In July NHSX held a listening event where innovators were asked one key question: ‘If NHSX and partners were to focus on one or two things, what do you think are the most important priorities?’.
Last week HTN published its insight, learnings, key themes and how NHSX will aim to address them.
The report includes 5 key themes:
- Standards
- Procurement
- Approach and scale
- Engagement
- Digital capability
In this feature sponsored by CCube Solutions, HTN asked industry experts for their views and opinion on this report.
Contributors include: Accenture, CCube Solutions, Allscripts, InfoFlex, InterSystems, DrDoctor, Siilo, Nextgate, Servelec, Ascom, Wellbeing Software, Isosec, Sesui, Health and Care Videos and Arden & GEM CSU.
Vijay Magon, CEO, CCube Solutions
It’s encouraging to see the approach from NHSX to engage with all stakeholders, including the supplier community to really understand some of the challenges.
It seems in a short time the centre has engaged well and is clear what needs to happen to really make progress.
It’s important to discuss these challenges as much as it is to hear about successful projects and implementations. We’ve found that with strong partnerships and relationships a lot can be achieved; just last week we celebrated a project with North Bristol NHS Trust on digitising hundreds of thousands of records, making them available when clinicians needs them, instantly. It’s saved everyone time, the organisation money and improved safety. It was only possible with strong relationships.
We would encourage people to go speak to organisations like this, hear about the transformational challenges they faced, the objectives they set and how they achieved them. It’s not just about the technology – it’s actually about careful application of the available technology to address operational problems and building on the success to solve more problems – a real partnership approach.
Niamh McKenna, UK Health Lead, Accenture
The Digital Health Innovators Report is a welcome consolidation of the commitments from NHSX to build clarity around standards, improve procurement approaches and put in place a support framework to accelerate the spread of innovations.
Health and social care innovation has to be an ecosystem model as a priority. One size does not fit all and often the best results come from collaboration. Openness and engagement with the industry will break down siloes and enable small and large organisations to work together to tackle some of society’s biggest challenges.
Michael Latimer, CEO Isosec
We wholeheartedly welcome this new report from NHSX. It’s great to see them listening to the industry and wanting to learn from Digital Innovators in the field. Their practical approach is refreshing, the direct willingness to listen seems earnest and we hope that they have the ability to follow this through into real world industry change.
To ‘move to an internet-like model of centrally agreed standards and local delivery’ is essential. Working to a consistent set of approved standards has long been an area where innovative technology suppliers like Isosec have grappled, especially when customers desperately seek authority approval to ensure they’re working towards best practice. It’s great to see this ownership in the report when the ecosystem today is inconsistent and often unworkable – so this is great news for suppliers and consumers alike. Innovation needs this direction to make it adoptable.
On the other hand, where the report states, ‘It will mean that NHS organisations can build or buy what they want, as long as they meet our standards of interoperability, accessibility, cyber security and so on’ it marks out a route that allows the latest technology to be adopted freely and will start the transformation from legacy purchases to consumer grade ones. This should mean that historical solutions that is no longer fit for purpose won’t have such a dominance over NHS technology, and hopefully allow grassroots innovation a clearer path.
Isosec is thrilled with the whole report and are already engaged with NHSX and looking forward to a brave new world of better technology. We can’t wait to see what’s next from NHSX, and hope to continue to be at the forefront of NHS innovation.
David Hancock, Healthcare Executive Advisor, InterSystems
I am not surprised by standards being rated the most important priority because to address the challenges of new NHS structures, new models of care, patient inclusion, improving patient safety, etc, we need interoperability standards.
However, despite a consensus on the need for standards, no reference in the report is made about how to get these adopted. Adoption and use don’t happen with the mere fact that they are created. Implementing these standards is not just a technical challenge but a cultural challenge too, because they demand changes to ways of working and offer opportunity to change clinical and care workflow.
At InterSystems we are trying to make adoption easier by making all the new Care Connect Interoperability Standards freely available to our customers who use our interoperability solutions.
It is going to be very interesting to see how NHSX delivers on its statement that the NHS will not buy solutions that do not adhere to key standards. This really will cut across the standards priorities, but other themes too such as procurement and engagement. As vendor co-chair of INTEROPen, I believe that engagement is key and this is the community that brings together all the stakeholders to make interoperability happen.
Richard Wyatt-Haines, Director, Health and Care Videos
The engagement of NHSX in with the digital health innovators is really good to see and the report evidences greater focus and increased intent. Good news and it forms a good basis to for long-awaited progress.
However, all the good work identified in the report about systems and processes and strategic alignment in NHSX will come to nothing if NHS staff across the board don’t have the mindset, culture and capability to purchase and utilise the incredible digital services that already exist to help the NHS address many of its problems.
The resistance to change remains significant. But it is completely understandable in the face of the day-to-day pressures, both in terms of demand and finance, that NHS staff and decision makers face on the ground. Somehow, this log jam has to be broken in order to achieve the scale of impact that is now necessary.
Oli White, Head of Commercial, Sesui
Working with a number of clients in Primary and Urgent Health, we echo the report’s findings that the reliance on a small number of incumbent technology providers, such as the major Patient Information Systems, can hamper our clients’ ability to deliver services to their patients in the way they would like. The inability – or unwillingness for these systems to fully interoperate with other platforms places significant restraints on what care providers can achieve.
In our minds, interoperability should be a cornerstone of future service design, and of procurement decision making, if we are to see a more flexible, agile and efficient NHS.
Similarly, the procurement process as it stands, with multiple, complex frameworks is weighted against the kind of smaller, more innovative business who are able to deliver truly fresh thinking. Many feel the level of effort and resources required to engage with the procurement process is too high, especially when there is an assumption that they will be competing against the established ‘big players’ who have established near monopolies. Rather than more rigorous enforcement of Framework agreements, to truly change service delivery, and encourage more creative thinking, procurement must itself be transformed.
Graham Ridgway, CEO, Wellbeing Software
NHSX deserves credit for working with digital innovators and listening to their insights, especially given that so many share its vision of reducing the burden on clinicians and staff so they can spend more time with their patients.
It’s also encouraging to see that the emphasis has been placed on interoperability and open standards, but we feel a key priority for both NHSX and innovators such as ourselves has to be on how new technologies can be made to work within the existing workflows and practices seen at NHS organisations.
An example of this can be seen in the potential benefits AI technology can bring to the health service, particularly in radiology.
We recently spoke with HTN about the importance of ensuring AI algorithms work in practice by focusing on how they integrate with existing radiology workflows. As an organisation we have been working to ensure AI vendors can connect their algorithms to the existing Radiology Information System (RIS) and the workflows it manages, and this has resulted in a number of successful roll-outs, including the adoption of AI at Dartford and Gravesham NHS Trust. As Neil Perry, the trust’s Associate Director of Digital Transformation said of the roll-out: “A key piece to the AI puzzle for radiology is automating the pull and push of diagnostic images based on the required rules for the specific AI service and then managing the results or insertion of the amended images back to the PACS.” His comments serve to highlight the role workflow integration has to play into the adoption of digital innovation.
In our view, a supporting emphasis from NHSX in the same area would help promote further innovation levels across the heath service.
Joost Bruggeman, Founder and CEO, Siilo Messenger
It is reassuring that from the offset NHSX has shown a commitment to speak with digital health innovators, including smaller companies, to understand the challenges that we face in bringing our solutions to market.
However, in its commitment to supporting interoperability, I am eager to find out more about how NHSX will establish and enforce its open standards.
While I agree that it is important to agree upon common rules so that different systems can talk to each other, I am interested to know who will be involved in the decision-making process on behalf of the innovators — David or Goliath?
I implore NHSX to reach out and speak with us about this so that these APIs are written from David’s perspective, so they are fair and that they take into account everyone’s needs.
Royston Adamson-Green, Director, Channel Sales EMEA & APAC, NextGate
Innovation is an important and necessary catalyst to deliver on the promise of a modernised NHS future. Unfortunately, thus far, the road to digital transformation has been met with burdensome usability, interoperability, workflow and patient engagement deficiencies.
As recognised in the innovators report, the path forward calls for widely supported and adopted standards to drive critical information sharing across physical, social care and mental health facilities. Commonly used standards help to build a complete and total picture of patients for better coordination of care, population health management and highly informed decision making for treatment and interventions. Standards also play a big role in ensuring individuals are accurately identified and correctly matched to their data, so that the information available is free of errors, duplicates and incomplete information. The challenge will be deriving the right incentives so that providers and tech supplies comply.
Increased scalability, as outlined in the report, will also help to create an infrastructure in which innovation can flourish. Programs such as the “innovation greenhouse” provide an easier way for small and medium providers to fast-track technology adoption.
Marc Warburton, Chief Executive of InfoFlex
Standards are fundamental in a multi-systems environment and the lack of their adoption acts as a barrier to implementing innovative solutions that are not going to remain in silos but that are to truly offer patient-based integrated care solutions.
The implementation of these standards, however, is slowed down by suppliers that do not see the need to implement them as soon as possible and, as a result, innovation is prevented.
Procurement processes have changed very little over the years and are primarily focussed on delivering solutions in silos – and do not encourage innovation to support integrated care. The introduction of an “Innovation Greenhouse Lot” is a positive move forward if it enables innovative solutions to be promoted and scaled up, but this also relies on standards being applied. There is a dependence between the five top themes identified which requires all of these themes to be addressed if the innovation required to support integrated care is to happen.
Andrew Imrie, Director of Development, NHS Arden & GEM CSU
It’s encouraging to see NHSX setting out its plans in response to recent feedback. It is particularly positive to see a focus on changing culture and capabilities. In our experience of delivering change within NHS organisations, digital transformation relies on a combination of people, process and technology, with people being the most important factor in the success or failure of a project. Understanding that at the outset and responding to the learning requirements that generates is essential.
NHSX’s plans to continue to support the development of digital leaders and enable staff to access e-learning and training is promising and should augment the benefits that are already being gained by enabling organisations to share learning and best practice through initiatives such as the Global Digital Exemplar (GDE) learning network. Through this network, we brought more than 1,500 healthcare leaders and managers together – both face to face and virtually – to share learning and best practice to help accelerate adoption of digital innovation. Key to its success has been our focus on facilitating information sharing across all clinical fields through specialist networks. In enabling digital transformation, we need to engage with staff at all levels so that they can see the potential of digital and are confident in using systems and applications relevant to their role.
The procurement focus is another area which stands out to us as an organisation. As an existing Health Systems Support Framework (HSSF) supplier, NHS Arden & GEM CSU has been involved in the recent market engagement, including the new ‘Innovation Greenhouse Lot’ and we are excited about the opportunities this provides to bring the NHS and digital innovators together. The creation of effective partnerships is key, which we have already witnessed through our involvement in a partnership that has developed a new approach to endoscopies using satellite technology and Artificial Intelligence (AI). This has been highlighted as one of the few examples of innovation partnerships being used in public contracting to design new solutions to longstanding challenges. With the approach NHSX has outlined, we hope this example will become one of many.
Tom Whicher, Founder, Dr Doctor
Here at DrDoctor we welcome the report and think it has focused on the key enablers to change – it’s vital that we have a shared set of standards, on which we can collectively build a digital ecosystem that the NHS so desperately needs.
It’s essential that this has scale in mind – it’s time to move fast with proven innovation. To do this, we need to help develop the digital capability across the NHS. IT teams are understaffed and under-skilled for the level of change that is required. For true digital transformation at scale, we need to make sure all staff, regardless of role in the health service understand how to leverage and make the most of the opportunity from technology.
Neil Layock, Managing Director of Healthcare, Servelec
It’s very encouraging to see such support for open standards coming from this report; as NHSX states, they’re essential if we’re going to enable seamless care throughout the entire health and social care system. We’ve really been at the forefront of advocating this in line with our aspirations to be completely open and interoperable. There is still a gap to close between those who innovate and those who resist. However, feedback from our interoperability team who attended this week’s INTEROPen Hackathon is that there was great energy and open-mindedness for working together to achieve better information sharing. Our team worked with other suppliers to integrate transfer of care packages, medicines reconciliation and even digitising baby weight recording and sharing, allowing professional and parental access, just from this one collaborative event.
Whether you’re a child, adult or elderly person, health and care systems need to join up so that the professionals have access to all the information they need to deliver the best possible care. It’s common sense – so as technology companies, we have a real responsibility to make sure the complexity is taken away. While our individual health and care solutions play a part in this, we believe it’s our commitment to interoperability driven by our Conexes platform that’s key. By working with other vendors, innovative partners and established third party systems we can join up the full journey to enable better outcomes through digital care.
Richard Strong, Vice President and Managing Director, EMEA, Allscripts
We very much welcome the collegiate approach taken by NHSX to ensure that they seek industry views to drive forward NHS digital ambitions.
Allscripts adheres to the view that interoperability between the various health and social care IT systems is key to creating a platform on which innovation can flourish.
Having been selected on the Health Systems Support Framework, Allscripts had to demonstrate that it is an open, standards-based company, and that it can deploy its systems using a ‘thin’ or modular approach, so organisations can obtain the functionality they need.
Allscripts is very committed to open standards, but standards need to be set in collaboration with industry. We strongly believe that if open technology standards are embedded in the NHS procurement process, it will support new models of care leading to improved patient outcomes and greater service efficiency.
Paul Lawrence, Managing Director, Ascom UK
All five themes in the NHS-X report are important to help health technology companies work better with the NHS, but the one that stands out for me is Engagement. Two recent NHS projects for Ascom, with the Royal Bolton and Chase Farm hospitals, owe their success to engagement with clinical staff right from the start. It cuts across everything we do at Ascom. You must work with clinical staff to find out what they need, rather than trying to sell the IT department your new shiny thing.
To quote Natalie Forrest, the CEO and director of nursing at Chase Farm, the NHS’s new award-winning ‘paperless’ hospital: “The technology development work was done by clinicians [in partnership with Ascom] instead of to clinicians.”
The Chase Farm team asked to see our nurse call and smartphone system. Then we worked with them to adapt it for their specific needs, and integrate it with other medical devices from other suppliers.
At the Royal Bolton, we worked with the hospital’s chief clinical information officer, Simon Irving (who is also a working consultant acute physician) to adapt our smartphone system to give different audio alerts and display priorities to indicate the severity of a patient’s condition, allowing up to 300 clinicians to prioritise work while staying mobile in the hospital.
This ties in with Digital capability, the fifth theme in the NHS-X report. In our experience, staff feel inspired and confident with technology when it enables them to do their work better – rather than their trust ‘going digital’ for the sake of it – and importantly allowing them to spend more time with their patients.
So I would say in conclusion that besides its other core functions, NHS-X’s National Centre of Expertise could consider co-opting clinicians with like-minded partners such as Ascom, who are enabling effective planning and implementation of major med-tech projects, to bring their expertise to the table and ensure we all benefit from past experience.
