The NHS will simply not be able to provide high levels of service at an affordable cost without digitisation and appropriate use of digital data at every level. This is the view of the National Advisory Group on Health Information Technology in England which last week released its report on how the NHS can harness the Power of Health Information Technology to Improve Care in England.
The Advisory Group which is chaired by Professor Robert Wachter was formed in late 2015 to advise the Department of Health (DH) and the NHS on its efforts to digitise the secondary care system.
Parting with paper is never easy
The Advisory Group’s report comes on the back of a £4.2 billion investment package to drive a ‘paperless’ health service. However this isn’t the first attempt at revamping NHS IT. Whilst GP practices are nearly 100% digital, efforts to digitise hospitals and NHS Trusts through the National Programme for Information Technology (NPfIT) failed to deliver, with the Programme disbanded in 2011 after nine years. The Advisory Group reflected on the lessons that can be learnt from the NPfIT, as well as the experience of the United States health system where over 90% of hospitals now have Electronic Health Records (EHRs).
The recommendations put forward by the Advisory Group are in my opinion both balanced and pragmatic. Too often ambitious projects stall because of misguided and unrealistic expectations. So, it’s refreshing to see that this report sets straight a number of misconceptions around the deployment of digital technologies, and calls for a pragmatic approach to digitisation, especially when it comes to the speed of implementation and expectations around financial return.
More haste, less speed....
Accepting that there is a degree of urgency to digitise the NHS, there are also risks with rushing change, especially in Trusts that are not prepared due to lack of finance, staff, training or the necessary culture to digitise effectively. Setting short deadlines for digitisation could perversely result in it ha ppening slowly or badly, or both. The report therefore calls for a staged approach to implementation where those Trusts that are ready to digitise are catalysed to do so, but those that are not ready are supported to build the necessary capacity. That’s not to say that organisations can drag their feet either. While acknowledging that some Trusts may need more time than others to prepare for digitisation, the report recommends that by 2023 all Trusts should have achieved a high degree of digital maturity.
PHG Foundation’s own experience, from engaging with members of the healthcare workforce involved in the implementation of new services and technologies, is that they generate a wealth of valuable lessons on the process of implementation but channels or incentives for spreading their insights are not always optimised
PHG Foundation’s own experience, from engaging with members of the healthcare workforce involved in the implementation of new services and technologies, is that they generate a wealth of valuable lessons on the process of implementation but channels or incentives for spreading their insights are not always optimised. Consequently others across the health system commit time and resources to address problems for which solutions may already exist. Particularly welcome therefore is the recommendation to organise digital learning networks so those at different stages of implementation can learn from and support each other.
Going digital – there’s more to this than money
The benefits of going digital are not just economic. In fact if anything the report notes that cost-savings may take 10 years or more to emerge, and so among all the other potential benefits of digitisation, financial return on investment is the one that is likely to take the longest to manifest. Given the current political emphasis on [short term] improvements in economic productivity, there is an obvious tension in implementing programmes to transform services, which are unlikely to deliver savings in the first few years. Yet if a success is to be made of these digitisation efforts then it will be vital to take a long term view, and one which does not lose sight of the clinical aims: improvements in the quality and safety of care. If the goals of this exercise are not focused on clinical objectives – this includes designing IT systems with end-users (healthcare professionals) in mind - then the impact on patient care, safety, healthcare productivity and efficiency could be detrimental.
It will be interesting see how the Government’s response to this report unfolds, including the Advisory Group’s view that the £4.2 billion currently committed to digitising the NHS is likely to be insufficient to enable digital implementation and optimisation in all NHS trusts. If the advice of the Advisory Group is heeded by policy makers and those charged with delivering a digital NHS, it’s possible we could finally realise the transformation so desperately needed not only to modernise the way our health data is managed, but also to lay the digital foundations required to develop better and more personalised care for patients. To quote the report, it is quite frankly ‘time to get on with IT’.