As of April this year all patients are supposed to be able to access their health records online, but what more can the NHS do to improve how it uses information and technology?
In recent years, there has been a significant focus on joining up healthcare IT systems, going paperless, and streamlining health information. Huge amounts of money, possibly billions, have been invested in – for the most part – failed efforts, such as the implementation of a nationwide patient information system several years ago. More recently, in 2013, the NHS announced the Care.data project to link patients’ GP records with their hospital records, but this too generated a fairly-negative response, with the general public veering between annoyed perplexity, because they had assumed records were already shared, and sudden anxiety over privacy concerns.
Why is it that despite huge efforts and funding, essential modernisation within the NHS has failed to take hold? After all, the benefits of implementing improved technology are clear and widely accepted. Automating systems would help drive patient safety and better data sharing would improve efficiency, save time, save money, improve care, and support the move towards integration.
There are several reasons the NHS is struggling in this area:
- It’s a huge organisation with information systems that have developed and evolved organically over the past 20+ years
- Most healthcare organisations have tens, if not hundreds, of independent IT systems built for very specific, niche purposes. The designers of these have, to date, had little incentive to ensure they talk to each other
- Concerns around patient information security
- It’s hugely difficult for individual frontline organisations to justify the cost of aligning their IT systems and, even if they could, there’s no assurance their partners could interact in the same way
- The centralised efforts to revolutionise NHS IT have struggled under the weight of complexity, trying to reach an ambitious one-size-fits-all solution
The key to moving past these challenges towards successfully joining up data and systems is to step back and consider the NHS simply as a business. It needs a business model, one that incentivises and supports the driving force of innovation (think Google’s marketing business model); it needs to keep things as simple as possible (Amazon is a great example of this); and it needs to put the patient (customer) at the centre of the process (think Facebook).
Automating systems would help drive patient safety and better data sharing would improve efficiency, save time, save money, improve care, and support the move towards integration
The last point is crucial. The current system doesn’t particularly incentivise individual healthcare organisations to solve their challenges and hurdles to entry. Patients, however, are highly incentivised, which brings us back to the opening point about people being able to access their health records online. It’s important because the healthcare system is now realising – and for the most part respecting – the fact that patients know and understand more about their medical conditions than ever before. The days when patients were discouraged from taking an active part in their own care are thankfully becoming a thing of the dark and distant past. Evidence suggests that the more involved a patient is, the more likely they will be to receive the right care. This is particularly relevant when we consider that 70% of England’s health and care spending is on just the 30% of our population with long-term conditions. And over the next 10 years, this is predicted to rise substantially.
This concept of patients as partners was the opening focus of the King’s Fund report The Future is Now, which highlights current, innovative health practices across the UK and Europe. One case study about a 70-year-old woman with a chronic auto-immune condition outlines how valuable it is for her to be able to access her medical records remotely. “She can see summaries of her current problems, medications, recent consultations, letters, test results, allergies and immunisations. With two passwords, she can access this information wherever she goes. 'That is very powerful – it makes me feel safe and in control’, she says”
Patients should be able to own and access their own health records – ideally in one place that is updated following each visit to a GP, A&E, or inpatient department; a sort of securely-controlled Facebook for health. Most people genuinely care about their health, and this sort of tool could help them understand it better, manage it, and possibly even connect with other people experiencing similar conditions. This joining up of a community living with the same chronic illnesses (ie a group of patients as experts) would be a powerful way to support people and spread innovative ideas without further burdening NHS finances. The opportunity for people to be more actively aware and informed about their health may even lead to individuals taking better, more pre-emptive care of themselves in the long term.
The argument against something like this might be that patients with typically-high health needs, like the elderly, aren’t necessarily the right demographic to operate technology. On the flip side, most elderly people now carry and use mobile phones. The real way to ensure usage would be to make any new technology easily accessible and as simple as possible – at least initially.
Starting simple and developing over time has been the key to success for so many innovator systems. Again, Google, Amazon – and of course Facebook – all spring to mind. Businesses like these are known as disruptive innovators, a term coined by Harvard professor Clayton Christensen to describe organisations that create a new, unexpected market, often eventually disrupting and lowering the prices within the existing market.
The current system doesn’t particularly incentivise individual healthcare organisations to solve their challenges and hurdles to entry
Another key component of the success of businesses like Google, Amazon and Facebook is their ability to join up and use data effectively. They can target ads to individuals based on their internet use and spending history. In a similar way, technology and measuring data will eventually allow us to personalise, and even predict, care for patients based on genetic make-up. Just think how much more morally satisfying it would be for this sort of innovation to be applied to supporting people's health.
I’ve been fortunate enough to witness transformative results through my work with Newton to deliver improvements within health and social care organisations, particularly when using technology and data to focus on care. Some examples include:
- Dramatically increasing the use of telecare devices at a large council through understanding the blockers to adoption, and building visibility to help navigate these, allowing adults in the care system to remain independent at home for longer, and saving over £5m annually
- Reducing hospital length of stay by 6.2%, a result largely driven by a well-structured and embedded electronic nursing handover tool, which helped highlight every patient’s next step, and saved £3m a year for an NHS trust
Reducing hospital DNA (did not attend) rates by 30% by using data to predict where DNAs were most likely to occur and directing supportive reminders to these patients
This combination of using straightforward, smart technology while focusing on patient care is a powerful one. It’s essential for modernising the NHS, rising beyond the financial constraints, joining up services and making integrated care a reality.
Ric Whalley in business manager for healthcare at Newton Europe
