Carter: NHS to adopt ‘meaningful use’

NHS Improvement should create ‘meaningful use’ standards for clinical IT systems and use incentives to drive better adoption of technology, Lord Carter’s review of hospital productivity recommends.

Carter also says that the new national body that is being set up to take on the work of Monitor and the Trust Development Authority should create a set of national and local dashboards to allow real-time comparison of performance in all clinical specialities.

The peer’s report makes 15 recommendations, including putting a “meaningful use” clause into provider contracts to encourage uptake of digital technologies.

The report says trusts need to make better use of their existing systems and/or invest in new modern systems to improve the access and accuracy of data they need to manage their performance.

At a minimum, it recommends trusts should have the key systems for: e-rostering; e-prescribing; patient level costing and accounting; e-catalogue and inventory management; RFID systems where appropriate; and electronic health records.

It says these systems should be integrated and boards should be made accountable for ensuring they are used to their full potential.

“But we know the NHS does not have a good track-record in implementing such systems, so we are recommending NHS Improvement take the lead by setting the standards for ‘meaningful use’ of such systems and incentivising trusts to achieve them,” it says.

Also, that some of the £1 billion earmarked for investment in NHS IT by government in its recent spending review should be made available for trusts to meet these standards, with a suitable ‘meaningful use’ clause embedded in contracts.

‘Meaningful use’ was introduced in the US by the American Reinvestment and Recovery Act 2009 to define minimum standards for electronic health records and reimburse providers for their implementation – although use and benefit has been harder to prove.

The idea is popular amongst NHS England’s digital leaders with indications last year that it was looking to create a ‘meaningful use’ technology fund with some of the money promised by Treasury.

However, planning guidance released last month and Digital Health interviews with life sciences Minister George Freeman and National Information Board interim chair John Newton in 2016 have focused more on the idea of technology enabling ‘transformation’.

Carter's long-awaited report highlights that data and information is critical for managing quality and efficiency performance across the care pathway: “To truly performance manage quality and efficiency on a regular basis, seamless real-time data is needed, which in turn requires investment in inter-operable information technology.”

The review recommends that NHS Improvement and NHS England should establish joint clinical governance by April 2016 to set standards of best practice for all specialties, to allow the analysis and assessment of clinical variation.

NHS Improvement should create an interactive portal to provide access to this intelligence, with national and local dashboards for each clinical specialty.

By October this year, trust boards should be mandated to review at least three specialities a month, in order to benchmark themselves against national standards of care.

Referring again to the government’s promise of at least £1 billion for health IT over the coming five years, Carter says some of this should be invested in systems that underpin the collection of performance data on quality and efficiency, and ensuring these systems are interoperable.

It adds that while some trusts have embraced technology in this way already, “it is inconsistent and rarely integrated.”

Digitisation of the health and care system is a high priority for government, with health secretary Jeremy Hunt saying over the weekend that the government's investment in health IT over the course of this parliament will be around £4 billion, with £1.8 billion directed towards the objective of creating a paperfree NHS at the point of care by 2018.