the UK: “86% of homes are online, 75% use a mobile device and 82% are online every day. We know that 9 million people are unable to use the internet themselves.”
“7% of the UK is completely offline. 8% have not used the internet in the last 3 months.”
Sam states that age is one of the biggest inequalities in terms of digitisation where only 7% of the over 70s can shop and manage money online. Other factors that affect digital engagement include people with impairments, people with low annual household income and those that rely on benefits.
“During Covid-19, more people have registered for online banking and possibly access to healthcare.”
Sam described a survey conducted which implies access may not be a key barrier, but skill and confidence is key for improvement.
On AI, Sam said “Three years ago, search engines were criticised as research has shown that when a user searched online for ‘hands’, the image results were usually all white. When searching for ‘black hands’, the pictures were far more negative depictions.”
“We know that AI is based on algorithms, but what are the main reasons for biased algorithms? It could be because of judgemental data sets, deeply ingrained social injustices, and unconscious or conscious individual choices.”
“AI itself, might not be very fair or equitable.”
“We need better data to solve inequalities in healthcare. Also, services need to be designed better such as building in languages other than English.”
Session three, we were joined by Kelvyn Hipperson, Chief Information Officer, Cornwall Partnership NHS Foundation Trust and Royal Cornwall Hospitals Trust
Kelvyn presented how the trust started to change healthcare in the county of Cornwall in response to Covid-19.
“A key lesson is that the public sector is at its best in a crisis. There was a technology push to user pull overnight with the fast rollout of MS Teams, and wide scale working from home.”
Over the next 3 months, Kelvyn said that they are working on enhancing patient choice through the following measures:
Developing patient portal capabilities through replacing SMS patient reminders with patients’ chosen messaging platform, an omni channel approach, as well as allowing for test results to appear in the portal.
“The next 3 months will focus on our Office 365 rollout as well as NHSmail migration, NHSE pilots and digital care plans, AI triage and remote treatment options will help deliver mental health care services going forward. Also, we need to refresh our data centres and develop solutions that work beyond our local borders. We are also looking to ramp up engagement of our EPR programme.”
Session four, Dimitri Varsamis PhD, Senior Policy Lead, General Practice Strategy and Contracts, NHS England and NHS Improvement took us through the incentives and delivery of digital primary care across California, Australia, New Zealand and the Nordics.
“All health care systems are dealing with the same issues and the same digital health issues. There are big differences in how much funding is made available in different countries towards healthcare.”
Dimitri told us of what he observed in every country, however highlighted “the key issues at national governmental level is trying to combine an old organisation with new technology.”
“The Norwegian healthcare system sees 98% of people using the internet, video consultations with patients at home is now approved for specialist health services.”
“The tariff system used in Norway is due to fear or unwarranted over-utilisation.” This means service users pay a fee for such tech as video consultations.
In Sweden, until now there was no concept of registration with a primary care provider. Residents of one county can visit a GP temporarily when in another county with the provider getting a fee for the service.
Denmark has many similarities to the UK according to Dimitri, “Denmark has universal coverage, free and equitable access where the GP is the ‘gatekeeper’. As well as offering a variety of different apps, the ministry and Danish BMA set up the equivalent of the NHS app. Patients can renew prescriptions, access the coded record, immunisations, vaccinations, notifications from their practice and so on.”
Lessons from Australia, according to Dimitri “Some GPs are happy to do 6-minute medicine appointments, where they get the flat fee from government, where some GPs charge more than that.”
Dimitri told us of the New Zealand model who, as we know, managed to be the first country in the world to rid itself of Covid-19 cases, as well as talking us through the USA: “The USA healthcare system is so complex; 907 health insurance companies with 60% of Americans covered through an employer sponsored program. 9% purchase health insurance directly.”
Dimitri tells us of what has worked in the countries mentioned above: “Integration between providers especially hospital and primary care.”
“Funding allocation based on drivers such as increased digital access, and earlier action and prevention.”
“The report and research will be made available before the end of the summer on the Winston Churchill Memorial website.”
The final session of the day, David Kwo, Digital Healthcare Specialist, focused on his findings from an analysis of all EPRs deployed in the NHS. Also, David tells us of the views of what future EPR systems could look like.
During the session David discussed the pros and cons of an integrated EPR or a best of breed EPR.
“EPR systems offer deep and wide functionality and have full patient data sets, well over 500,000 data items available for reporting and analytics.”
“Best of breed EPRs have inherent risk factors including technology skill sets and data quality as well as single points of failure. The pros of best of breed is that each department gets what they want. The cons are varied but the most significant is that systems can never be fully interoperable using a best of breed EPR.”
From a Freedom of Information request, David found 57 of 147 Acute Trusts are using best of breed EPR systems.
EPRs in the UK are prevalent in 147 acute hospitals in England with 57 of these being best of breed, 90 of these use integrated EPRs with 80 being EPR packages from numerous suppliers.
David also commented “A hospital’s budget does not make a difference to if an EPR can be afforded or not!”
“The lessons learnt from deploying large EPRs in the NHS include clear vision, clinical leadership and clear decision making, engagement, funding and adoption. Adoption is important; and also, very difficult.”
David then took us through interoperability explaining that the NAOs report stated that attaining interoperability in the NHS would be very challenging.
“There are risks in the long term as well as in the short term” on being able to achieve full interoperable systems.
The new shape of the NHS was then described by David as becoming an integrated care system. ICSs have three pillars of joined up care, preventative care and patient driven care.
“We are busy now trying to identify those specific and unique benefits of integrated EPR systems that work across settings.”
These benefits can only be gotten by sharing information across settings according to David.
“We are trying to map out all the different stages of EPR integration with ICSs, and we believe that a single integrated EPR across all settings is the ideal outcome for the NHS.”
“In the US, the majority of the case today is that these large integrated delivery networks, all have one instance of an EPR system across those care settings; that exists today and has done for many years.”
This is also the case in Finland, Norway and Canada.
“Most clinicians in the US today use a single integrated EPR system to care for patients across care settings – primary, acute, mental health, and social care.”
David then explained the roadmap for implementing EPRs in the NHS: “Acute trusts should move from best of breed to integrated systems, to then sharing a single integrated EPR – in which GPs are already there. Then, the inclusion of other settings such as mental health and social care should take place, with the trick being to time decisions to allow cross setting implementation.”