At A Glance
- Historically, data relating to health of patients was heavily 'siloed' according to organisational structure
- The NHS has in the past lagged behind other pats of the economy in terms of investment in systems and data
- However, the move towards a paperless, or paper 'lite', NHS continues
- The complexities of completing a procurement with a supplier for a major clinical or administration system should not be underestimated, nor the levels of dependency in terms of what buying organisations must do during implementation
- Implementation is only the beginning
Why is this area important
The digitisation of healthcare in England remains a varied picture, with different health and social care bodies at different stages of digital maturity. It is, however, generally acknowledged that after years of under investment in information technology in secondary care for example, many NHS provider organisations still have much more to do.
The benefits of having the right information at the right time for clinicians is well understood – both in terms of quality and safety. For example, effective clinical systems will ensure that professionals document handovers accurately, are accountable, and in the context of integration of care around the needs of the patient, will ensure that it is easier to share information across multi-disciplinary teams across different parts of the care pathway. At the same time, systems and data have the potential to deliver operational efficiency savings, better commissioning and greater understanding of the health of populations.
Historically, data relating to health of patients was heavily siloed according to organisational structure. That was due in part to sensitivity of the data collected, and concerns, (real or otherwise) about information governance. This approach was also partly due to the sheer complexity and volume of data collected by the NHS. It also reflects the way that systems were often procured in the NHS: system by system. At the same time there has historically, in our view, been a lack of incentives for NHS boards to make significant investment decisions in largescale IT schemes, particularly in light of some high-profile failures in the field.
The NHS Five Year Forward View (5YFV) made a commitment that by 2020 there would be “fully interoperable electronic health records so that patient records are paperless”. In September 2016, the Wachter Review, commissioned by the Department of Health, was intended to provide an assessment of the digitisation of secondary care in hospitals in the UK, and to make recommendations on the way forward. The review follows in the wake of a number of policy and funding announcements, including £4.2 billion funding to support the digitisation of the NHS.
Commentators might be sceptical that the NHS is again returning to the same ground on which there has been past failure – the achievement of integrated electronic health patient records across health and social care. For example, many hospitals in England had, until very recently, made little progress beyond so called ‘PAS’ (patient administration systems) and PAS Plus replacements alongside departmental systems (and in some cases, portals pulling together information).
Whilst most organisations are some way off being paperless, many secondary care organisations are progressing, or have plans or ambitions to progress clinicallyrich electronic patient record systems across their organisation – the corner stone of any ambition for a hospital to go digital.
We would expect the number of NHS organisations looking at so called population health management tools to grow. These tools aggregate patient data across multiple health technology resources (fully implemented from secondary care, primary care, social care, and mental health and community services) and include that data into a single patient record. Such systems are potentially extremely powerful in contributing to the vision of joined up healthcare. A single patient record allows users to monitor and identify patients with for example, particular chronic conditions across care pathways and at the same time produce analytics to help with population health that can assist in disease prevention.
The procurement exercise used to select a supplier should be used in the right way – to identify and agree key risk allocation points on deals, to flush out issues before they occur, and to gain common understanding.
Increasingly, the market is looking towards framework contracts for the procurement of digital systems that can be utilised by suppliers, providing what should be a swifter route to market for both suppliers and buyers. This brings with it (in effect) centralisation of certain aspects of contract negotiation, and to some extent we suspect consolidation of the market in the longer term. Suppliers are likely to have to find a place on the relevant framework in order to operate credibly in the relevant market. However, if frameworks are used, NHS bodies should not automatically assume there is nothing further to do – complex system integration procurements require a level of engagement between buyer and customer – within the confines of public procurement law.
Often, implementing clinical information systems are in effect significant change projects for the NHS customers who buy such systems: changes in work flow and working practices being required. Organisations need to identify suppliers who are likely to support them when implementing complex systems – if, for example, a hospital is implementing a complex electronic patient record system the process is unlikely to be straightforward. Trusts need to find suppliers who are not looking for ways out of contractual obligations, or continuously seeking changes for which they can charge. Allowing a supplier to believe that this is also a good deal for them (rather than a deal where they have too heavily discounted their pricing) is likely to help in that.
Finally, buying NHS health bodies must plan for the amount of resources that they will need to put forward to deliver successful projects, and not underestimate the time required from front line clinical staff.
Once the deal is done, and implementation of the project is complete, it must be recognised that going live with a system is the beginning and not the end of implementation of health information technology.