In October 2018, the Department of Health & Social Care (DHSC) published a grand, ambitious visioni for the future of technology, data and digital services in the NHS – covering the gamut from “basic IT to AI”. Central to that vision are the four “guiding principles” of user needs; (data) privacy and security; interoperability and openness; and, inclusion.
The DHSC also laid out architectural principles to direct health technology development and uphold commonly embraced standards for data, privacy and security. There is a push to embed tools in (modern, up to date) browsers, run all services in the public cloud, develop register APIs and open standards, in addition to decoupling patient record data layers from hosting and digital services.
Finally, the DHSC recognises that the current landscape is not an easy place to transition from and identifies five priorities to hone in on:
1. Infrastructure: This rolls up national open standards, cyber-security and data standards with the cloud and user needs, with a critical focus on interoperability.
2. Procurement: Buy the best technology, and / or upgrade existing services.
3. Digital services: Start with user needs, develop services that address unmet user needs if required – but only build what the market cannot yet provide.
4. Innovation: A framework of guidance for innovators and research, with transparent simple rules, a bent to collaborate & co-develop, as well as testing and iteration in the real world (with a sprinkling of AI)
5. Skills and culture: Recruit data scientists and analysts to crunch data and generate insight, have leaders drive data and tech into organisations, inculcate an open, agile and iterative culture, while establishing governing boards to set standards across the health and care landscape.
What does this all mean?
This is implicit recognition that, while technology should be a prime component of health and social care, it should be “offshored” into browsers, using the cloud, and deploying open standards to enable those who build emerging tech to do what they do best. Health and care commissioners should – in theory – simply be able to tap into the open market to choose the best options for their users, or to engage with the market to develop and refine products and services. We would finally be leaving health and care organisations to focus on delivering effective care, innovation and research, and not on upgrading MS Office suites.
The DHSC aspiration is at odds with some unfortunate truths: the NHS is a complex tangled stack of organisational, delivery and funding structures, cocooned within a risk-averse culture, that must juggle limited resources, rising costs, ever complex demands and diminishing public confidence. To top this off, the debilitating combination of oft-crumbling legacy technology with painfully lengthy and inextricable commercial contracts makes attempts at modernisation very challenging.
Moorhouse is familiar with these challenges, both as an implementation partner delivering components of the Five Year Forward View, and through supporting healthcare leaders to push through changes locally and at CCG level. We are aware of the improvements needed within the NHS IT estate, but the challenges in health IT loom larger than the DHSC vision.
Their principles are – in principle – welcome direction, but they are not enough. What are the tangible next steps to bring alive this vision, given that commissioners and local providers have not been explicitly empowered or given access to the purse-strings-that-be?
So, what can be done? Here are what we see as immediate next steps:
1. Address immediate clinical needs, measures and outcomes – and translate the value of technology to clinicians
Uptake needs to be tracked throughout the lifecycle of any digital products & services, and capital investment in technology or infrastructure translated into clinical measures and outcomes, if the value of technology is to immediately resonate with clinicians and non-technical commissioners. Peer-to-peer recommendationii remains a powerful engine for innovation dissemination, so winning over clinicians and commissioners is key to the DHSC’s vision taking root.
2. Support local commissioners to invest – even when in deficit
The aspiration to use HIMSSiii as a standard in order to achieve foundational, structural and finally semantic interoperability is admirable. However, cross care-setting interoperability services are currently locally funded. How are smaller players going to cope with the added expense? If this is indeed a priority for the DHSC, and given capital investment falls under its remit, we would be keen to see funding flows that follow this interoperability vision.
3. Ensure big GP IT suppliers play ball: shorten their contract periods & mandate open standards
Another hurdle entails existing commercial contracts. While future procurement can ensure contracts are short-term or with flexible termination clauses, at the moment careful negotiation is required. That may nevertheless result in an expensive extrication of healthcare organisations from their existing contractual set-ups and commercial relationships. Similarly, it is not in the commercial interest of large IT suppliers to have open data standards. Engaging with suppliers will be key to working towards a unified vision. How can we engage with suppliers to work towards a unified vision?
4. Implementation maketh success
Buying the best tech is not enough. The best tech is often the best-suited tech: products that are not necessarily the most advanced in the market can be a better fit for user needs, with a greater return on investment. Even then one must allow for teething troubles and time to bed in and disseminate change. Plus, the continued difficulty of ensuring procured technology is implemented appropriately. Providers must be equipped with a culture more amenable to change, with a resourced IT team within the provider to implement change in whatever form it takes, support and train users. Additionally, we need strong sponsors to push through change, and accountability to ensure that services and products are being used and continually optimised for better use.
5. Engaging and empowering the right people
Arguably the most crucial hurdle is bedding in a culture of constant, incremental change. By keeping change incremental, there is a smaller psychological and organisational cost of change to providers. Risk and cost is significantly reduced. The benefits or learnings from said change can then be disseminated to other organisationsiv. Best of all, incremental change can be reversed strategically, or iterated upon and tested till user needs are comfortably met. It also emboldens providers to trial more innovations.
Moorhouse has applied our healthcare and digital expertise while working with local commissioners, and seen how incremental change can yield incredible products and services within the NHS – especially in combination with effective change management practice. It will be fascinating to see how the DHSC pushes through its priorities in the near-term but don’t place any bets just yet.
iii. HIMSS is the Healthcare Information and Management Systems Society. It is best known for championing IT interoperability through its Electronic Medical Record Adoption Model; advancing through the eight stages of the adoption model achieves a paperless health system with a complete EMR system and seamless data exchange and continuity
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