By Colin Reid, Chief Executive of TotalMobile.We are on a journey. The Department of Health's (DH) first mandate told the then NHS Commissioning Board where we needed to get to in order to deliver an improved national health service. The DH's 'Power of Information' strategy plotted the routes of healthcare providers, commissioners and technology suppliers to drive better heath, care and support. It now looks like we are finally getting down to the mechanics of how the NHS's new technology provision will work.
The roadmap to success
NHS England are looking to build a technology strategy to support the 'Power of Information' and the 2018 paperless vision, and are seeking industry views on what this will look like. Their scoping document, 'Shaping a Technology Strategy for a 21st Century National Health Service', highlights some key areas in technology for the NHS to move forward. I certainly welcome a technology strategy and believe it will provide much needed support and guidance to technology suppliers as the boundaries of the new NHS market economy are still being established.
The main theme fuelling the strategy is 'knowledge for all'. For many readers this will probably resonate with patient access to care records, new medicines or patient choices, however, I immediately considered the benefits for our frontline care teams. The NHS has had some well-documented failures, and many, rightly or wrongly, have directed responsibility at frontline staff. In an accountable society, it is only right that safety targets are in place to ensure a standard of care is upheld, but current IT systems are not helping enough frontline staff deliver the required level of care.
Frontline staff in the driving seat
Now is the time to provide frontline carers with the tools to do their jobs. In the mandate's foreword, Health Secretary Jeremy Hunt cited "offering health professionals more power and space" and this should certainly be a key priority for any technology strategy in the making. Providing staff with shared knowledge that empowers them to make better decisions and saves their time on unnecessary repetitive non-clinical tasks. By supporting the frontline, the technology strategy can contribute towards a cultural shift from a closed, defensive and disparate organisation to an open, honest and an integrated one.
As pressure continues for trusts to meet targets, improve efficiencies and quality of care, there is a clear role for technology to help deliver these increasing requirements. I know first hand that the technology adoption curve is not always as smooth as we would like; I foresee some bumps along the way for the NHS.
Speeding up interoperability
Some technology suppliers are in the fast lane and moving quickly to support the new localised NHS. Some are not. From a technical point of view there are lots of different technologies and systems currently deployed, but that is not the issue - it is supplier co-operation. The National Programme for IT tried and failed to ensure that systems interoperate. Now the responsibility is on technology suppliers to work together to meet the national ambitions of the health service, but in some cases this is simply not happening.
What will it take to get everyone pulling in the same direction? Whilst I hope a technology strategy strongly emphasises the need to collaborate, I fear it may not be enough. I would go as far to suggest we need to consider a standard clause for every NHS IT supply contract that says that as a supplier you have to facilitate integration between your system and any other systems that are going to be deployed. Without this, I fear the technological abilities of the NHS will not advance as quickly as everyone hopes.
Putting the brakes on innovation
Our health service needs to adapt to the needs of the 21st century patient. Funding pressures mean healthcare providers are continuingly looking to technology to innovate processes, treatments, logistics, management and so much more, with a view to improving return on investment. Technology suppliers who are not interoperating are missing the bigger picture. How can we reflect on traditional ways of working and best adapt them for future requirements if the suppliers are refusing to work together?
New ideas can come from anywhere. IT-led innovations can uncover fresh approaches to a routine that a frontline nurse may not have thought possible. However, it is often the end users themselves who are the source of new ways of working, and the challenge is getting those ideas into working practice. It frustrates me when I see technology suppliers preventing these ideas becoming reality, which could change not just a team, a ward, a department, but a whole hospital if given a chance.
New technologies are driving smarter, quicker and more efficient computer hardware. Put modern, everyday equipment such as tablets and smartphones in the hands of frontline staff and see the difference it makes. Intuitive, easy-to-use applications and systems will empower frontline staff, especially from suppliers who have an approach to being flexible and listening to the needs of the end user.
Getting out and about
I read with interest as the NHS England scoping document referenced the need for a mobile technology strategy. There still seems to be a huge focus in the NHS on the back-office and the challenge now, in mobile terms, is to take these existing systems out into the field. Laptops and 3G cards allow clinicians and nurses to connect back in, however this often fails because there is no connectivity. This approach does not work because many current back-office systems were not designed for frontline workers.
Mobile technology needs to focus on the end user who is out there delivering the care. It is irrelevant to frontline staff whether these tools, such as task lists, forms, patient history can come from one back end system or ten; as long as they have everything they need at their fingertips on a device enabling them to provide better care.
One of our big focuses at the moment is looking at how we support trusts moving towards a single-electronic patient record system. The issue here is that even if you have one system within the trust that has all of the information, you are still not able to get this into the hands of the people who are delivering the care when they are out and about.
There are huge financial costs to trusts with only limited benefits with this approach - I believe that approximately 20% of benefits would come from consolidating all of the patient data into one central system, with 80% of the cost. Whereas if you extract the data from multiple systems to clinicians, I think trusts can achieve 80% of the benefits but probably only 20% of the cost. What is important is information and tools you are putting into the hands of the people delivering care. It is all about how you make it easy for them.
Keeping on track
With a plethora of views and opinions on where the NHS needs to be, it is vital that the technology roadmap does not veer off course. As trusts look to stabilise the short-term balance between quality of care and financial solvency, and Clinical Commissioning Groups get up to speed on the commissioning landscape, the vision for an integrated and coordinated health and care system must be maintained.
Imagine nurses or clinicians are driving to their next house call or walking across a ward, with a clear direction on how best to help the patients they meet along the way. With the best tools to do the job to the best of their ability with a sense of pride and satisfaction; being able to seamlessly integrate with other areas of the trust in real time, whilst still being able to give the patient the full attention they deserve on a daily basis. This is when we know we have arrived.