NHS tech: let’s walk before we run

Dr Shaun O’Hanlon

Forget the ‘shiny new thing’, it’s the basics of a digital NHS that will transform the service, writes health tech chief medical officer Dr Shaun O’Hanlon.

Artificial intelligence, 3D printing organs, robot surgeons – when thinking about the application of technology in healthcare, it’s tempting to focus on the latest shiny new thing.

While there is of course a huge amount of important innovation underway in our sector, if we focus on the biggest gains that technology can deliver for the NHS now, the answer is perhaps a little less sexy than this.

For, despite 30 years of work to digitise record-keeping, there is still some way to go before the fundamental platform of a ‘Digital NHS’ is achieved – the seamless sharing of patient information at the point of care and the use of analytics to better plan services based on real data rather than assumptions and gut feeling.

Simply moving from paper to electronic record-keeping is the first step towards this goal. While digital records ought to be a given in a 21st century NHS, sadly we all know that in reality, progress is still patchy.

Earlier this year, a coroner warned just how dire the consequences of paper communication can be – highlighting unacceptable delays in the communication of a medication change for an 87-year-old woman on Warfarin. She had died four weeks before the letter from the hospital advising of the change finally arrived with her GP. A recent NHS report on medication errors highlighted the key role digital technology has to play in addressing this important issue.

This is simply not acceptable in a modern NHS – and it demonstrates the critical importance of achieving even these most basic first steps towards digital services.

Sharing data can be revolutionary
Taking a more positive view, the good news is that once electronic records are in place, we can then share data between clinical teams to enable truly joined-up care. This is a game-changer.

Take the example of a pilot project in Newham, East London, which is allowing GPs and pharmacists to read and write into a shared patient record – a first for the pharmacy profession.

For the pharmacist, being able to see a full picture of the patient’s diagnosis and history, including attendances at A&E and test results, is, he says, nothing short of revolutionary. It means he can give better advice, monitor his patients more closely – and can even book follow-up GP appointments for the patient.

Working together within a shared record has also enabled GP and pharmacist to join forces to improve patients’ health. They are using the software to identify and treat Latent TB Infection in their area, which has the highest incidence of TB in the UK. They have a 100 per cent success rate in completing the treatment, which the GP expects will lead to a reduction in active TB among her patients in the future.

Imagine the potential of this joint working to improve patient care in disease areas like diabetes, hypertension and HIV. It is also a significant opportunity to relieve some of the pressure on over-stretched primary care services, by moving elements of care into pharmacies and direct to the patient.

NHS England backing
NHS England has recognised the fundamental importance of shared records in its recent announcement of £7.5m of match funding towards the establishment of five new Local Health and Care Record Exemplars.

These regional initiatives will build on existing local work on shared records to develop region-wide initiatives – with the aim of directly improving patient care. Bids were due to be submitted last week and I will watch their progress with interest.

But shared records are only one part of the story. There are huge gains to be made by using the data we hold to not only improve the care of the individual patient, but also to power analysis to plan and deliver better services for all.

Data analysis cuts patient waiting times
A powerful example is NHS Greater Glasgow & Clyde, which has used electronic data analysis to significantly reduce waiting times for vulnerable young people with mental health problems.

The health board has cut waiting times from an average of a year to just six weeks by checking supply and demand and planning capacity 13 weeks in advance, via an electronic system. It is now offering 1,000 more appointments a month than in 2014, when it was using paper records.

It is also using data analysis to understand patterns of non-attendance and to see how the board can work with families to reduce missed appointments.

How can we move forward?
I have outlined some powerful examples of how technology can benefit the health service – technology that is available here and now, not in some sci-fi future.

How do we accelerate uptake to ensure these successes are replicated far and wide?

We must always remember that technology on its own is never the answer; it is only the enabler. More important is the implementation, usability and sustainability of the systems.

  • Users need systems that are intuitive to use, with reasons and a purpose to use them.
  • Patients need to understand what benefits record-sharing brings (that’s the subject of a whole other article).
  • Localities need sustainable training and implementation programmes.

It’s clear we still have a long way to go – but the prize is worth fighting for.

Dr Shaun O’Hanlon is chief medical officer at EMIS Group. Follow him and the organisation on Twitter @drshaun @EMISGroup

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