Earlier this year, we sent out a survey asking what success in digital transformation looks like to a wide range of health and care professionals.
When the answers came in, themes included the need for collaborative working, both in terms of culture and with regards to implementation of electronic patient records systems, and the need for strong leadership to drive change. Population health management, recognition of health inequalities and how they can be addressed and funding all earned a mention as vital components in making digital a success.
With those factors in mind, we posted a new question looking at the immediate to near future: what will digital success look like for integrated care systems in three years? What can – and should – we achieve in that timeframe?
First up, we heard from Matthew Riley, Chief Information Officer at Here (Care Unbound). Matthew said that digital success centres around three key factors.
“Firstly, it would include the whole of the health system, including primary and community care. It would encompass social care, charities – all the organisations that care for patients in different ways,” Matthew began. “Patients don’t see the NHS as discrete units providing their care, so a successful digital strategy wouldn’t either. It’s easy to become focused on the big digital system projects – EPR swap outs, imaging, system integration, and miss the opportunity to make small valuable changes in those other areas.
“Secondly, it would grow out from the coal face. So we wouldn’t be pushing the technology onto people; we would be working based on what people really need to do their jobs, and use their experience, knowledge and instinct to understand what really works. There are some amazing innovators and experimenters within the system who aren’t always that visible, and we need to get behind them.
“Third, it would be using data in a way that really drives service improvement, whether that be providing insight into clinical practice, or helping to reduce health inequalities.”
Next we heard from Dr Ruby Bhatti OBE. Ruby is a solicitor with over 25 years of experience in non-executive directorships and a wealth of wider experience, including Chair for the Quality and Safety Patient’s Panel at Bradford Institute for Health and Research, board member for the NIHR Applied Research Collaboration Yorkshire and Humber, and Associate Hospital Manager for the Mental Health Department at Bradford District Care NHS Foundation Trust.
“Digital poverty” and “access to IT in rural areas” were raised as key issues, along with “ensuring that the digital tools used are more inclusive and can be accessed by those to whom English is not the first language”.
On the abilities of digital health to connect with the public, Ruby added: “I would hope that the digital success will use better innovative tools to reach out to citizens such as social media, videos and more infographic use.
“Patients and carers [need to be] at the centre of decision-making. In order to do this, all health professionals need to be able to access the most up-to-date information about patients. The digital success would be measured in the tools they use, and that tool must give them access to real data and up-to-date medical history for each patient.”
Digital healthcare consultant David Kwo commented on how the vision for success can differ depending on context. “For one ICS that I recently worked at, success would be all three acute trusts sharing a single shared EPR, with standardised workflows for each of the EPR modules, on a single EPR instance” said David. “They would be building on the strong clinical collaboration, governance framework and design principles that their clinical leaders have established.
“For another ICS that I am advising, success would look like five acute trusts sharing a single EPR (again on a single instance but using another product), but extending the same set of integrated workflows across primary, community, acute and social care with deep patient portal functionality. This would ensure a truly integrated care system designed around the patient and citizen.
“At the same time the ICS will have a population health management system that is well integrated with the EPR and a case management system (and Case Manager roles in the workforce) to ensure that target populations and cohorts can be seamlessly coordinated across care settings.”
For Deepti Atrish, Founder and CEO of PCL Health, the main ambition of digital success is to “provide access to healthcare to all and at the right time”, with technology at the heart of that to “enable digital interactions between patients and healthcare providers to deliver care outside clinics. This will become a major trend in the near future.”
Deepti continued: “For a success system of the future, healthcare will need to be data driven. Predictive and proactive nature of healthcare will help detect health deteriorations early. It is vital that all the key stakeholders get notifications and alerts timely.. Successful implementation of an ICS will have seamless connected care between health and care professionals keeping patients in focus. ”
“Digital success from my perspective would enable more collaborative care for patients across the community and secondary care, ensuring we have a single source of truth from the referral to treatment,” Claire stated.
Claire emphasised the importance of patients “engaging more with home monitoring tools to help support their care and keep the clinician up-to-date with improvements or deterioration, which in turn could alter the frequency of when patients are seen and treated. This care would be more tailored to patients needs rather than the standard protocols.”
We got a supplier’s point of view through Jacob Haddad, CEO and Co-Founder of Accurx.
“In three years’ time, I want to see frontline staff in ICSs regularly using technology to communicate and work as one team. The ability to genuinely deliver integrated care hinges on having the right processes and technology in place to address the current breakdown in communication across the health system,” said Jacob.
“If ICS leaders genuinely want the frontline of their organisations to be able to achieve the objectives around integrated care that they set, they must give them the ability to communicate and collaborate with patients in one place, so they can work cross-functionally across services as one effective team. That is what integrated care is about, and this can only be delivered through technology.
“Having one single source of truth for all communication with and about a patient will inform key decisions, provide more consistency and patient awareness of their care, and transform the way healthcare is delivered – ultimately leading to better connected services, significant time savings for staff, and shorter waiting times.”
In addition, Andy Meiner, chief revenue officer at ReStart, said: “There’s huge potential for integrated care systems to transform and enhance use of digital in the NHS if approached in the right way. Over the next three years I’d like to see significant progress made on tackling challenges in three key areas – virtual wards, data flow and integration.
“I’d like to see additional acute bed capacity created through virtual wards, supported by the use of home monitoring tools which are fully integrated into trust EPR systems. However, there’s a risk trusts won’t have the integration capacity required to achieve this as demand for integration services continues to grow. To mitigate this, ICSs can turn to expert providers for support on solving their interoperability issues.
“It’s also essential that ICSs focus on improving data flow across primary, acute, mental health, community and social care services to make sure patients on complex pathways receive the best joined-up care possible. For this to happen, ICSs need an integration strategy which sets out exactly what data will need to flow between care settings and how the flow will be implemented. This will need to be supported by the consolidation of IT systems across the ICSs, and a detailed sunset plan should be developed for decommissioned systems – outlining when they will be replaced and what with.
“To support data flow and build patient trust around data ICSs should develop a strategy that tackles the elephant in the room – data quality. Poorly recorded data affects all aspects of the NHS from patient safety to workforce management and this urgently needs to be addressed by providers.
“Finally, I’d like to see an increase in the adoption of technologies which allow the patient to interact with health and care services through a mobile device, in a similar manner to other sectors such as hospitality, banking and retail. For this to work effectively, suppliers of patient engagement platforms will need to integrate with the NHS App. It successful, this will have a significant impact on reducing missed healthcare appointments.
“ICSs have the power to transform healthcare with digital, more so than it has already. But systems need to start addressing these core issues now so patients benefit as soon as possible.”
Ross Fullerton, Chief Digital and Information Officer at Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System, shared his thoughts on this topic with HTN in an interview.
Data, going paperless and self-management were highlighted by Ross as key to ICS digital success.
When it comes to data, he noted that public perception and understanding is key along with the need for “seamless data” that can be used to deliver care but also for research purposes.
He commented that he would like to see less paper as far as possible, and added on the topic of self-management: “Citizens [should] have much richer access and control over how they engage with health and care on a day-to-day basis.”
Ross’s full interview, in which he shares insights into his own digital ICS projects including his approach, challenges and solutions, will be shared here on HTN at 11am.