In this, part two of our feature sponsored by CCube Solutions we asked industry experts for their opinion, reaction and comments on some of the key themes following a speech delivered last week by Secretary of State for Health and Social Care Matt Hancock.
In the speech Hancock said “better tech is not a ‘nice to have’ but vital to have for the NHS”. He spoke about the importance of people, standards, leadership, culture and scalability in order to achieve digital transformation across health and care.
Read the first part of the feature here
Siten Roy, Group Director of Surgery & Orthopaedic Surgeon, Sandwell & West Birmingham NHS Trust and Board member of West Midland Leadership Academy
It’s an excellent initiative to bring Strategy-Leadership-Technology together. It will make sure that hospital leadership, clinicians and IT own it together. Learning from Global experience and having the New Digital Aspirants Programme will avoid the previous mistakes. Equally important to address the concerns of the ‘techno-pessimists’ by actively involving all from the very beginning. Digital access between different institutions / GP’s/ Primary care may need some extra focus.
David Kwo, Independent Digital Healthcare Specialist
I welcome the Secretary of State’s speech on improving tech in the NHS. It’s great to see important issues, with which we have been grappling in the NHS, being given such visibility. His stress on leadership, best possible technology, EPRs and developing the digital workforce are particularly helpful. I would like to see a bit more definition now in a few key areas.
First, language. EPRs need to be more widely and consistently understood by our leaders. EPRs are not just passive records for viewing but are active intelligent systems for guiding and predicting care. Also, as much as possible, EPRs deployments should be designed and configured by local clinical staff to maximise clinical ownership and adoption. External suppliers will tend to design and configure EPRs less effectively, and more costly in the long run, than the NHS organisation’s own staff.
Second, roadmaps. His messages will be more compelling to our CEOs, FDs and boards, as our tech leaders, when clear roadmaps are defined at the various levels of the NHS health system. I would suggest that NHSX consider providing standard “enterprise architecture” templates for NHS organisations: at the hospital/GP practice/community level, the ICS level and the regional level. CEOs could see how their “business” components (clinical services, information reporting, etc.) fit with their technology components (software, infrastructure, data, interoperability, IT services, etc.). Such enterprise architectures are best expressed on a single “roadmap on a page” so everyone can see how their clinical services, EPR, and IT fit together and grow over time.
Third, data quality. Something that Mr Hancock did not mention, but I think deserves greater attention is data quality. Data quality is always imperfect within a healthcare organisation. But combining patient data from different organisations will tend to decrease data quality (e.g. blood pressure being defined differently). This is a challenge for ICS systems where best of breed “repository” designs tend to be used. Data quality could be given more prominence and transparently managed particularly with large scale programmes across locations.
Lastly, EPR roadmaps. I have found, when digitising large complex NHS organisations, best success when the CEO, clinical leaders and finance director agree that an EPR is needed as the foundation stone for clinical transformation and financial sustainability (and takes high existing systems costs and future clinical and research benefits into account). Such EPR roadmaps cover Mr Hancock’s highlighted tech features and other digital maturity ingredients as well: AI, standardised clinical terms (SNOMED), document management, data quality, early warning scores, voice recognition, API/FHIR based interoperability, patient portals, e-prescribing, barcode medication administration, mobile apps, cloud computing, clinical co-design, e-training, predictive analytics, population health, and research informatics. Shared EPRs are likely to become key to ICS’s. EPR roadmaps therefore are not only foundational to digital transformation but are a practical means of putting the Secretary of State’s vision into a local, coherent, practical perspective.
Dr Simon Hendricks, UK clinical strategy lead and product innovation manager, FDB (First Databank)
The role and development of technology is fundamental to supporting modern, high quality healthcare and any emphasising of this is a welcome reminder for the NHS and the wider health sector.
In the field of medicines management, utilising advanced and emerging technological innovation will ensure the continuing evolution of areas such as data analysis to ensure medicines are used well, monitored appropriately, provide cost effectiveness and ultimately provide optimal outcomes for patients. It will also enable triangulation with other data elements such as demographic information, seasonal variation, social deprivation scores, local geographies, co-morbid disease burden, and polypharmacy data. It will be crucial too in helping identify potential prescribing issues with harmful drugs such as z-drugs or benzodiazepines, identifying patient cohorts and localising where they may be issues.
Matt Hancock’s positive comments need to resonate within policy at all levels. Otherwise the risk is that major initiatives do not reflect or capitalise on the importance and impact of technology, and miss out on developmental opportunities. It was noticeable, for instance, that in last autumn’s Public Health England’s Prescribed Medicines Review there was limited mention ofthe role that technology can play in supporting the analysing of prescribing patterns and informing prescribing decisions.
Paul Targett, Managing Director, RIVIAM Digital Care
It’s fantastic to hear Hancock’s absolute passion for technology as transformation enabler for the NHS and his acknowledgement of the NHS as ‘the world’s most exciting public sector digital transformation project’. At RIVIAM, we have certainly seen a changing attitude. In the past there was talk about delivering new models of care, now it’s about delivering it using digital technology – working in agile ways, working in partnerships and ensuring interoperability.
We have just been working with one NHS Trust and, from kick-off to delivering an end-to-end digital immunisations service with automatic update of child vaccination outcomes to the clinical system, it’s taken approximately 2 months. By embracing a digital solution, it will reduce risks for the Trust and save them 1000s of hours of clinical time, which can now be deployed to improve patient care.
So, if you get the right leadership in place with an appetite to remove paper and embrace digital systems, the success of this NHS Trust alone shows change can be achieved safely, quickly and effectively. As Hancock says this is the way to create the sustainable NHS for the future and we’re glad to play our part.
Adrian Smith, Head of Digital Transformation, NHS Arden & GEM CSU
We wholeheartedly agree that we can’t focus on simply getting the basics right, one of the key points of Matt Hancock’s speech. We have to be making fundamental changes that transform workforce productivity through innovation and AI-enabled access to preventative, screening, diagnostic and emergency care.
The £140m investment for AI development over the next three years is welcomed and appropriate. The challenge will be to ensure a sufficient proportion of funding is allocated to Phase 4 projects – those ready for scaling – so that the NHS doesn’t simply fund more pilots and test beds that don’t attain any adoption at scale.
In addition to AI, although not mentioned in this speech, connectivity is key. AI handles data at scale in ways that humans cannot process but connectivity is needed, both to make usage real-time e.g. in the operating theatre and to ensure that care can be accessed even in the most remote and rural locations. The UK is pioneering the use of 5G in healthcare and Arden & GEM is working closely with partners in the West Midlands to explore and implement this potential.
As part of our delivery of the GDE programme evaluation, we’ve seen first-hand the success the programme has achieved and it’s positive to now see that funding shifting to digital aspirants. But there is also an opportunity to consider different models, such as the ‘Living Lab’ approach, where a group of Trusts work together, rather than individually, to share and deliver a specific solution that can be adopted by all, and where the broader engagement can increase impact.
Paul Jackson, Head of Marketing, Agfa Healthcare
As we move into the new year, it’s reassuring to know that technology will remain high on the agenda for this government and the NHS, and Secretary of State for Health and Social Care Matt Hancock is absolutely right in his analysis that most trusts want to move from paper processes to more modern, structured electronic systems. But actually delivering this change is much easier said than done, particularly without the financial resources needed to deliver these digital transformation projects.
As such, it was pleasing to hear the Health Secretary discuss technology which has the potential to save NHS trusts millions. There are many examples where this is taking place and I would encourage promoting, sharing and repeating proven best practice, rather than re-inventing it.
On Mr Hancock’s closing point, we wholeheartedly agree that leadership is fundamental to driving digital transformation in the NHS.
Recently, we’ve worked with some fantastic CIOs, such as Mike Bone from the West Suffolk NHS Foundation Trust. The trust is in no way unique in the challenges it faces, with complex processes and legacy systems that are unable to talk to each other, but with Mike helping to champion and deliver the project, we are making phenomenal progress.
In order to deliver similar results elsewhere, it is now the responsibility of NHSX – through the Digital Ready Workforce Programme – to bring people together in a culture that recognises the need to innovate, the role of digital in that innovation and senior IT leaders at executive level. Only then will we unlock the true potential of the NHS.
Mark Smith, Business Development Director – UK, Enovacom
It is refreshing to see our Secretary of State for Health communicating so passionately about the importance of technology in the NHS, and it is encouraging that the government is at last taking a longer term financing view with the new Long Term Plan, endorsing the need of our health system to have the best innovation in the world. However there always seems to be a disconnect between the strategists and policy makers view of the world and what is actually happening on the ground. It is still painfully slow and difficult to engage the NHS, even with monetary incentives and even mandated directives. Why is that ? because firefighting is the order of the day, every day !
With the haemorrhaging of clinical staff, technology needs to be embedded into any transformational service redesign plans of the future that ensures that patients move more efficiently and safely through the system, because demand driven by ageing populations will only increase.
If we look at a hot technology topic “Interoperability”, a buzz word that will stick around for a long time, why ? because it’s the catalyst that creates collaboration between the different sectors of the health economy, and there is an awful of it still to do.
Matt Hancock had suggested in order to promote “interoperability” more controls would be in place throughout last year to ensure that every technology supplier to the NHS complies with agreed standards, haven’t we been here before with HL7? what has changed really ? FHIR is a relatively new kid on the block , but for how long ? Delay of the final approved standards means suppliers are rightly reluctant to invest time in an “evolving” standard, especially when it’s a moving feast with a tweek here and tweek there, this only strengthens the need of technology providers that can create and manipulate any type of health standard, especially considering the objective of integrating community and mental health services, that potentially have more challenges with existing non-compliant health standard software suppliers.
OLM
Reducing the time it takes to get things done. 17 years is the average time in which, Matt Hancock, quoted for new products or devices to go from trial to mainstream adoption in the NHS. Too long. Technology is striding forward at a pace such as we have never seen before and the largest healthcare employer in the world needs to leave the fax machines in the cupboard.
He spoke of the importance of people, standards, leadership and scalability, raising technology higher on the agenda than ever before. This we applaud and have spent the last 30 years looking at ways in which we can connect organisations and create efficiencies for members of staff to do their jobs quicker and more effectively. With the cash injections that have been promised to the NHS, we have a duty to ensure that the money is not wasted and technology provides this assurance. As Mr. Hancock says, “It’s not that you can’t deliver great tech in the NHS – you can. We’ve all seen examples.” What it is about is ensuring that you choose the right technology and the right partners that will create the efficiencies and savings that we are all crying out for. Technology by itself won’t create change, funding also needs to be focused on supporting technology projects with suitable change management to realise the benefits.
We agree with Mr. Hancock and his sentiments but would ask him where the money for all of these projects will come from? There are still doubts as to how his plan can be rolled out in such a quick timeframe, much like the Prime Minster and his promises to build new hospitals. There was also no mention of social care during his speech and without a joined up plan, any savings will be lost to the winds of time.
Jacob Haddad, CEO & Co-Founder, AccurX
We welcome yet another call for better adoption of technology at the NHS front line. We’ve also spent the past year learning how fit-for-purpose software doesn’t just make care better for patients, but also massively improves staff morale. Whilst we agree wholeheartedly with the sentiment, we’re still waiting for practical steps that will make deployment of much needed technology feasible.
We’ve shown that parts of the NHS can be great at adopting software where it’s needed, with half of GP practices starting to use us in under two years. But having recently released our first hospital product, addressing three of the five NHSX missions, we’ve found large organisations just aren’t set up to try out new technologies without painfully long processes, entirely focused around risk, not opportunity.
Michael Abtar, Chief Executive & Principal Consultant IG-Smart Ltd
Our overall observation from Matt Hancock’s commentary, following his recent tour of the NHS, is that not much (if anything at all) has changed in terms of the NHS’s overarching technological objectives, and the barriers that have been preventing health and social care organisations from achieving those objectives, for at least the past decade.
We are all no doubt all too familiar with “siloed systems [which] put patient safety at risk…the need for interoperability…clunky tech getting in the way”and staff“having to remember dozens of different passwords”.
At IG-Smart Ltd, we routinely see three primary barriers which prevent health and social care systems from speaking to each other, and put patients at risk in the process:
1) There is no single canonical data model (e.g. SNOMED CT) consistently in use across the NHS. In other words, different organisations and different people refer to the same data using different descriptions, definitions, terms and names. So, even when it is reasonably practicable to overcome the technological barriers to enable data to be pushed and pulled between disparate systems (it’s invariable always possible, but not always cost efficient for cash strapped health and social care organisations), the data that comes out at the other end may be meaningless or of limited use (not to mention of poor quality – in part, owing to the focus of data quality within the NHS having largely been driven by commissioners and focused on payment by results and not clinical data quality/patient safety).
2) There has been an inconsistent decentralised approach towards entering into contractual agreements with software vendors, suppliers and developers. Local health and social care organisations often sign up to supplier/vendor terms and conditions that do not always lend themselves readily toward enabling health and social care organisations and national bodies to enforce standards (e.g. standards which require suppliers to open upon source code and enable systems to speak to one another). Giving suppliers and vendors the power to either refuse to adopt changes, or to place NHS customers on long change request lists – charging separate fees (which can be exorbitant) to make the changes.
3) A lack of clear centralised guidance on, and overzealous and erroneous local interpretations of data protection laws, like the GDPR and NHS information governance standards, like the Data Security & Protection Toolkit – lead people working in health and social care organisations to not know when it is and is not permissible to share patient identifiable data.
Besides the barriers that can prevent a joined-up approach, there is the challenge associated with the fact that joining systems up and sharing data across organisational and geographic boundaries can expose organisations to greater cyber security risks. Leaving Chief Information Security Officers asking themselves, how do I secure boundaries I cannot see?
What’s the solution?
I will not pretend to have all the answers and would possibly bore you if I were to describe all those I do have, but it would seem to be that to overcome these barriers, a collective centralised approach towards data modelling, systems procurement and development must be agreed across the entire health and social care system (and accepted by the major players in the health tech space). Whilst efforts have been made (both nationally and locally), to achieve this is still a very tall order, considering the fact that the NHS is made up of countless separate legal entities, that do not always sing from the same hymn sheet.
An example of this would be one large interoperability and data sharing programme that took over ten lawyers, representing health and social care organisations and major technology firms, over eighteen months of arguing about the terms of a data sharing agreement, only to fail to reach an agreement. I was asked by the commissioners of the programme to join a call to advise the on whether or not the plug should be pulled on the multi-million pound programme. It took me minutes to get to the heart of the issue (they wanted to do more with the patient data than was originally specified) and get the parties to see the wood for the trees (using vanilla, strawberry and tuti frutti ice cream to describe the different data sets and intended purposes of processing to make the concepts that they were finding it difficult to grasp easily digestible). Placing the much-needed programme to interoperate disparate systems and share data between multi-disciplinary teams back on track. Sometimes, the most complex challenges require the simplest of the solutions!
HTN is supporting a webinar next month focusing on Sharing patient data lawfully & securely; to hear what Michael has to say about the key best practices you can implement to enable patient data sharing.
