HTN was joined by Ian Dove and Fiona Costello from Aire Innovate to share findings from a recent HTN audience survey exploring frustrations and pain points around digital systems [view the report here].
We covered the biggest friction points experienced by staff on a daily basis, where manual workarounds are still happening and why, priority areas for digital system development, and approaches to addressing these challenges.
We started out with a brief introduction, with Fiona explaining a bit about Aire Innovate – “a low-code technology platform focusing on empowering teams to develop pathways and workflows that digitise and enable you to work smarter, not harder”. Ian talked about spending 14 years in the NHS before moving to Aire Innovate as director of product strategy.
Where are the biggest pain points with digital systems?
Our live audience shared some of their own experiences with digital systems, outlining a number of pain points including a lack of training, a failure to build with end users in mind, limited joined-up working, issues with data sharing, duplication, poor interoperability, and the need to log into multiple systems.
“I don’t think these answers are surprising,” Fiona observed, “and there’s a reason why we, as a sector, spend a lot of time talking about interoperability and how information flows between systems. People have mentioned training, too – certainly in the time I’ve worked in healthcare over the last 20 years, it’s always felt like technology was driven from the top-down, rather than by the people on the ground.”
Speaking from his experience of working in trusts, Ian talked about the disconnect between the vastness of an EPR and the individualisation of clinical practice and the workflows. “It’s difficult to get a monolith to change and that causes frustration,” he said. “It’s about making sure your team are on board and remain engaged.”
Answers from the survey also indicated that systems weren’t being built around user needs, Fiona highlighted. “The nature of procurements is that they do become very binary, and that unfortunately does become black and white when you’re bidding on these sorts of tenders – the day-to-day seems to get forgotten.” Sometimes, there can be a lack of understanding around what day-to-day use might look like for frontline staff and how processes or workflows operate, she considered. “Then, there are things like bugs and downtime, which erode confidence.”
Where do clinicians or admin staff spend the most time manually entering or transferring data between systems?
Ian reflected on survey findings detailing where frontline staff spend the most time manually entering or transferring data between systems. “We had a variety of different responses around patient information, manual data entry, and things like receiving information from other trusts or providers,” he said. “The electronic discharge records, we know there are changes in what needs to be included, blood transfusions for example, which don’t exist currently in the EPR so require manual work. Write-back functions and results reporting are also complex.”
The audience also gave other examples, including letter dictation, non-standardisation of referral forms meaning information is recorded in different ways, having to rely on patients to retell their story, consent forms, referral documents, and duplication. “These answers are very consistent with the survey, with difficulties transferring information across organisational boundaries, and that can have a huge impact on patient care,” Fiona told us. “It’s crazy that in 2026, we’re having to talk about manually inputting information post-acute discharge or referral into community.”
Considering how these issues might affect the quality of information ultimately being included in the clinical record, Ian pointed to manual entry, autofill, or copying and pasting detracting from the personalisation of the record. “We’re risking losing the richness of the data,” Fiona agreed, “and who knows what we lose there on context, social determinants, advice that has been given – there’s a balance that isn’t being achieved between the importance of context and efficiency.”
To what extent does this change when thinking about workflows, and workflows across multiple agencies including third sector?
Themes emerging from the report on how this changes when thinking about workflows and workflows across multiple agencies including the third sector, mentioned the lack of interconnectivity between different agencies providing different elements of care, Ian shared. “I have seen this myself during my time in the NHS, and how this affects the ability to take into account social determinants, and I think we need to focus on how we can deliver that richness within the clinical record.” Information governance can be an enabler, but it can also block innovation, he continued, “and we really need to sit around the table with IG teams to see the path though some of these blockers”.
“I think what was interesting about the report was some of the actual governance framework itself and the friction that was creating around the ability to share information across different providers,” Fiona acknowledged. “Having a framework that is inherently focused on interoperability, and really starts to look at those barriers and give GPs confidence on data sharing is really important.”
Audience responses picked up on this connectivity issue, voicing challenges about variations in information governance across councils, partnerships, and NHS organisations; the absence of a centrally-agreed process for integration, interoperability, and collaboration between multiple agencies leading to siloed work; and issues with sharing data.
To what extent do IT capacity or business case processes stifle innovation or changes to workflow? Does this also lead to manual workarounds?
Fiona highlighted an “overwhelming consensus” from the survey on the lack of IT capacity, long lists of queued requests, and how this can impact innovation or changes to workflows. “This is a common issue for healthcare organisations, and we’re seeing two-year IT backlogs; when you’re a clinician and you’ve got a patient in front of you, that’s a really big issue that is directly impacting the way you are delivering care. When there are these policy ambitions like the shift from analogue to digital, it feels like there’s a disconnect between the language and the day-to-day experience, compounded by capacity issues.”
Responses submitted by live audience members outlined how IT capacity affects rollout for updates and new systems, a lack of support and funding for clinicians to lead, and how unapproved workarounds can hinder data flows or mean people lose confidence in digital. Other points included not having the right people at the table when making decisions meaning a lack of end-user consideration, a lack of alignment, outdated infrastructure challenges, and a lack of specialist roles to drive innovation.
“Creating a culture whereby digital is seen as a solution rather than a blocker, and thinking about how to create confidence across your teams is key,” Fiona told us. “It’s how you empower those who are seeing the issues, and how you can give them the skills and confidence to make those changes.” She also recommended maintaining an element of agility to respond to feedback, and using digital champions to help support a positive culture. “The issue with IT backlogs and change requests is that the issues today may not be the issues come tomorrow, so it’s already outdated.”
Expanding on other survey findings
Fiona and Ian took us through some of the other survey findings, beginning with questions about whether frontline staff currently have access to tools to allow them to build or customise digital workflows without the need for a developer. “We absolutely should be providing people with the ability to do their job safely, effectively, and in a way that doesn’t create friction,” Fiona said, “and allowing them to do that themselves would take away those challenges highlighted around capacity.”
Only 9.5 percent of respondents to the survey reported having access to capabilities allowing them to make these changes themselves, Fiona went on, “and that erodes confidence because if you’re waiting in an IT backlog, reverting to shadow IT, that causes issues itself”. That might be the creation of things like spreadsheets or forms printed out to enable staff to do what they need to do, she said. “Some respondents felt like giving frontline staff those tools was far off in the distant future, but the fact is that shadow IT is them doing it anyway.”
Almost all of the survey’s respondents reported still using paper or paper processes to some extent, according to Fiona, but many also noted that this use varied widely even in departments of the same trust or organisation. “Digital champions could be really powerful in that context, because they could help drive forward the learning from departments who have digitised well,” she considered.
Fiona next presented findings from the survey on what one task people would transform tomorrow if they didn’t need IT resources or a developer to do so. “People talked a lot about manual re-keying and the burden that created,” she outlined. “I think that’s the benefit of Ambient AI: the ability to take unstructured data and input it in a way that makes sense and offers that context. We need to tackle some of those low-hanging fruit, because the administrative burden is really contributing to clinician burnout.”
“It’s how we can find a pathway with safe governance, enabling people to make a change in a controlled way,” Ian shared. “That might be providing a sandbox environment so clinicians and frontline staff can iterate quickly to solve pain points happening on a daily basis. We’ve started to deliver Aire Intelligence, which offers AI-driven development of things like forms, so you can upload a PDF and it’ll create a form for you, or a video document, and it will create a workflow for you – they’re the kinds of tools we need to iterate fast, with strong governance in the background.”
What can be done in the short term?
Ian moved on to make some recommendations about what can be done in the shorter term to tackle some of the challenges mentioned in the survey. “We’ve been working on a concept called Aire Blocks – small component parts that can fit into the gaps, allowing people to add functionality, and with AI, we can do things like that really fast. Start with the workflows, which will differ by organisation, specialty, and clinical area; understand those, and reframe the procurement around them.”
Focusing-in on referral and discharge processes, which emerged in the survey as areas where frontline staff were spending a lot of time, Fiona highlighted the importance of mapping out pathways and figuring out where the issues are at boundaries of care. “If you know you’re spending 20 minutes manually inputting referrals that come through as PDFs, that’s the place to start,” she considered.
Ian talked about the lack of flexibility within a lot of EPRs, and how this limited the potential to enable frontline staff to make changes. “An EPR is there to make sure the data is safe and the organisation has a solid platform to enable you to deliver that care,” he said. “A lot of the time the control sits with IT teams, and there are organisational controls to make sure changes can’t be made quickly. Now, we need to move to a place where those changes can be made, but in a safe, controlled environment – there are a wealth of service transformation resources in a trust, who understand workflows and process maps, and can identify and fix problems. Aire Flow, our workflow tool, enables you to build digital tools out in real time in terms of that process, meaning delivery in weeks, rather than years.”
“Nowadays, we can take a paper form and put that into AI, and it will automatically populate the form for you,” Fiona explained, “so we’re not even talking about creating the form any more; we’re talking about refining it.” A lot of it comes down to meeting people where they are and moving away from a top-down approach, she continued. “It’s important to create a culture of being able to talk to each other, collaborate, and see it in real time. That’s what we aim to do with Aire Blocks – create an environment with a configurable tool that is capable of delivering quick results.” Off-the-shelf solutions often meet 80 percent of needs, she said, “but it’s that 20 percent they’re not meeting that directly influences whether a clinician will use them or not, and it’s that 20 percent I think we’re collectively talking about”.
Moving forward with the 10-Year Plan
A big pillar of the 10-Year Plan is analogue to digital, although the day-to-day experience feels “some way away from that”, Fiona noted. “It’s given us that policy ambition, but there’s often things like resistance and governance that might stand in the way of being able to make some of those changes – it’s how can we create a safe environment for people to innovate in a way that optimises for productivity and efficiency, but also create that sense of ownership to improve that experience.”
“The 10-Year Plan has definitely given us a sense of urgency around tackling these challenges,” Ian shared. “The lag in the system at the minute is funding and the pressure on budgets; I’m talking to some of my old colleagues, and they’re really struggling with the financial burden that they have. I also think we need to look at some of the areas where there’s great practice, like Shared Care Records and their data sharing agreements, to see how we flow that down and replicate things that are going well.”
“Being able to have a response to these challenges which isn’t a procurement that’s going to take three years and be out of date in terms of needs and requirements by the time it goes live, is important,” Fiona said. “That might be thinking what we can do at speed and at pace, and how we equip people with the tools and skills, the confidence and safety to come up with the solutions to their day-to-day problems. It’s a culture, and that’s where we can look at using digital champions, empowering people to become architects of their own destiny.”
Ian shared his key takeaway: “The problems are consistent across the piece, but they’re not insurmountable. This is about building a shared understanding. There’s an industry out here evolving really quickly, but we also need to make sure patient safety remains the ultimate driver of these digital systems – I think we can solve most of these challenges with sound governance, and we can do that quickly if we continue to have these conversations.”
“Start with the workflows, not the systems themselves,” is Fiona’s recommendation. “Think about what will make a tangible difference when it comes to these friction points, whether that’s manual re-keying or information not being able to move across systems. Create an environment for agility and be able to solve them using tools like ours. I think that will create an energy and culture that’s going to be really important in this transition from analogue to digital.”
We’d like to thank Fiona and Ian for taking the time to share their insights, as well as our live audience, and contributors to the survey.
