Dr Philip Scott, Chair, BCS Health & Care, explores how digital transformation can improve our health and care
The COVID-19 pandemic has rapidly accelerated the adoption of technology and the innovative uses of data in healthcare. Outpatient clinics and GP consultations quickly moved to telephone or online video services. Many non-clinical staff were able to work from home or off-campus. Real or imagined barriers to data sharing were removed by government decree. Local and national analytics moved apace to gain insights into the trends of the disease and its impact on services. Now in NHS recovery phase, with “integrated care systems” forming across England, are we in a new world of efficient, joined-up, digitally transformed services?
Digital transformation of health & care
Certainly, the potential for digital transformation is high on the agenda. Remote consultations are likely to remain the norm in much of routine care. A more pragmatic approach to data sharing has been signalled by the new National Data Guardian. Assumptions about tech and data rightly underpin the NHS Long Term Plan. For many health and care staff, the introduction of new ways of working requires re-training and new ways of thinking about people and processes – and that requires education. The Topol Review stressed the need for professional education and training in the digital age, and the NHS Digital Academy is providing top-class leadership training for a select cadre of CIO level staff. But so much more is needed, not just in academic courses, but in continuing professional development, just as we expect of our clinical colleagues. BCS, the Chartered Institute for IT, along with partner bodies in the Federation for Informatics Professionals, are working hard to realise the professional standards that we need to see in digital health and 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?
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.
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