Three strategic tech priorities for digitalising the NHS in 2021
- 15 April 2021
With the NHS approaching its 73rd birthday, Satpal Biant, head of public sector at SAP, explores what should be the health service’s top tech priorities.
Next July the NHS will celebrate its 73rd birthday. Further distribution of Covid-19 vaccines will make it a less gloomy occasion than last yearās, but there can be no doubt that the forces unleashed by the pandemic ā most importantly digitalisation ā will continue to reshape the institution.
Digitalisation is causing upheaval across society ā from videoconferencing disrupting traditional ways of working to the rise of dark kitchens in hospitality and the boom of ecommerce overtaking high street shops. And as identified by the 2020/21 NHS People Plan, this digital disruption has gone right to the heart of the NHS as well.
The impact of the disruption will last beyond the pandemic. Of course, digitalising an institution like the NHS is even more difficult than a retail chain. The past year has shaken the healthcare sector ā but 2021 will be the year in which the NHS can regroup, adapt, and plot a path to the future. To get there I believe there are three key technological priorities the NHS should focus on for the next 12 months ā coordination and interoperability; cybersecurity; and innovation and intelligent automation.
Coordination and interoperability
The NHS employs 1.3 million members of staff ā making it the UKās largest employer, and one of the largest employers in the world. Its immense scale and segmented structure makes coordinating resources difficult.
A consequence of providing such a range of services over so many regions, is that over the years the organisation has splintered ā and so has its technology. Outdated legacy IT and more modern technology is therefore siloed and unable to interact. This was one of the most important findings of last yearās House of Commons Public Account Committee report, ‘Digital Transformation in the NHS’, which concluded that the lack of interoperability and limited capacity for information sharing across the NHS are two of the biggest challenges to its digital transformation. With critical information stored across unconnected servers, clinical systems and databases, tracking the patient journey across different departments of the NHS is incredibly complicated, hampering its ability to drive efficiencies across the organisation and streamline patient care.
Tackling this lack of coordination and encouraging greater interoperability should therefore be a major priority for the NHS in 2021.
Migrating parts of IT infrastructure to the cloud can be an important practical step towards doing this. Data stored on the cloud can be managed and shared more easily, making coordination easier. This should ease supply chain and procurement inefficiencies, and data derived from digital services can offer leaders greater insight into collaboration.
Cloud can also offer the NHS more computational power than on-premises IT. Such a massive organisation inevitably generates vast quantities of data, and as healthcare is increasingly digitalised, more and more will need to be verified, stored, managed, and analysed. Investing in cloud adoption in 2021 will mean the NHS doesnāt have to play catch-up in the future.
Better coordination and more interoperable data sets will have real-life impacts on patient outcomes. Hospitals or departments will be able to share health records with less friction, for instance. And when it comes to national health issues like Covid-19, obesity, or Alzheimerās, having access to deep and broad data pools could be game-changing. It should also make workforce planning and management simpler, meaning healthcare workers can do their job more effectively.
Cybersecurity
We witnessed a spate of nation-state cyberattacks at the close of 2020, highlighting the growing threat of cybercrime for public and private organisations. While only the biggest and most successful breaches make headline news, attempts are far more frequent.
As our healthcare system becomes more reliant upon a digital foundation, the NHS must ensure itās protected from cyberthreats.
A robust security system should feature reliable backup storage to prevent data loss and ransomware, in addition to redundant server infrastructure ā distributed data centres that ensure both data and services are available to customers even if one data centre fails. Cloud services can also help shore up the NHSās security as cloud security can be updated regularly with full adoption from all connected devices, preventing blind spots.
Encryption is also vital. At a fundamental level, encryption simply makes data unusable for those who do not have verified access, so it should be the bedrock of any organisationās data security capabilities. Multi-factor authentication is another important security tool that reduces the risk of breaches using stolen or lost devices.
Innovation and intelligent automation
As Covid-19 will continue to be a threat in 2021, the NHS must be ready to adapt to innovations quickly, and indeed innovate itself in response to crises. As such, decision-makers should prioritise this as a key organisational outcome in 2021.
Applications and digital health solutions will need to be made faster, updated more regularly, and distributed more quickly in 2021. The best way to do this is to build these applications and solutions using a secure cloud platform. These can then be scaled and distributed across the NHSās many regional arms.
Another area in which innovation will be particularly key is intelligent automation. Automation can bring massive efficiency benefits while freeing up staff to do more rewarding, high-value tasks. The private sector is coming on leaps and bounds in this regard, by ensuring intelligent automation of business processes from the back office to the front office and reaping the benefit. The NHS is making some progress, but with a staff of over a million and budgets stretched, applying intelligent automation to core clinical processes where possible should be a top priority.
An opportunity for renewal
Prioritising the technology outlined above would be a positive step forward ā but the NHS must go further. As the Public Account Committeeās 2020 report identified, āclear and transparentā governance arrangements are vital for real long-term success. In the past, implementation plans have been convoluted and opaque ā blocking innovative private sector solutions and obscuring the procurement process, to the detriment of the government, private companies and the public.
NHS leaders must take this opportunity to layout implementation plans with rigorous success metrics in place and accountability for decision-makers built-in. The private sector should be embraced for the value it can add from the get-go, and decision-makers should consult the public on their needs.
2021 is an opportunity for renewal ā not simply in terms of the technology used by the NHS, but in a broader sense. It can be the year NHS decision-makers embark on a truly long-term strategic plan. By doing so, the NHS will be in a strong position for many years to come.
19 Comments
Can someone get these comments in chronological order? It’s vey hard to follow the drift.
Oh and the last thing the NHS needs is SAP with its monolithic 20th century technology.
Ewan
My previous ‘Replies’ get Ewan’s name wrong and I think the ‘n’ on my keyboard misses intermittently. Humble apologies….
But it does need to count (y) our money, A & E!
Some observations from my hospital bed.
Kevinās low hanging fruit is actually quite hard to reach, but if we jump we can probably reach it. FHIR is the best available approach to doing this but requires three non-trivial steps.
Agreeing the data elements needed adequately define a piece of clinical content (both mandatory and optional elements) and how to represent them (data types, units, terminology bindings, etc). We have been working on allergy/intolerance for 20 years and we are still arguing about the details.
Amend systems containing relevant data so they can provide these data elements.
Amend systems wishing to ingest these data elements so that incoming data can be handled by appropriate workflow to store it in the system, rarely do you just want to stuff data from system A into system B.
We also need to FHIR enable these systems, but this is quite straightforward with good third party tools and open source libraries to assist vendors.
This approach can enable some high value data to be shared but is not scalable to achieve the data fluidity we need to fully exploit the potential of digital technology.
Terry, I love ultracrepidarians, seems to fit here. Sure we need to address process, but it is unrealistic to expect to standardise this across the NHS (there are good and bad reasons for variation) any approach has to accommodate the extreme complexity of care processes and data and their variability.
Richard I think it was Ā£12bn not Ā£22m, some of that was spent on a failed attempt to standardise process.
Until policy makers, politicians and tech companies understand the complexity of health data and processes and how hard it is to achieve data fluidy we wonāt progress as we could. The slow pace of progress over my 40 years in the sector is not because we donāt have clever, committed people working hard or because we donāt have the funding. Itās because itās hard and rather than focussing on the hard problem we get waves of people who know nothing about health, the ultracrepidarians, imposing simplistic solutions that donāt work and distract us from the hard work that really needs to be done.
Ewan
What ever you DO, DO IT nationally, why? Because that way is… Fair4All!!!
Eva, I bow to your knowledge in tis but I should like to point out some actions which apply across every ‘industry’. Firstly there can be no solution to any problem unless that problem and its ROOT cause is identified and a common understanding of it across stakeholders. Only then can a ‘solution’ be developed (with technology still on the distant horizon) via definition of problem and examinations of solution options, without pre-judging the applicability of current soliton, standards etc..
Then a project setup, with objectives, sponsor, accountability deliverables, skills, milestones, review and go/no go/revise points and all the other paraphernalia of a proper project. It should be noted that project management will be of no use if what he/she is managing is dog’s breakfast.
In all Government projects, I detect no scent of these essentials, and believe me, I have tried to track several of them without success. Examples are the 50+ glowing NHS futures reports in my document listing them and other news one which are doomed to the same fate; oblivion.
The principles I outline are startlingly simple and effective. If the solution, especially technology (Matt Hancock’s obsession) assumes upfront that existing ideas/standards/technology etc, will be used then the project will be (put politely) sub-optimal. The maxim here is; ‘Assume Nothing and Prove/Verify Everything’.
Errata.. Eva, sorry.
Sorry again! Ewan, Ewan, Ewan. I had K/B collywobbles.
Thanks Ewan and Mary for answering my query about why hospitals, GPs etc who treat me cannot – or will not – communicate with each other electronically. However, They haven’t answered my question “why do the Great North Record seem able to do this, but their colleagues in the south can’t.?” Is it expertise, leadership or just plain will. They blame ‘Connecting for Health for the wrong approach, “rip and replace’ or a failed attempt to “stardardise process”. But that was long ago., about ten years. Surely,in these ten years, they could have devised a new approach which would work. Or did they not think that ineroperability matters?
My own experience makes me disagree. One cold night in January last year, I was rushed , blue lights flashing, to Resus in hospital K. My records however were in hospital H. I had to wait while the consultant spent what seemed hours trying to dig my records out of hospital H. His time was wasted in the search and my life was endangered. This was not just me. I imagine that this search is played out a hundred times a night across the country. All for the lack of decent transferable records. To me, a nonagenarian, patient, interoperabilty matters.
Richard, your ‘unique’ experience is quite common. My wife visited hospital H on two sperate days in the same week. Day 1 we had to spell out all sorts of things about here medical history, which fortunately we could. Day 2, different department, we were asked for the same info again. I quietly fumed but when I related this to others, many said they had had the same problem at some time.
In short, if the NHS data sharing was a horse, they’d shoot it as an act of mercy.
Technically, the NHS is NOT NATIONAL and in 2021 that is unacceptable and horrendously inefficient – volumes are not the issue, the issue is weak senior leadership that is not held to account for failed IT projects.
I would say 2020/21 was the year NHS tech transformed. We should review as we’ve seen some very good interop introduced and also revealed areas of weakness.
I don’t see legacy IT as a barrier to interop, we can’t buy new IT systems to resolve issues. These older systems may not match the latest dataset but that doesn’t prevent them from being interoperable, i.e. being able to get information in front of (external) clinicians, admins, etc or being able to inform external clinicians/trusts of key events.
Much of this is ‘low hanging fruit’ which tends to be seen at a clinical/technical level rather than managerial (unless a pandemic is in progress).
I would say 2020/21 was the year NHS tech transformed ? I disagree, but it HAS hi-lited significant weaknesses.
I am now growing weary of reading articles by Ultracrepidarians(*) talking about technology as an end in itself. This is not only wrong but very dangerous. The order of service is: get processes fixed, fit technology to suit. There is no other way (at least that works).
(*) āUltracrepidarianism is the habit of giving opinions and advice on matters which one knows nothing aboutā -William Hazlitt, essayist.
I am now growing weary of reading articles by Ultracrepidarians(*) talking about technology as an end in itself. This is not only wrong but very dangerous. The order of service is: get processes fixed, fit technology to suit. There is no other way (at least that works)
(*) āUltracrepidarianism is the habit of giving opinions and advice on matters which one knows nothing aboutā -William Hazlitt, essayist.
“…the lack of interoperability and limited capacity for information sharing across the NHS are two of the biggest challenges to its digital transformation. With critical information stored across unconnected servers, clinical systems and databases, tracking the patient journey across different departments of the NHS is incredibly complicated, hampering its ability to drive efficiencies across the organisation and streamline patient care. ……Tackling this lack of coordination and encouraging greater interoperability should therefore be a major priority for the NHS in 2021.”
Yeah, yeah, but I remember, way back in 2002, wise people saying exactly the same thing. In fact,they launched a national initiative called ‘Connecting for health’, to solve the problem once and for all. Sadly, after spending about Ā£22 million, nothing happened – except in the far North of England, where GPs, hospitais and social services seem to be getting linked. Where I live, however, in a leafy London suburb, the four hospitals and my GP who treat me seem to me to be as disconnected as they were 20 years ago. They seem to communicate solely by stately snail-mail letters on beautifully headed notepaper. They do sometimes use the telephone.
Why is this? Do the hospital managers, IT staff and GPs down south not believe in interconnectivity and data standards? Or do they believe that IT stops at the hospital gate? Or do they find the technology too challenging? I would really like to know, but I suppose they think that as i am just an aged patient, my view does not count.
Up north it looks as though the answer has been to allow read-only access to the GP record. As this is – supposedly – a “cradle to grave record” that makes sense, but doesn’t solve the GP problem of what happens to patients referred to secondary care while there.
Interoperability of patient records *does* depend on the records being held entirely electronically in the organisations contributing the records – *&* the format of the records being transferable – for want of a better term – between systems & organisations.
In 2002, Richard thought he was coming to a greenfield site – & seemed to think, when he found how wrong he was, that a slash & burn policy would effectively return the NHS to a greenfield state…
Not sure any of these enthusiasts for collecting data & storing it “in the cloud” (btw – is this allowed under DPA2018 if “the cloud” is not geographically located in EU, UK or privacy equivalent jurisdictions?) don’t seem to be aware of the complexities of record structure – or of retrieval of information relevant to the problem being considered from a record stretching over up to 100years!
TSB – & other banks – had severe problems while migrating from one banking system to another: & compared to medical records, banking is simple!
I wish them luck: it will be needed: but unless it makes the lives of the front line easier, getting any system adopted by already stretched front-line (& all the others required to use it) will be the most difficult thing to accomplish..
i have to be honest … on the front line the NHS has great careers for clinical people and managers BUT not for technical people, i know a few great technical people but they have to ‘pretend’ to be NHS managers when their real interest is technology, this is such a shame and it needs addressing NOW otherwise other countries are going to take the lead in digital healthcare and reap all the reWARDS, and those rewards are on an Epic scale ! be honest health leaders
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