• 16 Jun

    Shifting the goalposts: the quest for a digital NHS

    Sue Farrington Posted by
    Sue Farrington

    It was a match made in heaven – a rapidly advancing digital landscape of innovative tech meets an NHS ripe for an ‘information revolution’.  Or so we thought.  It turns out things aren’t quite that simple.  As the NHS reels from the recent spate of cyber-attacks, the Patient Information Forum (PIF) and MHP Health have taken a fresh look at the ongoing quest for a truly digital NHS and find themselves clinging onto hope for the future.

    By Sue Farrington, Chair, Patient Information Forum; Isabel Lawicka, MHP; and Paula Pohja-Hutchison, MHP

    A digital health revolution?

    “The future of countries, businesses, and individuals will depend more than ever on whether they embrace digital technologies.  And many of those who stand to gain the most are not yet connected.”

    World Economic Forum, The Global Information Technology Report 2016

    The exponential rise in new digital technologies over the last decade has opened up seemingly endless possibilities in the field of healthcare.  There has been much focus on connected medical devices that are creating a digital health revolution and making use of technology to put healthcare truly in the hands of the patient.

    And yet the NHS still seems to be grappling with some of the basics of digitising its systems and services.

    Timeline graphic

    Headline government commitments on achieving a paperless NHS, accessing medical records online and the creation of digital centres of excellence have been abundant.  But progress has been painfully slow.  Electronic patient records were first promised a startling fourteen years ago.  Since then, at least eight policy documents have set out varying commitments to new digital advances.

    In a similar amount of time, the online retailer Ocado went from not existing to delivering 150,000 orders a week[i].  This is of course an unfair comparison, given the differences in the scale and nature of the challenge, but it does hint at the fact that there has been a digital nimbleness in other sectors that we haven’t yet seen replicated to full effect in the NHS.

    “Patients want to access their test results, book appointments and view their records in the same quick, convenient digital way we access our bank accounts and do our shopping.  Without these facilities, patients have less control and clinicians’ valuable time is used with non-clinical questions, reducing the time they have to spend on care.”

    Juliet Bauer, Director of Digital Experience, NHS England 2017

    The moving target of a paperless NHS

    Rather tellingly, Jeremy Hunt MP, Secretary of State for Health, admitted recently that previous targets for a paperless NHS wouldn’t be met.  The goalposts have now shifted several times, with the latest target set at 2023.

    In addition, the recent Next steps on the NHS Five Year Forward View sets out 14 IT-related commitments, with the expectation that these are embedded into local strategies.  Giving trusts the freedom at a local level to take the digital agenda forward in this way leads to an inevitable uncertainty as to what extent change will happen at the pace it needs to.

    “I perhaps rather bravely said I wanted the NHS to be paperless by 2018 in my first few months as health secretary, and I am quite relieved that most people seem to have forgotten that I made that promise.”

    The Rt Hon Jeremy Hunt MP, Secretary of State for Health, 2017[2]

    Does the future look bright?

    So, what should we realistically hope for in the not-too-distant future?

    Professor Klaus Schwab, Founder and Executive Chairman of the World Economic Forum, has suggested we are at the dawn of a “fourth industrial revolution”, characterised by a range of new technologies that are fusing the physical, digital and biological worlds, and fundamentally changing life as we know it.  There are also clear signals of a bright future from investors, who are starting to bet heavily on the potential of technological innovation to transform the way healthcare is delivered[3].

    There is a real risk that the NHS will fail to catch the wave of this revolution if it doesn’t adopt the agility we have seen in other sectors.  The results of our recent Twitter poll on this topic pointed to an NHS lagging severely behind.

    PIF graph

    Despite a commitment from April 2015 that all GPs should offer their patients online access to a summary care record[4], 92% of respondents stated that they don’t typically access their medical records online.  In the most recent NHS England GP patient survey, just 1% said they access their records online.  This contrasts with the 95% of people who responded to our Twitter poll saying that they typically do their banking online.

    This begs the question as to whether the NHS is successfully communicating about its current, if limited, digital capabilities and providing patients with the right support to make use of them.

    Our findings and recommendations

    We see the following as the main benefits to be gained from ‘going digital’ in the NHS, and what’s currently standing in the way of achieving this vision:

    Benefits of ‘going digital’

    • Interactivity
    • Targeted ‘real-time’ patient information
    • Records follow the patient
    • Patients become true owners of their information

    Current barriers to ‘going digital’

    • Cultural resistance
    • Lack of understanding/evidence of benefits
    • Concerns about digital exclusion
    • Poor interoperability of existing systems
    • Concerns about data security

    In order to ensure that the NHS picks up the pace on progress in this area, PIF and MHP Health believe the top five priorities for the next five years should be:

    • Ensuring patients are able to own their online healthcare information and are confident in its security.
    • Developing the digital platforms necessary to allow patients to interact with their healthcare information and to support shared decision making between patients and healthcare professionals.
    • Prioritising interoperability between systems so that data can be used to their full potential in securing better patient outcomes.
    • Realising the potential of wearable technology in self-care and the management of long term conditions – for example, innovations like the snap40 device (a wearable that monitors vital signs and alerts doctors when health is deteriorating), which is being trialled by the NHS in Scotland
    • Exploring the use of virtual reality (VR) in preventing ill health, in line with the strategic aims of the NHS Five Year Forward View. This has been seen in a recent University of Oxford study looking at the use of VR in managing the symptoms of some severe mental health conditions.

    In five years, there should be no excuse for the goalposts on digitising the NHS having shifted yet again.  We at PIF and MHP Health remain optimistic that much can be achieved in this timeframe with the right focus and leadership.

    For further information, please take a look at PIF’s report published earlier this year – Personal Health Records: Learning from voices of experience

    [1] Ocado Group, The Evolution of Shopping, accessed on 10 May 2017 via http://www.ocadogroup.com/who-we-are/our-story-so-far.aspx

    [2] Health IT Central, 2017, Health Secretary hints paperless 2018 target is unrealistic

    [3] The Financial Times, 2017, Digital disrupters take big pharma ‘beyond the pill’

    [4] NHS Choices, Your health and care records, accessed on 17 May 2017 via: http://www.nhs.uk/nhsengland/thenhs/records/healthrecords/pages/overview.aspx

    Posted on Friday, 16th June 2017