The state of Healthcare IT

There are two versions of the state of health IT in the UK.  The one portrayed by the media and politicians, and the one illustrated every day in hospitals and GP surgeries when citizens use the National Health Service. The former focuses solely on part of the National Programme for IT that has unfortunately run into trouble and the latter on the successes.

The state of health IT is a mix of both.  However, the outlook is positive not least because work is underway to fix what has gone wrong but also because the NHS and IT industry are moving on, beyond NPfIT, to set out a vision for how information technologies can deliver real value for patients, health professionals and tax payers in the future. 

Why IT in health?
The goal of employing information technologies in healthcare is to have a well organised, precise and seamless health service that benefits clinicians and patients. It is becoming increasingly apparent that we desperately need to achieve this goal because of the challenges facing the NHS. 

We know the health service in the near term need to find a 20 per cent productivity improvement over the next five years, but we also face the long-term challenge of changing demographics. The current population of patients with long term conditions, 15 million, demand roughly 70 per cent of the NHS budget. According to Sir John Oldham, NHS Clinical Director for Quality and Productivity, this population is set to grow 250 per cent in the next four decades. If we provide care the way we do today our health budget will soar to 30 per cent of GDP by 2050 compared to eight per cent today says Oldham.

It is not sustainable. We need to transform the NHS into a sustainable, modern health service that is flexible yet robust. I can’t imagine how the NHS will transform without better use of IT, automation and process redesign. Looking at other big industries and organisations the only way they have been able to carry on is transforming the way they do business through IT. The NHS must to the same. 

Where is health IT today?
The NHS has done well in adopting new technologies. Hospital theatres are using the latest hi-tech robotics in surgery including the interesting use of Xbox Kinect and its motion sensors. Through the National programme for IT we have network services and broadband connections (N3) to link IT systems and NHS organisations in England. The NHS has rolled out digital scan and x-ray systems, GP records systems, electronic referral systems, and e-prescription services with success. 

However we don’t have fully integrated electronic patient record systems across the NHS that join up the health service and make a patient’s journey seamless with improved outcomes. Other information and digital technologies are also lacking in scale to help the clinicians do their job more efficiently and effectively, such as decision support tools, mobile devices, and information analysis systems. These are enabling solutions that would, if scaled up, help transform the way care is delivered across the NHS. 

But parts of the NHS has done well and should be looked at by others. There are examples where integrated electronic patient records have been successful. One can be found in Aintree University Hospitals NHS Foundation Trust where over 3,000 NHS staff uses a modern integrated EPR system, including clinical apps and business intelligence, to deliver better care for over hundreds of thousands of patients.

Another, St Helens and Knowsley Teaching Hospitals NHS Trust are delivering health records electronically, with information about patients accessed and entered directly onto the system with digital pens and mobile devices, enabling better care through timely and accurate information.

Others are working on getting patients engaged in their own care. South London and Maudsley NHS Foundation Trust is launching an online health record that will give patients access to their records as well as allowing interaction to the system directly and joining up with GP practices and Primary Care Trusts.

Where will Health IT go?
For one, the NHS needs to focus more on using information to deliver better care. There is little doubt that one of the most valuable assets of the NHS is the large volume of administrative and clinical data to be found in information systems throughout the NHS. This data is capable of providing the source for effective research, planning and decision making in commissioning healthcare provision at local and national level. 

At the moment, much of this information is in isolated data stores in discrete organisations. While used locally, its use is not optimised. For example, if this data were made available as a web service to commissioners, this historical data could be put to good use to detect patterns and trends and also enable funding to be focused on preventative and prospective care rather than reactive care.

Using information to deliver preventative care and changing the payments system would help the NHS scale telehealth services.  NHS medical director Sir Bruce Keogh believes telehealth solutions are the future in changing the doctor-patient engagement model, including driving more efficient management of the long term conditions population. With the Whole System Demonstrator (WSD) project, a big telehealth pilot in England, due to report in the coming months, the NHS and Department of Health will work on educating and promoting wider uptake of these services. 

In terms of forecasting, Ovum, a technology analysts firm, believes the UK health IT market will grow to top £3bn by 2016. Most of this growth will come from telehealth services and integration work of joining existing systems together and adding new applications, followed by the biggest spend areas of EPRs and digital imaging and x-rays. Other areas of demand will come from the commissioning front where business intelligence, reporting services, modelling, and risk stratification systems are urgently needed in the new commissioning model focusing on outcomes, choice and efficiency.

How do we get there?
Now this is where the most immediate pieces of work need to be done. Many of the solutions that would benefit the NHS are in the market already but there are barriers standing in front of adoption.

One of these is the lack of understanding of the strategic importance of information and technology in the NHS by CEOs and Boards. Under the National Programme for IT, Trusts were not called upon to make what we might consider as risky business transformation and ICT decision and therefore may lack the necessary experience and ability to make such decisions effectively. This means there might be hesitance in undertaking the transformation that is essential today.

Proper informatics teams or functions need to be uplifted and recognised at board level as engines for driving transformation, efficiency and productivity. But this is not enough, it is equally important that the CIO works closely with clinical leads to ensure solutions and processes meet front line requirements and buy-in. 

Another area of work to do surrounds the overall strategy and direction the NHS wants to take. The NHS is not a single entity; it is federated with 100s of budget holders and Accounting Officers driving their own agenda.  The policy move in September by the DH to move towards a ‘connect all’ strategy and local decision making on IT investments gives the NHS an opportunity to make decisions that fit their organisations. However, to maximise the benefits from information technologies in the NHS we need coordination in certain areas. The DH is working with the NHS and IT industry to set out a technology strategy that looks at how the NHS makes best use of various IT solutions and directions.

For example The NHS needs interoperability in order to share patient information across the information silos that exist today. Therefore common standards accepted by the NHS and industry will be needed. Work is already underway with the Interoperability Toolkit (ITK) which allows disparate systems to interoperate and speak in a common language. But more needs to be done, including funding, but especially in creating demand from the NHS and setting out a costing model for suppliers.

Finally, procurement processes in the NHS are a barrier to transforming the NHS. Rigid and lengthy processes locks out innovation, drives up cost and increase the risks both sides have to take. This often leads to solutions that are not fit for purpose and outdated when deployed. Again the NHS and industry need to come together to improve the procurement process and skills in the NHS so that the health service gets the most of its investments.

The future of technology in healthcare should be a productivity-improving and cost-reducing agent, pulled through by solid business cases and justified by the needs of patients, clinicians and other professionals; rather than pushed through by an enthusiasm for technology and the fear of falling behind. After all when technology is used to enable the clinician to multi-task, to focus on critical tasks rather than administration, to interact more efficiently internally and externally and to communicate virtually, it can deliver vast benefits.

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