To complement our new report, Delivering the benefits of digital health care, we’re running a blog series exploring how digital information technologies can help to transform health services. The series is a mix of interviews and thought pieces from a range of perspectives including frontline staff, digital practitioners, researchers and others.
It’s no secret that healthcare lags behind other industries in capitalising on technology. While the National Programme for IT (NPfIT) brought some advances, it ultimately failed to digitise hospitals and was abandoned after a £10 billion investment. Now, the Department of Health has set aside £4 billion for the digital agenda. But without correcting our past mistakes, attempts to create a paperless NHS are doomed to fail.
We’ve spent the last year reviewing the evidence of technology’s impact on healthcare, and speaking to those leading the way. Our research has identified seven lessons that executives in every healthcare organisation need to know.
1. Transformation first
Technology will only succeed if it supports new ways of working. Technological interventions have failed where technology has simply been layered on top of existing structures and work patterns, creating additional workload for healthcare professionals. You need a transformation programme supported by new technology, not the other way round. This principle underpins everything.
2. Culture change is crucial
You need to invest at least as much in programmes of organisational change as the technology itself (and ideally significantly more). You will need leaders with a deep knowledge of both clinical and technological systems, a culture that is receptive to change and an environment where all staff feel empowered to spot opportunities to improve. Clinical champions and active staff engagement can help with this. It is critical to make sure all staff interacting with new technology receive training before it is introduced, followed by ongoing support.
3. Design systems with users in mind
Technological systems should solve problems for their users, not create new ones like laborious data entry. For example, a decision support system needs to provide prescribing advice at the exact moment the clinician is thinking about prescribing. When systems meet clinical needs they are much more likely to succeed and when clinicians experience technology making their lives easier, they are much more likely to be supportive of ongoing change. Clinicians should always be involved in the development of systems. You should also customise the information you present depending on who is looking at it.
4. Make the most of data
You need to invest in detailed analysis of the data that is collected by digital systems. This is the main way that you will be able to improve and learn from experience, making processes better and better over time. In order to achieve this, you will need a team of highly qualified analysts and data scientists. This may not be a quick or cheap solution, but the potential for long-term gain is enormous.
5. Expect a long journey
Even if you follow all of this advice, you won’t get it right first time. You should see this as an on-going learning process that might be painful at times. But the investment will pay off in the long run. You will need people who can adapt both clinical practices and the supporting technology as you evolve. It is now routine for large health care organisations in the US to have chief medical and chief nursing information officers.
6. Support data sharing
Sharing data across multiple settings is fundamental to realising the benefits of a paperless NHS. A lot of work needs to be done at a national level, but there are also things local leaders can do. The first is getting the balance right on customisation. Modifying an electronic health record system will make it better suited to your needs, but changing it too much can inhibit data sharing. Secondly, weigh up the benefits of a single system versus multiple specialist systems linked together. There is no consensus on what is most effective. A single system will always be the second-best option compared to a purpose-built solution for a particular specialty, but it is more likely to support integration.
7. Protect patient data
Concerns about patient data falling into the wrong hands or being lost has historically made patients and professionals alike resistant to digital systems. Robust data security will improve public acceptance. Make the most of tools available to you such as the HSCIC information governance toolkit. Whatever processes you put in place, make sure they are clearly articulated to patients – particularly when seeking permission for non-clinical uses of data.
Ultimately, realising the potential of technology isn’t easy. It takes time, money and perseverance. It needs visionary leaders, committed staff and an understanding of what is on offer. But in the long-term there are opportunities to transform our health system into one that is proactive rather than reactive; coordinated rather than fragmented; and forever improving to offer the best possible service to patients.
A version of this blog first appeared in the HSJ.
The views presented in this blog are those of the authors and do not necessarily represent the views of the Nuffield Trust or our partners.