IT Adoption in the NHS: Learning from Past Lessons

MPs are still venting frustration over the huge sums of taxpayers' cash wasted in the now dismantled multi-billion pound National Programme for IT (NPfIT). As recently as September 2013, the Commons Public Accounts Committee raised alarms again over the programme's "extremely disappointing" projected benefits and the high costs that are still pulling on the purse strings of the NHS.

The committee is right to be frustrated. NPfIT has delivered limited benefit to clinicians and patients more than ten years after it started.

Inherent Limitations of the Electronic Patient Record
Globally there is very little empirical evidence to suggest that implementing a monolithic electronic patient record (EPR) system liberates information in the way that is needed to benefit patients in the era of joined-up care, across boundaries.

EPRs that were designed decades ago are no longer fit-for-purpose when it comes to joined-up healthcare. As a "closed" system, the EPR does not allow information to be shared or care to be delivered efficiently across boundaries. They do little to help clinicians coordinate care and they fail to empower patients and citizens to be more engaged in their own care.

The relevance of these large-scale IT systems is diminishing much more rapidly than many IT companies would admit. The economics of the world and our own health service are simple. We have more people retiring and living longer with a decreasing number of people paying tax. There is an inevitable outcome to this pattern: current healthcare economies have become unaffordable.

Healthcare of the future will therefore need to shift its primary focus from treating the illnesses of patients to taking preventative initiatives to improve wellness and reduce the onset of illnesses. To be impactful, NHS trusts must be able to identify patients at risk and put in place measures to control adverse and costly events. The patient must also be at the centre of their care and will face a new onus to manage that care. And when patients do need healthcare services, their health must be coordinated across acute trusts, primary care, social care, community bodies and any other organisation that needs visibility of their data.

A life and death scenario
Having access to the right information at the right time can mean the difference between life and death. Throughout the health service, the absence of clinical documentation is hindering the crucial flow of patient data. Take the case of a patient in hospital at risk of sepsis, a condition that kills 37,000 people in the UK per year. Those that don't die may face as many as 11 additional days in hospital.

To determine if a patient has sepsis or is showing signs of potential sepsis, a clinician needs access to the patient's lab result showing elevated white cells. The clinician also needs clinical documentation including vital sign information from the bedside - such as heart rate, temperature and respiration.

If the clinician can see that three or four of these indicators are positive, then he or she has the necessary data set to augment the decision to administer a potentially life-saving broad spectrum antibiotic - costing the health service only pence compared to the cost of a required extended stay or readmission.

But the digital clinical documentation that makes this basic information available to clinicians has largely not been implemented in the NHS. Even those trusts that do have data tools find that data is spread across different software applications and systems, yet is simply not liquid enough to be easily accessed.

Ministers who have dismantled NPfIT are now pushing for locally-led and interoperable alternatives to provide the data that clinicians need in a usable format that benefits patients.

This local decision making is a good idea. But much more important is the need for a system-wide view - a similar model that is being used in parts of Europe where healthcare organisations are procuring around care pathways instead of buying solutions for a city hospital or to meet the needs of a pathologist.

The health service now needs a single source of truth in order to help clinicians make decisions that can reduce unnecessary hospital stays for patients and provide aftercare support that patients need.

This does not need to cost trusts many millions of pounds. Hospitals do not need to abandon existing systems and IT investments that include EPRs. The technology does exist now to allow trusts to utilise their existing IT assets and at the same time liberate this necessary data.

NHS England is now pushing for a paperless health service by 2018 - which some see as a highly ambitious target. But if the meaning of that goal is to implement the necessary information systems to augment clinical decisions and avoid repeating the mistakes seen in trusts like Mid Staffordshire, then that goal can be achieved.