NHS at 70: digital natives, migrants & refugees
The NHS is celebrating its 70th birthday. It is a unique and remarkable organisation and deserves much credit. But like many 70-year old’s, it struggles to adapt and change. Nowhere is this clearer than in its struggles to adopt digital technologies and meet heightened demands of a new generation of patients – digital natives, their parents, (digital immigrants) and their grandparents (too often digital refugees).
NHS: the world’s largest cottage industry?
The NHS comprises 15,000 organisations and is more like a cottage industry than the single monolithic structure it is perceived in the national psyche. This fragmentation makes for an awful lot of communication to ‘join-up’ organisations to deliver patient care and it also slows innovation. It is remarkable that the NHS ranks as one of the most efficient health systems in the world given this constraint. But this efficiency comes at the expense of patient outcomes and staff who waste too much time on non-clinical activities as recent reports for the BBC highlight. Too often patients or their carers are left to integrate and make sense of the disintegrated information they receive from multiple sources, something most are not equipped to do. If we fixed this at the national level, then the NHS could do a lot better with additional funding than simply treading water given growing demand. The adoption of standards, the release of open data and maybe more common systems could go a long way to achieving this. But we need more than system inter-operability – we need open standards to allow small innovative vendors to compete and lower costs. Initiatives such as this one from the PRSB, INTEROPen and RCP are sorely needed (declaration – we are a member of INTEROPen).
Too many Pilots, not enough implementation
With an eco-system of 15,000 organisations one would expect innovation to thrive and this is certainly the case, whether digital or clinical. But this fragmentation makes it hard for the NHS to quickly scale innovation, regardless of where it comes from. Stimulating and generating good ideas and proving them in a few pilot locations is one thing, making them available across the country a much tougher challenge. Fragmentation is one challenge but integration into treatment pathways, training and resourcing are also issues. This is a costly and frustrating problem and a deterrent to innovation; who wants to spend time and invest in innovative digital solutions that do not achieve impact because of a lack of take-up? The NHS needs to take a more holistic ‘end-to-end’ view of innovation and explore ways to ensure the best innovations can be quickly scaled. And it needs more ‘followership’ from local CIOs, CCIOs and others not to re-invent the wheel but adopt solutions proven by others.
Artificial Intelligence (AI): an answer to NHS skills shortages and costly delayed diagnosis
Delayed and inaccurate diagnosis are prevalent throughout all healthcare systems, including the NHS. Too often £10 problems become £100 ‘solutions’ because of these delays. Although not a focus at this event, AI has the potential to improve performance in these areas and elsewhere. AI promises to improve clinical decision-making, quickly and cheaply, alleviating staff shortages, stress and burn-out throughout a medical establishment. AI has potential in all 8 areas of clinical weakness highlighted in the BBC report above, not least in speed and accuracy of diagnosis, a major NHS weakness. But AI is clearly a challenge to the clinical establishment and will meet resistance, well-meant or otherwise. An early example of AI adoption is Babylon Health integration of AI into their app and DeepMind Health with Streams. But AI is also appearing in other areas such as radiology, where it supports triage. AI could deliver much needed transformational change and help close the finding gap and make the NHS fit for the 21st century. It could also help shift the focus of physicians onto patient relationships and caring; a focus on illness to one on wellness. But Healthcare AI needs to move from clinical trials to mainstream adoption and address issues of transparency, accuracy and above all, trust.
Patient ownership of data: patient knows best
A very topical issue given the recent prominence of GDPR and moves by the NHS to inform patients and ensure access to data for research and improved outcomes. Patient-controlled records such as Patients Know Best illustrate the trend to patient ownership. But the take-up is patchy, and opinion split on the value and impact with some GP’s and others resistant and fearful of the dangers of increasing levels of ‘self-diagnosis’. But tthere is evidence that AI imbedded into apps and tools can outperform clinicians in many areas and these can only improve with time. Digital natives (and this includes a growing number of digital native GPs!) are keen on apps that make healthcare access 24/24 and 7/7. These work from any location and use devices they are comfortable with. They avoid travel, waiting rooms, other ill people and limit waiting time. Add-in a growing range of smartphone health diagnostics and it is easy to see patients with far better data and diagnostic tools than a GP or clinician today.
Theses reflections on Digital healthcare and the NHS are triggered by attendance at ‘Healthcare Digital Technology Congress’ by Convenzis, Mancheter June 26th 2018. For more on Governemnt plans for innovation and IT in the NHS see Innovations in Medicine 2018