In the second of a two part series we asked leaders from the industry for their views on the main challenges in healthcare technology and we asked if there is progress to be made, what could be done to address these challenges?
In part one of the series we asked our audience via LinkedIn and we received a fantastic response in just a few hours, with some very insightful and interesting perspectives from across health and care, click here to read the article.
We would also like to thank the sponsor of this series, CCube Solutions.
Contributors include: OLM, Difrent, Sectra, Orion Health, Wellbeing Software, InterSystems, CCube Solutions, IMS Maxims, DrDoctor, Enovacom and InfoFlex.
Pete Hansell, Associate Director, DrDoctor
We’re in the middle of a health tech revolution with new concepts and offerings coming to market every day. The challenge for the NHS is to work out which of these are actually most valuable and then get them deployed at scale without attention being diverted too early, leaving the job half done.
Rinesh Amin, co-founder, DrDoctor
The main challenges in reality are less technical and more about helping organisations adapt to change and set themselves up for the future. Once an organisation is enabled they tend to be able to progress really fast. This can only happen by investing in staff properly through time, coaching and support. And by leadership creating conditions where it’s ok to sometimes get things wrong.
Shane Tickell, chief executive, IMS Maxims
One of the major challenges we face at the moment is securing investment for healthcare technology. Prime minister Boris Johnson announced recently that £1.8 million is going to be spent on NHS buildings, with £850 million going on 20 new hospitals or wards.
That’s great for the areas that will benefit; but it will make very little impact on the NHS as a whole. A week before Johnson made his announcement, Ernst and Young issued a report that put a value on NHS data. It argued that if it could be consolidated into a single, longitudinal data set, the NHS’ 55 million patient records would be worth around £10 billion a year.
Half of that value would come in the form of operational savings, better outcomes, and ‘wider economic benefits to the UK.’ What kind of investment would we need to secure that return? In a blog post, I argued that if we assume a return on investment of 1:10 we would need about £1 billion.
So that would be my challenge to the government. Invest £1 billion in NHS IT, and invest it in indigenous, SME companies. And get back £10 billion to spend on NHS facilities and anything else you like, while supporting the economy and jobs at the same time.
Vijay Magon, CEO, CCube Solutions
The NHS is set to embrace technology, innovate, and improve delivery of patient care. Unfortunately the NHS is still largely reliant on paper, with a lot of organisations set to miss the long-standing paperless 2020 target. Funding tops the list of key challenges facing the health sector – there are a few others including motivation, standardisation, and technology but these are being addressed given that several Trusts have achieved paperlite (if not paperless) delivery of healthcare.
There are a lot of proven systems across healthcare with strong reference-ability, where organisations could mirror what they have done, learn from their successes and their recommendations.
Until we move away from paper, we can’t truly realise interoperability. Those who tackled the challenges a few years ago are now moving on to achieve more; they have clearly shown that once organisations are digital we can start to explore and understand data, structured and unstructured content, but we need to make this information available at the point of care first in a quick, efficient and cost effective way. In terms of electronic document and records management, one of the important considerations with any implementation, it must be viewed to be more than replacing paper with a digital system. Clinicians needs an intuitive system to access information within seconds. This can be largely supported by the correct filing and structure disciplines and also a well-designed system truly understanding user journeys and activities. Once done correctly it can be a platform to provide access to structured and unstructured data, and help support the interoperability agenda and beyond.
We have helped a few Trusts achieve paper-light healthcare delivery and clearly demonstrated that careful application of available technologies really does work in terms of financial savings and improvements in patient care and safety – systems must be interoperable and share data that complies with established standards. These Trusts now have the digital foundation necessary to explore and exploit new technologies like AI and Smart-Apps, while improving standardisation and interoperability between systems.
My advice would be to really understand your workflows and ensure the methodology is right when deploying an electronic document and records management system. Speak to reference sites and explore what clinicians think of the software.
David Hancock, healthcare executive advisor at InterSystems
NHSX has made interoperability its focus, and that is not surprising, because surveys have told us that interoperability is the number one issue for chief information officers.
And I do agree it is, however looking at the delivery missions that NHSX has set out, it’s clear that interoperability is one of many issues. As comments in the LinkedIn thread have made clear, we need to make the IT estate fit for purpose. We cannot have clinics being delayed because it takes 30 minutes for clinicians to log-in to their PCs or moved because the computers are not working.
We need to sort out single sign-on. We need to make sure that IT support is available 24/7. So, before we talk about interoperability, we need to sort out those issues. A big push for public cloud would help, and so would an injection of cash for hardware.
We do need to get to interoperability, though, because we know that sharing information is a big issue across hospitals and across patient journeys. NHSX has said that it will not buy any systems that do not conform to standards, which is helpful; but we need to agree those standards.
We also need to move towards the structured exchange of data, because without that we cannot do population health management. And while we are doing that, we will need to tackle some of the institutional and clinical obstacles to integration and transformation.
At the moment, when we talk about integration, we often mean that we want one organisation to spend money and change the way it works to benefit another organisation. We need to find a way of making sure the benefits are recognised across a health and care system.
Then, we get to the big change that NHSX talks about, and that is moving away from individual systems, and getting onto platforms with open APIs so that developers can take data and build it into new apps, including apps for patients.
So, we need to tackle the current issues we have with technology, because they really impact people at the sharp-end. Then, we need to tackle interoperability, population health, and platforms and services. It won’t be easy. We are trying to change the engines while the plane is in flight; but I do think we can see where we are going.
Graham Ridgway, CEO, Wellbeing Software
Healthcare technology is brimming with innovation, both from within the NHS and from the HealthTech companies, especially after Matt Hancock’s ringing endorsement of more independent providers in the procurement process.
However, the desire to celebrate and encourage innovation has to be supported with a structured approach to sharing examples of best practice, especially across the NHS. The challenges of going from early adopter use to mainstream adoption has had many tomes written about it. If one particular trust succeeds in adopting elements of AI technology, for example, how can other trusts learn from this model, adapt it for their own use and avoid the technology and adoption pitfalls the innovators overcame along the way? Getting processes in place that enable the sharing of this knowledge and experience is critical for a quicker and more repeatable adoption of these new technologies.
One particular challenge that a best-practice approach can help to address is the issue of user adoption and integrating new technologies with existing systems and working patterns. With the sector flourishing, we still need to capture the specialist knowledge of how information flows through the NHS, and create pathways that maintain the careful balance between modernisation and continuity. Not to keep the old, but to speed in the new.
Gary Birks, general manager, UK and Ireland, Orion Health
In order that Orion Health can serve the population health market we rely on health and social care services to progress the integrated care agenda and sometimes on clinical software vendors to support interoperability to create integrated digital care records.
That means we can only run as fast as the NHS and local authorities can run when it comes to creating an integrated health and care system, and we can only run as fast as their traditional clinical software vendors can run on interoperability. At the moment, there is a lag in the development of both. That said, this is being accelerated by NHS England and NHSX, seen most recently in the NHS England work on the Health Systems Support Framework. This is just one example, of driving interoperability through the use of standards and market conditions.
With respect to driving the integrated health and social care agenda the NHS Long Term Plan is in place and is being supported through programs such as the Local Health and Care Record exemplars. Part of the challenge of delivering integrated care is in the management of the complex stakeholder landscape and the competing priorities and workloads of each. Those stakeholders need to be managed to a common cause. Simply aligning budgets to one of those stakeholders, say through devolution, may not fully align stakeholders to shared and agreed outcomes to which technology investments can be aligned.
Given the focus on technology rather than outcomes, customers have approached IT as a commodity and expect the price to align accordingly. The benefit and value to the organisation, clinicians and patients is often overlooked. That expectation against an expectation of vendors developing cutting edge innovation conflicts. For us that innovation supports change at a population level and the cost of innovation to vendors is significant, an innovation investment that healthcare technology vendors are expected to accept.
The NHS needs to trust and appreciate its vendor community and likewise vendors need to understand and to be willing to partner with the NHS.
The area that Orion Health works in is a very complex area, but to make progress, ultimately, we all need to be less focused on cost and more focused on outcomes, and less focused on how many people we are treating in hospital and more focused on how we can deliver for the whole population.
Chris Scarisbrick, Sectra
Technology challenges in NHS diagnostics were once about moving from film and light boxes to digital images. But the opportunity to deliver diagnostic services across regions, to pool scarce specialist expertise beyond individual trusts, and to allow images to follow patient pathways, means the challenge today is to break images out of their traditional departmental and organisational silos.
Realising this ambition starts with the right leadership and vision. We are encouraged to be working with trusts where chief information officers and chief clinical information officers recognise that imaging is no longer the sole domain of radiology, and that taking an enterprise approach is so crucial to allowing effective clinical decisions.
A growth of regional tenders for imaging technology demonstrates that the vision is for effective imaging to flow beyond the confines of any individual hospital. There is now an appetite to work collectively and collaboratively across trusts to deliver diagnostic services as a region.
Cloud technology will play an important role here and can provide the mechanism to ensure all regional partners can move forward together, unrestricted by infrastructure. So far, the shift to cloud for imaging has been limited. Internet first guidance, updated only recently, means that this is likely to become more commonplace, and vendors must be able to support this.
Already we are working with trusts to allow images to flow to regional multi-disciplinary teams, so that effective diagnoses can be made for patients. The impact for professionals has been tremendous.
Regional approaches to imaging will only continue to expand. The prize – better and faster diagnoses, lower cost, maximising scarce resources and the ability to design services around the patient.
Chris King, Difrent
Every day, the vast majority of us walk around with tiny boxes in our pockets or bags, that hold the promise of Artificial Intelligence, Machine Learning and both Virtual and Augmented Reality. Most of us will barely scratch the surface of the computing power these boxes hold. Yet because they exist, there are generations – not just millennials – who walk in to their health sector working environments each day, growing in frustration at the time it takes a computer to boot up, or an obsolete version of Internet Explorer to load the one screen they will stare at for the next eight hours.
So when an announcement is made (£250m being channelled into the growth of Artificial Intelligence in NHSX) you can sense the waves of cynicism flooding social media at the prospect of another doomed “IT” (or is it now just a default “Digital”?) adventure. If our colleagues can’t update to the latest browser versions, forgive them their raised eyebrows at the promise of being upskilled in the latest, must-have technologies.
What needs to be done? Well, for starters, we could all do with dialling down the cynicism. The only way that is likely to happen is if someone in authority (no matter which decision-making body is in vogue this week) helps everyone clearly join the dots between the creaking and obsolete, to this brave new world we are promised.
If we are to leapfrog away from being unable to share a document across an unapproved, market-leading platform, to the better identification and diagnosis of diseases and conditions – then everyone involved will need to understand how this will happen. No magic wands, no silver bullets fired. Address the cynicism, manage the expectations and work with leaders, teams and individuals to plot a clearly defined path from here, and into a future where we all want to work with the technology we use each day.
Marc Warburton, Chief Executive, InfoFlex
Integrating secondary and primary care data to support patient care, directly involving patients in their care and gathering health outcomes data to confirm the effectiveness of treatments are 3 of health tech’s main challenges and which InfoFlex is helping to resolve.
Clinical systems used by both the acute and primary care sectors can no longer be implemented in silos. It is essential that all new system implementations should fully support interoperability and the real-time exchange of data that is required, providing clinicians with a complete and seamless patient record to support clinical decision making and patient care. Similarly, existing clinical systems must have a clear strategy and timeline to support this level of functionality, if they do not already do so. Interoperability is essential if the sharing of patient care across the healthcare sector is to be effectively achieved. This cannot be limited to just the viewing of data but must provide access to data entry on the relevant systems for all those involved in the patient’s care.
Involving patients in their care is key and the technology to support this is required if this is to be achieved. Patient access to their specialty specific clinical records must be provided and they need to be able to easily communicate with the clinicians involved in their care. Patient portal functionality needs to become part of a clinical system’s standard functionality, providing a fully integrated patient record. Clinicians and patients need to share their use of the systems that support the patient’s care. Providing patients with the functionality to contribute to their clinical record is also essential if the volume of patient outcome data needed to support improvements in healthcare is to become available.
A clinical system’s ability to integrate, to support interoperability and to provide patient portal functionality are all essential components that underpin shared care between clinicians and patients.
Mark Raeburn, managing director, OLM
The main challenges around health technology have been already identified by NHSX and these revolve around standards, procurement and opening up the sector to innovative approaches. Here at OLM we wait with anticipation to see what NHSX proposes as solutions.
In addition to these challenges, another key challenge is time. Customer resources are so stretched that ensuring users have time to feed into the development of the solutions is difficult.
Our target was to create something that the target audience wants to use and that enables them to deliver outstanding care. This target sounds simple enough, but it is a challenge, and one that is often missed by software companies. For us to get this right we knew we needed to invest in next generation technology and listen to the feedback of the practitioners. Building technology around the users ensures that pain points are solved, and time is given back to the worker. Whether that is in a care, health, or educational setting, time is the most precious asset and technology that provides additional time is priceless.
Mark Smith, Enovacom’s Business Development Director in the UK
The biggest issue by far is the lack of health and social care resources, The National Health Service is the biggest employer in Europe, 1.2 million people with another 1.1 million in Social Care. if you look at the research produced by three separate think-tanks, namely The Heath Foundation, The King’s Fund and The Nuffield Trust all found that NHS hospitals, mental health providers and community services have 100,000 vacancies and there are another 110,000 gaps in adult social care. If this trend continues then all of these organisations predict that there will be 250,000 vacancies in a decade.
Brexit is also a major concern because of the uncertainty that this creates for non UK nationals working in our health and social care system, and given the amount of non-national employees in our healthcare system there is clearly a risk of losing this valuable resource if this uncertainty is not tackled, whether Brexit happens or not.
Some of this workforce are not all doctors and nurses , there are also employees in all areas including IT, and with the huge interoperability effort at the top of the NHS agenda, innovative technology is required to reduce the burden on the current workforce who are forced to cope with an increased demand for their services using outdated paper based procedures.
Even though the government has recognised the depth of the funding challenge by committing to 3.4% per year growth through the Long Term Plan, which will provide a foundation for strategic funding and is a positive step, in real terms the actual growth is still less that the long term average funding growth for the NHS. If you then consider the frightening trajectory of the ageing population the key challenge is managing the surges in demand without reaching breaking point, winter pressures is not a relevant term anymore as the pressure is continuous throughout the year.
The other area of concern is Social Care, clearly with the severe lack of resources and the drive to treat more and more patients in the community there is a big accident waiting to happen, the infrastructure is old and poor , legacy IT systems do not comply with new health standards. Significant investment is required in technology to just bring the sector into the 21st century , systems need to be more co-ordinated and enabled to send real time data between a variety of health professionals to optimise care and continue to create efficiency wherever possible, as demand is not slowing down any time soon.
As the country landscape morphs into the STP / ICO footprint there is still a lot of fall out and politics to navigate which only means more delays and procrastinations, the Implementation Framework is out, and the time to submit plans is rapidly approaching the deadline being March 2020. Between now and then there is an awful lot of uncertainty and likely to be a very drawn out process.
– Thank you to the sponsor of this feature CCube Solutions. To view some of their case studies, please click here >
