HTN was joined by digital leaders from across the health sector for a deep dive into best practices for success in health tech transformation. Our panel shared details of current and past projects, looking at what worked and what didn’t, learnings, best practices, and overcoming challenges.
Panellists included Simon Brown (Simon B), head of digital at Royal Papworth Hospital; Tom Stocker, CHCIO and EPR Advisor; and Simon McNair (Simon M), head of business development for digital services at Restore Information Management.
Starting off the introductions, Tom shared a little bit about his background in NHS services commissioning and in digital regulation, before getting “absolutely hooked” on the power of data and digital in around 2017. Since that time, his focus has been on enabling digital transformation, including working on the Clatterbridge Cancer Centre’s digital strategy, supporting the EPR business case at the Liverpool group, offering integration support at Mid and East Cheshire, and working with Norfolk and Waveney around integration and EPR workflows.
Simon B talked about spending the last 10 to 15 years with the NHS, working at South West London ICB and with One London prior to coming to Royal Papworth. “One of the initiatives I was leading on was driving out the NHS App straight after COVID, and before that I was in the private sector working within digital agencies,” he said. “My background is a mixture, but it has always been looking at how digital technology can improve on where things are now.”
“I head up Restore Information Management’s business development function for digital services,” Simon M told us. “I’ve got a background in information management, digital transformation, and patient communication management. At the moment I run a team of about 12, working with the NHS to support those enablement programmes linked to the deployment of technology.” In practice, that work has been particularly focused around helping NHS organisations with legacy paper and data challenges, he went on, promoting their ability to access information more effectively to improve outcomes and patient care.
Deep dive into successes in health tech projects
Simon M talked about observing an improving understanding about paper-to-digital programmes and how they work to underpin NHS investments in tech, systems, and EPRs. “We’re working with a trust in the Midlands, and part of that is securely moving and cataloguing 500,000 patient records, before putting in tech to enable auto-ordering and intelligent access, integrated with the trust’s patient administration system,” he said. Along with this process, the project has focused on promoting investments the trust has made in its EPR and clinical document management system, he continued, “and that’s a good example of the work we’re traditionally doing in the secondary care market”.
Other areas of focus include work to free-up space, getting access to information, and making sure records and data are available with the NHSE National Document Repository, Simon M shared. “What I think makes a project a success is having a clear vision, a clear timeline, a funded budget, and the right controls in place for ongoing management,” he noted. “Then flexibility, particularly as a supplier, because what we do often has other dependencies on larger programmes – as a partner to the NHS that is really critical.”
“As I learned when I first came into the NHS, it’s all about people, product, and process,” Tom highlighted. “But in the NHS I would actually add an extra ‘P’ for paperwork! You need the paperwork to be right, so you’ve got the right mandate, governance, and resources around your project.” He shared a small recent project to create a chatbot designed to capture symptoms for cancer patients during treatment to enable them to be treated for those earlier. “That was fun, because it was in the innovation space, and there was enough energy behind the idea and the product to be flexible with the clinical team about how it should work and how we could do it right for patients.”
Tom also talked about learnings and successes from recent projects working on patient portals, voicing “surprise” at how differently trusts have used and deployed them depending on their priorities. “In one instance, an organisation I worked with was incredibly focused on waitlist validation; in another it was doing it to such a high level of quality that it was an incredibly slow process going into two specialties, almost over-boiling what could be done to the detriment of other specialties.” What makes things work well is having engaged people, a great product, clarity on processes, and the paperwork to underpin it, he considered.
Simon B agreed with Simon M and Tom’s points on communication, flexibility, and the importance of people, understanding their motivations and the drivers they have to be either supportive or unsupportive of a particular project. “Keep it simple,” he advised. “We have a tendency in the NHS to overcomplicate things, and to have lots of people involved – we’ve potentially got a new EPR coming up on our radar, and it’s about whether we need to have certain meetings, keeping involvement simple – that’s what makes a project successful.”
A recent Ambient Voice Technology (AVT) project at Royal Papworth had a “really small” core team of three or four people, Simon B explained, led by a divisional director from the clinical administration side. “Quite often, you can have lots of stakeholders from different teams, but then you’re going to have lots of different people with different interests,” he said. “But reducing that and having a focused team can work better.” The project offered both financial and time savings, he reported, and in one month an additional 1,200 patient notes were uploaded and logged into the system. A Power BI dashboard is helping visualise which clinicians are using it and which aren’t, which is helping to inform work on creating behavioural and cultural change, he added.
Measuring success and the NHSE Digital Maturity Index
Tom shared some of his thoughts on the NHSE Digital Maturity Index. “I don’t think it represents what we are, or what we should be,” he noted. “What we should be, is proactive people working collaboratively across our organisations to improve care – I’ve done a little bit of work in the private sector, and although sometimes we feel we’re not as shiny as people in the private sector, I think we are a lot shinier in our digital teams in the NHS, and we’ve got some really good talent.”
Getting the digital strategy and clear ambitions or KPIs in place is key, according to Tom. “Then there are two extra bits for me – the last mile question, and the extra mile question. The last mile question is how you use data, getting down to specialty level, to make sure everyone who should be using a solution is using it the right way. The extra mile question, then, is not just doing the minimum and then moving on because there’s not enough time; it’s using data to get to grips with what we want out of it, thinking creatively about what the effects will be on services and what benefits we can unlock if we make small changes to the way we’re doing things.”
“As a supplier, it’s important to get as much detail as possible about the organisations we’re working with, so we can have a baseline for assessing progress,” Simon M considered. “I think everyone here will understand this isn’t a ‘one-and-done’ process; it’s an ongoing journey, and that’s reflected in some of the reframing of the Frontline Digitisation programme. That is now more about enhancing the investments and large-scale transformations that have been made – it goes back to how data is used to drive decision-making and how tech is used effectively to inform those decisions.”
With the pace at which technology is evolving, there’s a risk that a system of measurement and assessment set out today could be out of date in 12 to 24 months, Simon M continued, meaning by the time you deliver on ambitions the landscape around them has changed. Ongoing assessment and continuous review of your system of measurement is central, he noted, “as tech is driving changes at a rate we didn’t see five or ten years ago”.
Simon B highlighted the disconnect between digital maturity assessment and what is happening at an operational level. “We delivered Windows 11 across the whole of our estate by our deadline of October last year, but there’s no connection between that and the way digital maturity is assessed. We need to be getting to what good looks like, how far we are advancing improvements in patient outcomes and patient care, and that is very much driven by the data, for me.”
Part of his previous role with South West London was creating a data strategy, Simon B shared, starting to transform BI into data intelligence in order to find out what the data is revealing and how it could be used to inform future direction. “We don’t do that enough in the NHS,” he said, “and when it we do, how do we then have those discussions about how that can benefit other teams and departments?” It’s not only about that communication across teams, but also with third party vendors or suppliers, who might have a different perspective, he went on. “They will bring insights from elsewhere and add value to what we look to implement from an operational perspective. It’s that bigger conversation about how we view things and how we use it that should be a bigger part of digital maturity assessments.”
Lessons learned from working with vendors and suppliers
The easiest vendors to work with from an integration perspective are usually those who know their product, have good database design, and don’t create extra bureaucracy where it isn’t needed, Tom considered. “It’s best when you can get straight through to a technical person and just solve a problem. And then it’s how you can get good quality engagement without paying more – I’m yet to see basic negotiation training being put to use in a digital context, whereas when I used to commission multi-million NHS services for a CCG, we’d get training every year on things like bringing down price points, structuring procurements, and so on.” NHS digital has a lot of catching up to do on that skillset, he added, “which would put us in a very different position with our vendors”.
Sometimes, vendors and suppliers can struggle with their understanding of the NHS context and how the NHS at large works, Tom told us. “To get that high quality engagement it’s key to get them on site on day one, helping them to get to know what they’re working with, because the NHS is a very different beast to almost any other organisation.” Things have changed, and now it’s possible to use AI to do things like code a basic patient portal in a few hours, he continued. “We don’t yet have a firm plan on how we as the NHS are going to engage with that, and how we’re going to do AI outside of highly-regulated little boxes – are we going to develop our own code base? There’s still very little going on in that space.”
Simon M also offered the supplier perspective, emphasising the importance of having good information upfront, not just in terms of specific requirements for the project at hand, but also on what is happening at an organisational level. “It’s having really clear scope up front,” he noted, “and the better engagement there is, the more you’re going to get from the market. There’s a lot then to be done in terms of particularly joint deployments, around what dependencies are from a supplier side, and what the dependencies are from the NHS side, transparency about resources and technical capability, and sometimes compromise on some expectations.”
Reflecting on his experience prior to the NHS, Simon B talked about working with a restaurant chain as a client partner, and how their approach was to send chefs to Italy to live and breathe the culture and way of life as part of their training. Offering that kind of insight and experience in the NHS would help with engagement with suppliers and vendors, he suggested, because they would have visibility of the issues needing to be solved, and the outcomes needing to be achieved. “I strongly believe we need to improve our briefings for third-party suppliers,” he said. “Soft engagement to begin with, and then bring them on board as best as you can, whether that be through problem solving, hackathons, and so on – that’s how we will get more out of those relationships.”
Taking a forward look
“You end up essentially building a library of lessons learned, so when you see something that looks like the last project, you can go back into that knowledge base,” Simon M observed. “Then you have things you have never done before, and it’s about having that maturity to understand on both sides where you are, to put the right resources in place, and be transparent about that. Over time, it’s like muscle memory, and you get used to operating in a certain way, so you’ll be able to react very quickly to issues that come up, and then the more you’re able to do that, the more you have a blueprint to continue to deliver in that way.”
Tom discussed how in previous projects, the issue hasn’t been in the approach, it has been in not giving enough time to the political process, knowing when an organisation is not ready for something, or when there are factors or dynamics at play that will prevent something moving forward. “I’ve been coming up against that more and more,” he said. “We’ve had so much in the way of politics, financial restrictions, supplier-driven upgrades, Windows 11 changing all the different servers; we’ve had to migrate, we’ve had to do failovers, we’ve had to harden our cyber security posture, and so much of our capability has been in BAU and legacy management.” Getting the right team of people together, setting up the delivery context, and setting out the ambition, remains the key, he concluded.
Simon B echoed the need to get the right people involved, getting key stakeholders on board, like procurement. “Kick-off meetings are quite standard, but it’s having all those stakeholders at the very first meeting, then deciding if they should be involved in the next one, or in future meetings. Then you come to looking at a year from now, how we can get more out of data, and how we can use that to deliver change for better patient outcomes. That’s what I want to see more of.”
Simon M highlighted the changes taking place across the NHS, and how getting to a place where the future model is in place both nationally and regionally will help from a commissioning, service delivery, policy, and decision-making perspective. Alongside that, there remain other pressures across the health sector, EPRs to implement, and technology to review and deploy, he went on. “In a years’ time, I would hope to have more clarity about what’s to be delivered nationally and regionally, policies and programmes to leverage tech consistently, and so on. There are still challenges in terms of compliance, retention, and records; but also how you enable those major investments so you’re maximising their value moving forward.”
We’d like to thank our panellists for taking the time to share these insights with us.
