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Digital Transformation in the NHS Webinar: ReStart’s View

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On 1st July, Jon Hoeksma from Digital Health chaired a thought-provoking webinar on Digital Transformation in the NHS. The subject of the discussion was the National Audit Office’s (NAO) ground-breaking assessment of the NHS’ implementation of digital transformation across health and care, published in May this year.

With a focus on the application of government policy (rather than analysing the merits of it), the NAO report is a must-read for NHS IT leaders. The full report is available for free here.

In order to form their conclusions, the NAO carried out a thorough assessment reviewing strategy documents, business cases, financial data, trust digital maturity and interviews with key stakeholders plus case studies at five different trusts.

What is digital transformation in healthcare?

Yvonne Gallagher, Director of Digital Transformation at the NAO, began by setting out what the Government is aiming to achieve via digital transformation. It’s about more than IT alone – how does digital transformation help solve problems within the NHS?

Whilst there has been a significant step towards adopting new technology for diagnostic tools to help clinicians, the NAO was more concerned with the goal of joining up health and care to improve efficiency and help staff, i.e. how to make interoperability work in the NHS landscape. To this end, a paperless NHS is still deemed an important objective.

Digital Transformation in the NHS

Types of interoperability in healthcare

According to the NAO, if a developer was to build a brand new healthcare IT system today, they would start with the four levels of interoperability identified by HIMSS (Healthcare Information and Management Systems Society). These levels are well documented as the technical types of interoperability, not necessarily a layered approach to achieving it.

Yvonne acknowledged that some trusts do have enterprise systems which incorporate the HIMSS levels and achieve interoperability but questioned why everyone is not doing it.

The NHS’ interoperability challenge: best of breed or single system?

We all know that there are thousands of IT systems in use across health and care, and they all have different standards. The starting point for interoperability is not zero; legacy tech is the base.

How has this occurred? Clinicians want the latest state-of-the-art system. For these end users, it doesn’t matter if their new system does not integrate with other systems. When multiple hospital departments or healthcare organisations think in this way, the result is siloed systems. There was discussion as to whether the best of breed approach is actually favourable over single EPR systems as there is not a single point of failure.

The NAO also found that the cost of enterprise systems is often a barrier to widespread adoption. There is limited research around demonstrating the value of manual processes being replaced by these large enterprise systems – do they actually save a trust money?

A further barrier to implementing interoperable systems is lack of adoption. Clinicians can be reluctant to learn a new system.

Layering systems leads to fragmentation of patient records

Yvonne Gallagher’s findings implied that new technology is being layered over old tech, leading to fragmentation and little cost efficiencies, as patient records continue to be held in a vast array of different systems.

With the varying range of standards among discrete systems, some don’t even contain simple personal data such as name and address; whilst others don’t have a field for NHS Number – that failsafe universal constant for every patient in the uk.

The scale of the interoperability challenge: data and leadership

The constraints of the NHS digital landscape are not unusual. The NAO has found similar challenges across governments departments where data needs to be pulled from systems into other systems, coupled with GDPR (General Data Protection Regulation) and security considerations.

HMRC was quoted as developing digital maturity because it provides guidance to staff when dealing with various scenarios. No one is doing this in health and care. The strategy around digital transformation is all very well but the ‘how’ is missing.

The NAO report is frank in its recommendation that to overcome interoperability problems, the NHS needs strong leadership and a culture that understands data collection, data security and data sharing. At the moment, guidance is lacking about how this should be addressed to help frontline workers. It was also acknowledged that there’s no looking back at previous IT failings within the NHS to understand what went wrong and prevent the same outcomes going forward.

Should legislation drive interoperability in the future?

One of the most provocative statements during the webinar was whether legislation was needed to force hospitals to adopt the same systems and standards. An analogy was made with the railways – law was eventually required to mandate the use of standard track sizes.

Interestingly, there is support for more statutory governance of some areas of joined up health and care. A report published last week from the NHS Confederation Integrated Care Systems Network surveyed ICS (integrated care system) and STP (sustainability and transformation partnership) leaders with 29% favouring statutory integrated authorities and half (49%) preferring a middle way approach.

The conclusion on legislation from Yvonne Gallagher during the digital transformation webinar was that any legislative changes would come with more challenges – enforcement to mandate compliance. Furthermore, even if legislation was introduced, the NHS still faces the question of how interoperability is to be delivered.

ReStart’s view: interoperability starts with clinicians, not systems

ReStart has been building integrated healthcare for over 13 years. Being 100% requirements-led, we start with the end user and what data they need to do their job efficiently to improve patient care.

In our experience, delivering high levels of interoperability doesn’t stop with systems upgrade or replacement. Clinicians have to decide what data they want to see where and when, and the tech team has to deliver it to them.

Far from adding complex layers of additional technology, IMX simply asks ‘what information do I need as a clinician?’ and pulls that data directly from source systems into an intuitive user interface that is customised to each user’s needs, across any health and care setting.

And since IMX is built incrementally, it is flexible enough to scale easily and quickly as a health or care organisation’s digital maturity evolves. This modular approach is perhaps key to digital transformation across the NHS.

Further information

National Audit Office Digital Transformation report

NHS Confederation Integrated Care Systems Network Survey

Listen to the webinar and view the slides at Digital Health Journal Club (free sign up)

To discuss your digital maturity and interoperability requirements, speak to an expert today on 01392 363888 or email

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