How can digital transformation improve health & care?

What professional education do CIOs and Chief Clinical Information Officers (CCIOs) and their teams need? A few basic themes are: clinical leadership (we’re not doing “IT projects”, we’re trying to help clinicians do their jobs), patient safety (technology is not magic and sometimes makes things worse), the socio-technical nature of organisational change (implementing technology that changes business processes in resource-strapped settings operating at close to 100% capacity is not simply a “deployment”), not reinventing wheels (like using established data and interoperability standards) and that the hype about AI is still mostly hype.

Evaluation – an important professional duty

Another important professional duty is evaluation. This is not merely “benefits realisation”, where the projected savings in the business case are imagined, sorry “measured”, but also looking at unintended consequences both good and bad. A current example is the promotion of 111 to reduce demand on hospital emergency departments. Has it worked? We don’t know, because the government is pressing ahead with the roll-out and not releasing the evaluation data (so far). It is similar to patient apps, intended to empower people to self-manage their conditions and thus reduce the need for health services. Has it really worked or has it (as in the recent experience of a Derbyshire general practice) increased “cyberchondria” and demand for appointments?

Improving the usability of IT systems

A final example of professional education and ethical duty is improving the usability of IT systems used in health and care. A recent study showed that none of the emergency department systems used in the UK meets industry benchmarks for usability. This is arguably true of much healthcare software and is not unrelated to levels of physician burnout and data overload – such a recurring and significant issue that the Journal of the American Medical Informatics Association devoted a special issue to it in May 2021.

Sometimes generalist IT leaders are shipped into senior NHS jobs. Do they have a sufficient understanding of how health and social care are different from other sectors? Of course, there is the old “we need to learn from aviation and banking” argument. That does have some truth but ignores not only the byzantine complexity of NHS but also the unfortunate reality that infrastructure and development spending on NHS IT has been consistently and substantially inadequate when compared with major industries (and social care even worse), as first headlined by the Wanless report twenty years ago. Perhaps a health informatics induction programme should be mandatory for CIOs that join the NHS and social care from other industries?

Closing thoughts

There are positive signs. Integrated care systems have the potential to realise interoperable economies of scale, share digital best practice across larger communities and implement consistent data sharing. The great success of the vaccination programme, in contrast to the hugely expensive and not very effective private sector Test & Trace, has shown what the NHS can do. Let’s hope that the post-pandemic economic phase does not trigger another destructive austerity era, but rather sees the value of investing in the health and care workforce and the professional skills they need to achieve the benefits of digital transformation.