“I’m pretty certain that the health informatics community know how to create the open digital ecosystem we need to support the emerging new models of care, but I have concerns that a lack of knowledge and experience amongst policy makers, vested interests in the care, informatics and vendor communities and a naive belief in the Tooth Fairy. Might mean we don’t achieve what’s possible.”
There are two things it is certain that we need to do to help address challenges that an ageing population creates for health and care. Firstly, we have to get much closer integration of health and care and move care nearer to the patient. Secondly, we have to leverage digital technology to support this change using both big data and small data to deliver more appropriate care more effectively.
I’m pretty certain that the health informatics community know how to create the open digital ecosystem we need to support the emerging new models of care and that there are examples of successful approaches that we can draw from. However, I have a number of concerns, that:
- Policy makers don’t have sufficient knowledge of the available options or the technical understanding of Informatics and digital health and care to make informed decisions.
- Informaticians and technologist from outside of the domain don’t have sufficient understanding of health and care to provide good quality advice to policy makers and worse believe that they have.
- Organisations on the ground also lack sufficient knowledge and technical understanding which means they are not able to critically appraise proposed solutions from vendors and may be tempted to implement solutions that appear to address immediate priorities but which are not scalable or sustainable and which create vendor lock-in.
- That many in the NHS, vendor and digital health communities have existing positions and conflicts of interest which disincline them from taking the radical steps necessary to work towards the creation of the open digital ecosystem we need.
The imperatives outlined in my introduction are recognised by policy makers and are the thrust of the approach outlined in NHS England Five Year Forward View Central to policy is the creation of new models for the delivery of health and care and policy makers are, rightly in my opinion, facilitating and encouraging various approaches to create new organisation and structures to deliver care. At the heart of all of these is the creation of some form of accountable care organisation (ACOs) with total responsibility for the health care of a given population. ACOs could emerge from various directions including General Practice, NHS Trust, Local Authorities ,the private and third sector. Yesterday NHS England announced 29 Vanguard sItes to implement 3 approaches These are: multispecialty community providers (or MCPs), primary and acute care systems (or PACS), and enhanced health in care homes. We also already have work around the Integrated Care Pioneers with the initial 14 now expanded to 25 and work under the Prime Minister Challenge Fund to improve access to GPs also has relevance and finally we have the ambitious plans announced for Manchester, which are likely to be replicated elsewhere.
All of these initiatives have massive implications for new and existing digital technologies, both to mobilise data and to enable the digital delivery of services to citizens. It will be necessary to create interoperability between existing systems across health and care and changes to make it easier to implement and integrate new digital services and apps. This integration requires interoperability both of data and workflows to allow the sharing of both information and tasks across multiple actors in care communities and needs to liberate information in open and computable formats to facilitate big data analytics to help us understand needs, what we are achieving and how we might do it better.
All of this has to happen in an environment where privacy, information sharing and governance issues are addressed but while this is in many ways the biggest challenge, it’s something that I’ll leave for a future blog.
There are many companies developing new and existing products to meet these challenges and while many of these have a more open approach than has traditionally been the case most are still based on solutions tied to particular vendor or technology. My view is that such approaches which give a small number vendors a dominant position are unlikely to have long term sustainability and even where they do create a degree of vendor lock in that is against the public interest. As far as possible we need to create solutions based on open standards independent, of particular technologies which allow multiple vendors to play allow the easy replacement of any single proprietary component to avoid vendor lock-in.
If we are to achieve progress policy makers need to recognise their lack of knowledge and be aware that those advising them both public sector IT specialists and vendors may a have vested interests which mean their advice must be critically appraised. This can only be achieved by a more open, collaborative and transparent process. All of us have our own agenda seeking some mixture of money, power, sex and glory with concerns about how we pay the bills. No individual or organisation can offer informed and impartial advice and it’s only if we are all honest about our motivations and concerns and debate the options openly that we can make progress – I’m in it mainly for the glory, have paid off the mortgage but could still use a bit more cash and a gentlemen never tells.
I outlined one approach I think has great promise in my previous blog
For more about ACOs see: