We often hear about how some of the IT systems used in the NHS are in great need of upgrade. Two of the common criticisms surround the use of:
- systems 20 years and older
- the numerous, non-integrated systems in use that health professionals are having to navigate on a daily basis
At first blush, an obvious and idealistic answer is a wholesale replacement of all of the systems currently used with one modern, streamlined, efficient system. However we must first consider whether this is possible (or desirable, even) given the history of the development of national IT solutions in the past and also whether this potentially expensive solution is a realistic option in such testing financial times for the NHS.
At a recent Guardian event ‘Digital disruption: the role of tech entrepreneurs in improving healthcare’ the panel discussed that some of the IT systems in use date back to the 1980s. Some might say that such a situation cannot possibly be allowed to subsist given the huge advances in technology that have taken place in recent years, but, does ‘modern’ always mean better, even in the context of technology? If the technology still achieves its purpose, why spend money making improvements?
Critics of the ‘out of date’ technology point to the fact that systems are unsupported and therefore not secure; are difficult and expensive to maintain and are slow, inflexible and difficult to integrate with other systems. That would tend to suggest that in this case, a modern system is needed as not only are the current systems old and outdated but from a financial perspective, it is inefficient to continue using them.
A problem closely related to the use of old systems is the fact that health professionals working within the NHS are having to work across multiple IT systems on a day-to-day basis, many of which do not synchronise even within a single provider organisation. The issue is exacerbated because different healthcare providers often use different IT systems. Health professionals are then using up time navigating the various systems (which may force some to turn to applications such as phone apps to ask colleagues for the information that they need). There is also a huge potential margin for error, for example where acute providers are unable to access the vital patient information (e.g. allergies) held on GP records. It is easy to imagine significant consequences for a patient.
Can these multiple IT systems be replaced by a single system used across the entire NHS in the same way as the banking sector has modernised its own systems?
Whilst it is generally accepted that updates to NHS IT systems are needed it seems unlikely that we will see the introduction of a single, nationwide new system in the new future. The National Programme for IT has left a bitter taste and served as reminder that the process of integrating an entire system changeover is hugely challenging.
It is widely recognised that ‘bottom up’ rather than ‘top down’ system changes are more likely to be successful and we expect to see wider regional and place-based collaborations such as STPs, ICSs or smaller groups of organisations carrying out updates to existing systems with a view to increasing functionality and enhancing interoperability. The use of ‘spine’ systems with appropriate ‘bolt-ons’ for different types of healthcare providers for example, have become increasingly popular and could be seen as a more affordable and less risky way to bridge the gap.
Whichever system is used it is likely that at least some modifications will be needed to ensure that it meets the needs of individual organisations. It is therefore important to ensure that these bespoke requirements are correctly recorded in the contractual documentation. Trusts should also be aware that unless a purchase can be made through a compliant framework, it is likely that their IT requirements will need to be procured through a competitive process and appropriate steps will need to be taken to ensure that process is managed correctly and effectively.