This morning I logged in to my bank account on my smartphone, checked my balance, transferred some funds, and rated the service received for a book that I ordered online—all before my morning shower. I then sent an email to my boss explaining that I would be late today because it was going to take me most of the morning, including travel time, to attend a ten minute follow-up appointment at my local outpatient clinic. Why is health care so far behind the times?
This was the topic we recently explored at a breakfast session at the Nuffield Trust’s 2011 Health Strategy Summit. The average cost of a face-to-face outpatient appointment, we were told, is £85. But many of these appointments could be done over the phone for as little as £10, or even via the internet for just £1. In a time of financial pressure and need for efficiency savings, why are the vast majority of these appointments still carried out in person?
The other topic we discussed was that of personal health records. The NHS currently operates in an environment with multiple, different IT systems. The issue is the inability of many of these systems to communicate with each other, not only across providers or commissioners, but often within them as well.
This issue is not unique to the NHS, but is one that has been solved elsewhere. An example from the USA showed how information from 675 different clinical systems, across 65 independent offices could be pulled into one system to generate a single record.
Nothing discussed at the meeting was particularly new or groundbreaking. Indeed, these discussions have been going on for many of years with seemingly minimal progress. How then, do we turn discussions into actual progress? One way is to explore and learn from the successes of other countries. For example, the health care infrastructure of some Middle Eastern countries could hold useful lessons for the NHS.
Another is to explore how other sectors of the economy have tackled similar issues. Clearly the confidentiality of patient data is rightly an issue of overriding importance in health care. But if banks are able to keep my financial information relatively secure, whilst providing me with easy, secure access, then surely the same can be done for health records.
Unwillingness to move away from current arrangements is also a barrier. A study in Birmingham showed that, of patients who stated they would prefer a face-to-face appointment, 98 per cent of people said that they were satisfied upon receiving an alternative.
Finally, changes to national guidance could assist progress. Should hospitals still be sending faxes to GP practices? Should heath care professionals be provided a budget for investing in smartphone technologies, which many currently pay for themselves?
Given the financial pressures facing the NHS, and entrenched resistance to change, the question is whether we will still be having these same discussions in five years’ time. I fear so.
Robert A (2011) ‘Digital revolution: bringing the NHS into the 21st century’. Nuffield Trust comment, 24 March 2011. https://www.nuffieldtrust.org.uk/news-item/digital-revolution-bringing-the-nhs-into-the-21st-century