I believe passionately in the power of information and digital technology to transform the way we deliver health and care, indeed I consider it essential if we are the meet the growing demands the health and care system faces within the resources likely to be available.
We need to mobilise information to help us redesign services and target the resources available most effectively. We need to use digital technology to deliver higher quality more convenient services more efficiently and we need to make information about how services perform transparent so that the public, patients and health and care professionals can see how they perform and how they can be improved.
However, we need to leave decisions about how local health and care communities realise this potential to them, measure their success in terms of the health outcomes and efficiencies they achieve and avoid mandating particular approaches. While I think it is inevitable that the effective uses of digital technology will lead to a reduction in reliance on paper and an increase in the use electronic record systems it is not true that a move away from paper towards electronic records will necessarily lead to an improvement in the quality of care, indeed when the emphasis is on implementing particular systems rather than improving the processes of care experience tells us that the opposite is more likely. Focusing on becoming paperless and implementing EPRs is a dangerous distraction which potentially provides local health communities with an excuse to fail at their core task of delivering higher quality care.
The primary focus needs to be on how we apply digital technologies to mobilise information and knowledge at the point of care to improve the experience and outcomes for patients and health and care professional at the frontline, while an important secondary focus should be on how we use information and knowledge to design, target, evaluate and improve care.
We should have zero-tolerance for systems that slow down or make tasks at the frontline more difficult (as is so often currently the case) Our expectation must be that good design can create systems that meet upstream information needs without additional frontline burdens.
The incremental upgrading and of digital technology in line with the incremental redesign of care processes is more likely to bring about positive-only changes in care quality than radical big-bang implementations which at best typically result in a substantial negative impact before any net positive benefit is achieved (which in health and care means avoidable death and suffering.)
This requires a new approach from the health IT industry, but one that current technologies can deliver and which can be successfully built on top of the substantial, and in many places excellent IT, already in place. This approach will draw heavily on app and portal technology, open-systems, open-interfaces, open-standards and data transparency. It will require the extension and opening up of existing systems and infrastructure to create an open health IT ecosystem creating a mixed economy for open-source and proprietary components. My experience with both the established health IT vendors and the rapidly growing app community convince me they are more than up to the challenge.
The Centre does have a role to play in creating an environment in which local health and care communities are encouraged and enabled to embrace information driven, digital ways of working, but have to be careful balancing this with the risk of creating unintended consequences and sub-optimising behaviour in local health and care communities. The Centre needs to ensure that personal and organisational incentives are aligned with the need to deliver integrated patient centred services in ways that improves overall quality and drives down overall cost (which they currently are not) and also has a role in creating the technical, cultural and commercial environment in which successful innovation can be translated in to widespread adoption creating a vibrant market.
In playing its’ part the Centre needs to have a clear understanding of the history – In NHS this history of has many clear examples of both spectacular success and failure and needs to engage with those who not only share their vision, but who also understand this history, what life’s really like on the front-line of the NHS and the practical implementation challenges of achieving the vision.