COMMENT: Going for 'Gold' in healthcare informatics

James Turnball of Northgate Managed Services explains why the NHS needs to work in partnership with the IT industry to improve the NHS informatics infrastructure and boost patient care

In this comment article, JAMES TURNBULL, managing director of Northgate Managed Services, explains why the NHS must summon up some Olympic spirit and unleash the power of information to raise the bar for patient care in the UK. But they do not have to do it on their own. If the approach is a team pursuit, the finish line may be closer than many think, he argues.

James Turnbull, managing director of Northgate Managed Services

The NHS truly is a global brand. The opening ceremony of the London 2012 Olympics , quite rightly, presented the health service as one of the UK’s most-treasured possessions – and one of its proudest accomplishments.

It is generally accepted that, despite widespread consensus about the benefits of technology, the informatics infrastructure of the NHS has not yet been fully optimised

But, following a sporting summer where athletes have pushed themselves towards the limits of human achievement, the NHS must itself raise the bar if it is to maintain its position as a world-class performer and redefine the gold standard of patient care.

Setting a new personal best for the NHS will depend upon its ability to capitalise on the vast opportunities of electronic healthcare, and unleash the power of information that can drive improvements in health and social care. The medals are there for the taking, but we need to get out of the starting blocks. It begins by getting the right team in place.

It is generally accepted that, despite widespread consensus about the benefits of technology, the informatics infrastructure of the NHS has not yet been fully optimised. But the Government’s recent NHS Information Strategy for England does provide renewed hope that the promise of electronic healthcare could soon be realised.

As the flames of a London 2012 are extinguished, the NHS must summon up some Olympic spirit and prepare to maximise the promise of healthcare technology

The Power of Information presents a clear framework for how health data can be harnessed to help enable significant improvements to patient care. It sets out a powerful vision of what, with a collective will, can be achieved, and provides a strong outline of the step-change required to transform the way healthcare in the UK is delivered. It is a vision based on common sense and achieving it will require a team effort.

The flagship milestone of the strategy is the promise to provide NHS patients with secure online access to their personal GP records by 2015. Alongside this, healthcare providers and commissioners will be encouraged to communicate electronically to minimise gaps and delays in treatment pathways, join up services and improve the patient experience. Significantly, in a move away from the one-size-fits-all approach of the NHS National Programme for IT (NPfIT), local health organisations are now being empowered to make their own decisions in terms of informatics systems, providing they comply with nationally-agreed specifications and standards.

Delivering ‘joined-up’ care across a broad and complex national organisation is a key priority. It will be dependent upon the willingness of stakeholders – clinicians, commissioners, payers and patients – to share information. System interoperability is a technological issue that, with the introduction of national data and technical standards, can easily be overcome. But securing the willingness to share information is a human and cultural challenge that presents potentially the biggest barrier to change.

Dame Fiona Caldicott’s imminent review of information governance will be instrumental in helping to allay fears about the security, confidentiality and abuse of information. It is a battle that other industries have long since overcome – and healthcare can do the same.

Building a legacy

The aims of the NHS Information Strategy , while challenging, are in fact not overly ambitious. The technology is already there. Moreover its front-end deployment in healthcare will only provide patients and health practitioners with the same basic access to information that we all routinely experience in other areas such as banking, travel and retail.

In a clinically-led NHS, true clinical empowerment will only happen if clinicians are given the systems they want and the functionality they need

The way patients interact with the health service must be transformed to mirror the ‘self-service’ models we’ve become familiar with elsewhere. Simple and innovative technologies such as mobile apps, cloud-hosted services, clinical portals, web-based appointment systems, and automated repeat prescription services can help to redesign the patient-clinician relationship and accelerate and improve pathways of care. These technologies already exist, are easily implementable and, used properly, can help ensure that the right information gets to the right person at the right time.

The information is there, too. The NHS is awash with data, but much of it lives in individual silos – as untapped islands of information stored across disparate local systems, but blind to the wider organisation. The task is to integrate that information into a single view that is securely accessible to all appropriate stakeholders. And the benefits are undeniable.

A fully-informed clinician armed with instant access to a patient record, and a comprehensive view of a patient’s history across other healthcare settings along the care pathway, will be more empowered to make the most appropriate treatment decision. This can only improve health outcomes and lead to a safer, more efficient and more effective health service.

And, finally, the support to make it all happen is also readily at hand. NHS organisations do not need to go it alone to build the infrastructure. Effecting meaningful change is not a solo pursuit, it’s a team sport. The health service’s primary concern is the welfare of its patients, and while technology can play a major part in helping to support that, commissioners, clinicians and healthcare providers need to maintain their rightful focus on patient care and delivering clinical excellence. Implementing IT solutions is not a core competency or capability of healthcare professionals – and neither does it need to be. The trick is to identify and partner with informatics experts, and to consider outsourcing the management of IT infrastructure so that healthcare professionals can concentrate on clinical care.

But, clearly, progress is a collective responsibility. Success will require buy-in from patients, policymakers and healthcare professionals, and the support of technology experts.

The journey ahead is well documented: the vision and the timeline have been laid out in The Power of Information . So how will we get there? The solution is to form the right team and take incremental steps towards winning the race.

Tactics for success

For healthcare providers and commissioners charged with the responsibility of being the architects of change, the first task should be to conduct some gap analysis. Organisations should consider where they are along that journey of change; what are their current systems? What are their existing levels of delivery, security and mobility – and what small steps do they need to take in order to edge themselves nearer to the finishing line?

Equally, once those goals have been identified, providers and commissioners must consider whether they can make the journey on their own, or whether they need help along the way. If a partner is the preferred route, what kind of support is required? Does the organisation need some form of managed services where responsibility for implementation and system management is outsourced to technology specialists? Does it need help on consulting in terms of understanding and developing a strategy? Is it looking to buy infrastructure or software as a service, and who is going to deliver the project and support the change management in terms of making it all happen? Choosing a partner that can help to deliver the key objectives will, in many cases, be pivotal to progress.

The trick is to identify and partner with informatics experts and to consider outsourcing the management of IT infrastructure so that healthcare professionals can concentrate on clinical care

The road ahead may appear daunting – but it does not need to be. Help is at hand, and best practice is already emerging. There are countless examples of innovative technologies being deployed across the NHS that are already delivering patient-centric services and enhancing health outcomes. In both NHS Scotland and Northern Ireland for example, the introduction of comprehensive clinical portals are helping to bring together all aspects of the patient record to form a single view for clinicians. Likewise, mobile virtual desktop technology is enabling clinicians to access data at the patient’s bedside, providing centralised information using a single sign-on. These systems are being supported by privacy breach detection solutions that monitor access and bolster data security. The implementation and management of systems such as these has often been outsourced, taking the strain off NHS resources and allowing health organisations to focus on patient care.

The technology and methodology behind these kinds of innovations is easily transferrable, but the successful introduction of any new system depends upon securing the involvement of key end-users in the design, development and implementation phases. In a clinically-led NHS, true clinical empowerment will only happen if clinicians are given the systems they want and the functionality they need. Their input and buy-in is critical. Identifying a technology partner that not only recognises this, but is also able to build clinical engagement into the system design process, is essential.

A podium finish

There can be little doubt that electronic healthcare has the potential to transform health service delivery in the UK. The NHS has a long and proud history, and remains a world-leader in the provision of high-quality care. But, as the flames of a London 2012 are extinguished, the NHS must summon up some Olympic spirit and prepare to maximise the promise of healthcare technology. It will be a marathon, not a sprint – but with the right team in place, the finish line is well within reach. And victory will put the patient on the podium for some gold-standard care.

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