Simon Stevens said in his first HSJ interview as NHS England chief executive that “when it comes to IT, our critical interest is the ‘I’. The ‘T’ is supporting infrastructure that others can help bring about”. He was more right than he probably knows.
While the NHS is still trying to decide whether electronic patient records are a good idea for hospitals, and found itself the bemused host of a religious debate about the merits of “open source”, health systems around the world are moving forward.
‘We had no idea that the real earthquake wasn’t the move from vinyl to CDs – the enabler of transformation was the digitisation of the content’
Conversations that I have had around the world – from Scandinavia to Singapore, Canada to Sao Paulo – show health systems are now looking to the benefits of digitised healthcare far beyond the simple automation of healthcare providers.
Investment in electronic patient records around the world has opened up the potential for the next generation of innovation. Healthcare stands on the brink of a revolution that is analogous to the transformation of the music industry in the past.
Revolutions playing out
In 1983 I was studying for my A-levels and working on Saturdays in the now defunct Laskys hi-fi store in Brighton. I remember our first CD player being delivered: the Sony CDP-101.
We wondered whether this new technology – at £500 a player – would ever take off. The consumer experience of a CD wasn’t a huge difference to an LP: you still needed a device to play it in and you still had a prescribed tracklist.
That is the phase that healthcare services are going through. Electronic patient records (EPRs), like CDs, add a set of benefits in their own right – improved accuracy, portability, longevity – but the financial case for these benefits can seem marginal.
‘Physicians expect solutions that are mobile and fit in with their working patterns’
Many of the gains associated with EPRs are against costs that are never counted, such as patient harm from transcription errors or delayed treatment because patient notes aren’t available.
We had no idea that the real earthquake that was about to hit the music industry wasn’t the move from big vinyl to small plastic. The enabler of transformation was the digitisation of the content.
Digitisation created the conditions for the reinvention of the music industry, from creation to distribution to consumption. This second generation of changes introduced mobile devices such as the Apple iPod, device convergence around mobile phones, and movement of content to the online cloud.
Now, anyone can publish their work, and all of my music is accessible at a moment’s notice anywhere in the world, with tracklistings programmed by me.
In healthcare, this second generation of solutions is emerging. In the US, President Obama’s highly successful Meaningful Use programme has transformed healthcare IT in the past five years.
Physicians expect solutions that are mobile and fit in with their working patterns. EPR systems are becoming connected across health economies and the focus is moving to using technology to engage the individual in their own health, make a reality of shared decision making and enable the consumer to track their own clinical data, choosing what to share with their doctor or nurse.
‘If technology can make music smart, imagine what it could do for something as complicated and important as healthcare’
But even these second generation changes are not what will transform healthcare forever.
The music industry is now in its third generation of reinvention. That reinvention is “intelligent”.
It is Amazon predicting what I would like to buy based on my previous buying history and making sure those goods are in a warehouse near me before I decide I need them. It is Apple letting me choose one song or one artist and creating an entire playlist or radio station based on that guidance; and it is new delivery mechanisms like Spotify, which consider my desire to actually own content to be outdated.
If technology can make music smart, imagine what it could do for something as complicated and important as healthcare.
The third generation of transformation is what excites clinicians around the world who have already made the step into digitisation.
They are looking at the advantages of taking the data that comes from high quality EPRs for patients and the general population, lifting it above the venue of care, standardising the terminologies, linking the data around the patient, and using it to drive population health improvement in near real time.
‘NHS’s world class academic institutions give it a unique opportunity to lead the world’
We can already see patients whose hospital care has been changed because of their statistical risk of readmission, thus lowering that risk.
For example, chronic obstructive pulmonary disease patients home scales are monitored by cloud based algorithms to alert a care manager if the patient isn’t managing their weight as agreed. Also, patients’ lives have been saved because an algorithm monitoring for risk of sepsis alerts their home nurse that the high temperature they have just recorded is something much serious, when read alongside a lab test result from two days previous.
The use of predictive algorithms and advanced decision support is where digitised health data gets smart.
Some doctors argue that this is demeaning to the profession of medicine, but I’m with Albert Einstein who said: “Never memorise something you can look up.”
If technology can make doctors, nurses and carers as smart as Einstein, they can use their skills to do the really hard bit – handling ambiguity and dealing with people. Technology liberates them to do what is uniquely human.
And if this technology can make every patient an expert in their condition – prompting, nudging and supporting them to manage their health – we have the conditions for a healthier nation and an affordable health system.
Small steps, giant leaps
The digitisation of healthcare data is the first small step to unleashing a world of innovation. The future of health research will be a combination of trials and retrospect data analysis.
Future papers in the BMJ or the Lancet will be accompanied by an algorithm that can be deployed into practice, and provide details on how the algorithm performed in simulations can run parallel in a live environment.
‘Technology can reduce the lead time from research implementation in care from 17 years to 17 months’
Technology can reduce the lead time from research implementation in care from 17 years to 17 months, but not if we are locked in a world where the limit of our aspirations is to capture small datasets for administrative purposes or to be used in research.
The NHS’s comprehensive and relatively equitable structure – allied with its world class academic institutions – still gives it a unique opportunity to lead the world in the use of information and technology to change healthcare.
I look forward to seeing the drive and creativity of Will Cavendish, director general for innovation, growth and technology at the Department of Health, who has taken on responsibility for NHS technology, to get us on the right track.