Gartner says NHS over-reliant on closed systems
- 21 September 2017
Leading technology analysis firm Gartner has said the NHS IT market is too reliant on closed proprietary systems, and must follow other industries and drive to open platforms and surrounding eco-systems.
Speaking at a recent event on OpenEHR in Salford’s Media City, Gartner health analyst Mike Jones said: “I think there is an over dominance in the market in systems that are not open.”
Proprietary systems, he said, result in data becoming locked in supplier’s systems, resulting in a lack of interoperability.
Jones said the future was a move away from single solutions, following other sectors which suffered similar over-reliance on a handful of dominant mega-suites like Enterprise Resource Management, and moved away from this.
Gartner has looked at ehealth strategies in 35 countries and concluded the traditional core mega-suite EHR model, a model that Gartner had long championed, is broken when the aim is to join up a complex, ever changing health and care economy with the citizen at the centre.
“The traditional model of having an EHR on its own, as sole tech to innovate an ecosystem around is flawed, you need an open platform,” said Jones. He said about two-thirds of the countries that Gartner has looked at have all come to a similar conclusion.
“This happened in the enterprise resource planning system market 10-15 years ago where they realised they needed to have innovation across an eco-system was not going to happen by just relying on core systems.”
Instead, many have moved to a shrunken core ERP – once dominated by SAP and Oracle – that now sit within a much more diverse eco-system of business applications.
To achieve their ehealth ambitions shared by many countries, of patent-centred care, he argued the direction of travel needed, he said, was towards open platforms, and supporting eco-systems, based on open data standards.
“Gartner has seen platforms take off in many sectors, and we think the same needs to happen in health,” Jones said. “There is a huge opportunity for the NHS to create open networked platforms.”
He pointed to Android and Apple IOS as examples of platforms that have been hugely successful, because they enable many people and companies to create tools and applications that add value.
“The most important effect is the networks effect as platform grows at an exponential rate of the value it provides,” Jones said.
“Platform business is something that allows business eco-systems to create and exchange value. In health, it can be in the form of insight or care, but what it really does is match business to consumers.”
Jones, a former NHS CIO, said that there are formidable challenges in health, but some clear steps needed: “First, is leadership and culture, we have to overcome tribalism.”
“Second, we need open architectures and to move away from siloed solutions.”
Next is the strong governance and to overcome misaligned funding. Finally, he said a new approach is needed to governance of IT services and getting past idea that everyone has their own architecture.
“It needs some hard decisions from CIOs on where they see the future of their IT service, it needs much more collaboration on IT services,” said Jones. “And we need to drive requirements of markets – which currently doesn’t address the needs of eco-systems
He said failing to do so will only result in further failures. “Otherwsise, we wind up with more white elephants and a market failure. What we end up with is very low value from those core systems.”
Jones added: “Gartner’s view is that citizen-centric services need an open platform at the centre that is able to deliver person-centred care.”
Asked where to begin, he urged NHS CIOs needed to begin by requiring suppliers adhere to open data and interoperability standards like FHIR and OpenEHR, “You need to say that before we do business with you we need you to make data open and exchange data using open standards.”
22 Comments
This all makes sense to me thx Gartner for being brave enough to say so. I think focus needs to be on dealing with the (expensive and frustrating) legacy of paper (digitising this) and getting the “eco-system” as Jones puts it moving to encourage co-production of care i.e. meaningful patient input and involvement…together this can transform healthcare…
Am not sure I can totally agree with all being said here. I was a CIO (Dir IM&T) at a couple of large Acute Teaching Trusts for some 15 years, most at Board level. But even when not on the board on not I always had access to both the Board and the clinical directors and I set / sold the strategic direction. Though i have been retired a while now and i appreciate things may have changed.
Regarding the plethora of NHS IT systems. There are many sides to this discussion too. Back in the 80’s when the NHS started to embrace IT (for wider admin and clinical support use), we did broadly have singularity of systems, well at least at Regional level. Each Region had a Regional Computer Centre, usually staffed by extremely smart people. The RCC selected the systems and ran the contracts, at Trust level we implemented then and ran the hardware. Regular RCC/Trust/supplier (not called Trusts then) meetings worked out the upgrades and future developments. By and large, with some frustrations, it worked.
But by the late 90’s that had all gone, completion and market forces were the bywords. So the NHS IT market opened up with suppliers from home and abroad and suppliers sought to lock Trusts into their propriety systems, and why wouldn’t they? After all it takes a great deal of funding to develop, maintain sell, implement NHS IT systems, especially when each Trusts wanted its own variations. But suppliers did provide a growth path that broadly followed the national and market direction.
There has always been the siren call of the “wonder system”, I have seen many and been hugely impressed with their potential. Sometimes totally integrated packages of everything, sometimes as a sort of “EPR Reporting system” taking feeds from local best of breeds. Usually very expensive with massive implementation upheaval, cost and risk to patient & administrative care if things got off to a sticky start. To make the most (in some cases anything) of these systems usually requires unprecedented levels of procedural and cultural change in the way a hospital works, from top to bottom. Unless the whole being of the Trust (ie: everyone) is totally bought into this, the risks are massive. At worst a total breakdown of operational systems on wards, clinics etc. Or a half way place where you have bought a Ferrari but never get out of 1st gear as you use it to deliver meals on wheels. Any clinical or financial benefit is lost.
Never underestimate the difficulty of bringing about such absolute change in a large hospital Trust. So one can perhaps sympathise with trusts who opt for the lower cost, lower risk option of existing suppliers offering an reliable, affordable, doable upgrade path .
An excellent discussion with many valid points. In my experience across a number of countries, the software vendors do approach sharing of data differently; the software selection does matter.
That said, more often it is IT and clinical organizational challenges that prevent sharing of data, not a technical barrier. I’m empathetic to the NHS challenges of having to ‘change the tires while the bus moving’, however this effort is essential to building and efficient health system that is patient centric and supports digital patient engagement for population health improvement.
The earlier comment about not seeking perfection, but rather just getting on with it, is appropriate. Waiting for a national data structure and governance policy that standardizes care is not going to meet the patient care needs anytime soon.
Unfortunately, the white elephant in the room and that the very problem we are trying to solve is inherently self-caused. Within NHS IT, we have very little say in technologies or vendors that are adopted by clinicians. Most CIO’s within the NHS are not on the board and are simply overridden in decision making by senior clinicians who buy into the vendors sales pitches.
When attempting to counter this with reasoned technical discussions, the “clinical risk” card is played which trumps any and all arguments and gets the clinicians the systems they want with little or no understanding of the technical consequences.
This merry-go-round has no end in sight however. Most technical teams know how to achieve benefits and would greatly embrace more open-source solutions, but until IT has the power to say no we will be stuck with a heavily fragmented IT infrastructure, closed systems and vendors rubbing their hands in glee at the thought of locked-in data.
Back in 2014 Gartner described openEHR as an immature standard (see page 25 of https://www.regjeringen.no/contentassets/355890dd2872413b838066702dcdad88/gartner_survey_ehr_suppliers_systems_norwegian_market.pdf )
Now we have Gartner’s Mike Jones waxing lyrical about an openEHR based product with somewhat dubious ‘open’ credentials.
What has changed in openEHR to change Gartners’ assessment?
Ummmm…..3 years and a track record of implementations? Technological innovation continues and learning from other sectors such as ERP. There’s nothing worong with changing you mind from the evidence (we are supposed to be working in medicine after all…).
Unfortunately the report Gartner made for the Norwegian government in 2014 had several misunderstandings and errors about this topic.
Agree with all of the above comments. Let’s not also forget that the NHS is breaking at the seams and that it is struggling to provide basic care and follow up for NHS patients.
Last I heard the NHS has 1% of its budget set aside for digital tech and it has 0% for innovation.
It is unrealistic to think that in this climate (particularly with primary care about to collapse), that any meaningful change is going to happen any time soon.
What health secretary/NHS leader would back large IT projects when they have such a history of failing AND when they could use that money to recruit more nurses and doctors needed to carry out the fundamental duties of the NHS?
This reads like promotional content. The problem isn’t that the systems are closed in fact some are far from it. The problem is one of a number of things :
– Failure to get a grip on the basics of the DPA and consent – God help us when GDPR comes in.
– NHS Paternalism and layers of bureaucracy between APIs and patients / industry.
– Bad or poorly managed contracts that don’t get APIs out there fast enough or at all.
– Relating to contracts lack of API neutrality enabling suppliers to pick and choose who they want to work with rather than the NHS.
– The Obsession with debating perfectionism rather than getting on and doing something useful with what we already have today.
– Every organisation reinventing the same wheel & “not invented here syndrome”.
– Waiting for national components like Identity which take years and are always late when things can be done locally today.
The two main GP systems EMIS and TPP have APIs albeit some of them are legacy and clunky but we’re only talking about 2 systems we have to work with! They even have local identity processes and patient facing APIs. As a patient I have yet to get to my data in a useful format despite this capability being available for years.
Major hospital system vendors typically have comprehensive APIs. The likes of EPIC, Cerner , etc. have all kinds of services, even patient facing services. These are up and running in other countries just not the NHS it seems. More worryingly these same hospitals are buying new solutions to enable them to send patients encrypted emails for GDPR. WHY!?!
The problem is you have 100’s of organisations 1000’s of instances of systems and many more contracts. Not to mention poorly informed IG departments who don’t get the basics of consent. There is almost literally nothing nationally coordinated. This alone is enough to prevent anything ever happening.
Then you have the people, processes and politics who stand in the way of change, resist it or leverage it to their advantage and the patient rarely gets a look in.
All this before you get anywhere near to the technology at which point you get the old boys health informatics club sat around in their suits pontificating about standards and open source.
The number of NHS organisations who still run their own email servers “because their different” should be a national scandal al a Hillary Clinton.
IT in the NHS is a self protecting industry, they are all looking to build their on little empires or get some sort of super hero t-shirt.
Patients don’t give a flying fig about any of this and not once have I ever heard anyone say “what is the quickest and easiest thing we could do to benefit patients today”. Not once, ever!
As an “old timer” this sounds like a very familiar argument, one at least 20 years old, so its good to see that “Déjà vu” is alive and kicking. Regardless of the many and varied technical aspects I think that for the NHS there remains a major “elephant in the corner”. That the NHS is neither structured nor run as a single organisation, or should that be entity.
Sure we have some common denominators, such as the NHS No, that should mean we can link everything with everything. But Acute is different to Community, often different to Primary. While NHS Exec, Regions, CCG’s (PCT’s as was) and Acutes were restructured in the 80’s for competition and accountability, not homogeneity. This means that financially, organisationally and culturally all to often these bodies are miles apart. This is not even to consider the disparities in funding streams between organisations and National IT strategies.
So to move away from locally preferred options (be that best of breed or some wiz bang EPR) if we want the NHS IT market (ie: individual trusts,) to move away from their safe (though maybe limited) closed proprietary systems and drive to open platforms / surrounding eco-systems, there probably needs to be a reassessment of why the NHS remains so fragmented at its structure, management and delivery.
My personal and honest opinion – yes, local accountability and responsibility for what’s being done locally re: financial stability and operational efficiency, but when it comes to the data … far more should be being done at the national level, why ? … because it would be more efficient and would treat (i.e. access to their view their data and hopefully, in the future, to maintain it) people more equ ally.
Having been present when this was delivered, it is great to see that the discussion is happening! Small steps, lead to change and change is on its way. The INTEROPen charter where suppliers have signed up to sharing and open API’s is definitely the way forward and the momentum is increasing. We need to be patient. With trusts like SalfordGDE where this event was held leading the way, it will happen. Take a look at http://www.interopen.org
Whilst there are some valid observations in the article, let’s not forget that f it wasn’t for the proprietary systems, there would e no data to share!!! The vendors developed their systems in isolation at a time when there was no coordinated approach to patient care.
Now there is, what is needed is an approach that enables that data to be extracted and shared across disparate systems.
It’s not technically that hard. The barrier, I fear, will be the bureaucracy that will need to oversee it.
And yes, it’s interesting to see that Gartner have changed their tune in the past decade, from a monolithic solution, to an open shared solution.
wages not waste Proprietary software is poor value
The value in any medical system is not in the data it holds – core data holdings for any given class of healthcare system should be standardised – but in how the access to the data is structured, how it is displayed and the inference engines (AI) that draw inferences/patterns/trends from it.
The NHS has wasted jaw-dropping amounts of money on wave after wave of data normalisation programmes – whose main job has been fetching data from systems and transforming it into some common format so that some often quite basic processing can be done for national purposes. If the same amount of energy had been put into coercing suppliers into common data formatting and holdings the NHS would be very much further forward in so many areas by now. If that could be done, huge amounts of cash and energy could be put into better ways to use/display/mine that data without the constant (and repeated) impediment of data normalisation and the cost of paying suppliers to do that work over and over for solving a product they perpetuate!
Gartner have fundamentally missed the point. The problem in the NHS and Health in general is rarely a technology issue. Analysts talk about sharing data as the holy grail, but this has been happening for many years, both within NHS Trusts and between them. The real challenge is creating a data-driven culture where decisions are made based on evidence, and clinicians, managers and executives are prepared to change behaviour to improve patient care and reduce unnecessary cost. Even with the oldest systems, data can generally be extracted and joined with data from other departments or other NHS Trusts. Getting the insight from that data into the right hands at the right time is the real driver for transformation.
I think you are conflating two different issues. Interoperability is fundamentally different to intelligent use of data, but one is predicated form the other. You’re right in what you say, but I don’t think Gartner missed the point because they are talking around a different issue. The level of interop at present is simply not good enough to facilitate system-wide clinical decision making work well and needs to improve. No amount of Epic/Cerner implementations will solve this.
This is a huge change in opinion from Gartner who have been previously been championing megasuite systems as the way forward. Building a platform around open standards should allow innovation to flourish but will require a strong leadership from some visionary CIOs to get the ball rolling. A ‘bi-modal’ strategy where an open platform is evolved alongside already deployed systems is a pragmatic approach.
and the fly in the ointment….! we’re not comparing eggs with eggs! can you remember filling in a data sharing agreement with your bank or sitting down with the bank manager whilst he explains how they are going to share your data??? no! you just rock up to any cash point and expect to be able to see your bank balance and withdraw cash! However the NHS is under immense scrutiny of data sharing, look at the concerns over eDSM now multiply that over even more systems! Until data sharing is clarified and amended doesn’t might what bright ideas or amazing systems are out there, its never going to happen!
The difference is that your bank is your bank. But, your GP practice, hospital, out of hours service, etc are all separate organisations. That’s a wonderful mine field of different data controllers and needs for consent to view data. The NHS is not a corporation, it’s a network of organisations working under one flag.
But you can go to a different bank and still read you’re balance and withdraw cash.
The simple answer to most things is to centre around the patient. Far too much in the NHS is centred around itself, no wonder it buys systems that lock the data in – it’s the model of the nhs.
your are right, health is provided by many different organisations, some under the NHS flag, some not, some of these organisation need to open up and all need to work together (share our data) in order to provide solutions for all who live in the United Kingdom
Comments are closed.