OPINION: Resolving the digital paradox

Initiatives to accelerate innovation to the frontline are welcome, but details around funding, technology assessments and integration need ironing out to make rapid health transformation a reality, says IMS MAXIMS chief clinical information officer and chief medical officer Professor Michael Thick

Accelerating the adoption of technology at scale and pace has to be a good thing, right?

The government’s latest proposal for digital health, the Accelerated Access Review (AAR), intends to shorten the time from bench to bedside innovation and is an encouraging step for technology adoption.

Simply layering new products onto existing pathways is also no longer viable

The review shows promise and offers valid solutions. It makes a strong case for collaboration between suppliers and the NHS to enable end user design from the outset, which in the past has been a challenge. The collaboration must happen much earlier too; a critical factor for clinical engagement in and uptake of technology solutions. Simply layering new products onto existing pathways, the review notes, is also no longer viable.

Like any review of this kind, the devil is in the detail. While accelerating the adoption of technology is welcomed, important questions remain around integration, assessments, funding and the bigger digital picture that will determine how much of a good thing the review will be for the paperless agenda.

From isolation to integration

The AAR is right to highlight that innovations such as patient-facing apps should be encouraged, but we need to address how this fits into the broader transformation agenda for healthcare providers. It is now widely accepted that the adoption of mobile working is part of the future, but standalone, patient-facing apps that do not share data and knowledge with an enterprise solution presents a significant challenge for managing the care pathway.

It is also important not to omit apps developed for healthcare professionals that, when integrated into an enterprise-wide solution, deliver significant benefits to the patient, professional and hospital.

Getting value from apps in the delivery of care requires a highly co-ordinated view

Getting value from apps in the delivery of care requires a highly co-ordinated view, in both clinical and organisational terms. A myriad of self-contained, non-reporting apps makes holistic and informed care, nigh on impossible. There are undoubtedly certain functions that a small standalone app would be able to support quite quickly in a hospital environment, but if we are to transform – rather than tinker around the edges – there must be integration with the electronic patient record (EPR). Interoperability and the use of agreed open standards are essential if we are to benefit from these innovations.

Moreover, if apps are to be assessed for effectiveness, this should be done in the context of the enterprise-wide solution, not in isolation. They also need to include the very people who have the duty to care.

Earlier this year, NHS England CEO Simon Stevens announced funding for apps that would have a positive impact on patient health and care delivery. The next step, and the secret to acceleration in this instance, has to be a rapid pathway to get suitable applications in front of the people who will assess and evaluate these apps.

The bigger digital picture

They say a week is a long time in politics. It’s also true of health tech, with Sustainability and Transformation Plans (STPs), Local Digital Roadmaps and the National Information Board’s 10 domains and 33 programmes shaping the digital agenda at scale and increasing pace.

How does the AAR fit in with these national and local priorities, particularly as there is increasing uncertainty around capital funding? Where will investment come from for the plans set out in the AAR?

It is clear that the digital paradox remains firm: to save money and transform services, the NHS must be ‘digital by default’, but in order to deploy digital services, organisations must invest.

Taunton and Somerset NHS Foundation Trust has embraced the ‘digital by default’ approach. It has laid solid digital foundations with the deployment of an open source EPR that enables clinical decision support, ePrescribing, medicine management and more. Through the Global Digital Exemplar (GDE) programme, the trust is accelerating its adoption of mobile working, giving due consideration to how this will affect its staff and digitally enabled patients along a care pathway.

Professor Michael Thick

We are currently working with the trust to deploy a range of mobile clinical functions to enable e-observations for conditions such as sepsis, which will enable faster delivery of healthcare, a more efficient way of working for the clinician, and a much safer journey for the patient with enhanced quality and experience. Taunton and Somerset is a digitally ambitious NHS trust, with a firm grasp on the importance of interoperability and standards for shared care.

With mental health, ambulance and community trusts in line to join acute hospitals in the GDE programme, NHS frameworks for technology adoption such as the AAR must look at the bigger picture that incorporates an increasingly digital patient, while also ensuring that the wider health and care economy can benefit from such innovation.

If the AAR gives us the platform to speed up digital adoption, then the GDE programme can be the spring board to deliver integrated care. Therefore, further commitment both in spirit and resource from the government would go a long way to solving the digital paradox.

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