“The overarching objective of harnessing the information revolution is to make the NHS paperless by 2020” NHS England 2017
The GP sector is nearly 100% digitised. However in contrast to comprehensive GP sector digitisation, the digitisation of hospitals has been inconsistent and fraught with obstacles, and the patchy computerisation of this sector continues as a significant, and growing, impediment to healthcare delivery.
Digital transformation is a huge challenge that will involve enormous changes in culture, structure, governance and training. Digital skills are therefore needed across all healthcare roles, from non-clinical management, to healthcare assistants, radiologists, surgeons and nurses.
According to Associate Chief Clinical Information Officer for NHS England, and Understanding ModernGov speaker Dr Harpreet S. Sood, the IT skills gap in the secondary care sector is seriously hindering progress in the transformation of services, supplier management and expectations at the NHS Digital Academy; formed after last year’s Wachter review.
Research consistently shows that the largest obstacle to digitisation of healthcare delivery is not the actual technology, as might be expected, but the underlying service expectation of new technology from healthcare professionals. Dr Sood said after the Wachter review “the key observation was that we are lacking in clinical professionals who could drive this transformational change (in IT) via technology and informatics”.
Initial assumptions often suggest that the benefits of digitisation accrue more to patients and their service experience as opposed to clinicians, who, it is perceived, have to bear the brunt of increased digital complexity and wrestle with greater quantities of information and data. Problematic scenarios are easy to imagine. Replacing a quick handwritten note by a doctor or nurse with a bafflingly complicated screen of drop-down menu options and there will surely be negative consequences for these already time-pressured staff. Quick clinical assessments could turn into laborious data entry sessions as the distance between doctors and nurses and their patients grow.
The purported benefits of computerisation are well known. The health sector accounts for nearly half of all reported data breaches in the UK. Paper-based records are a huge contributory factor. Cost saving is achieved by removing paper (with its attendant errors and lost files), electronic storage is more accessible and more secure, human error is reduced with a user-friendly electronic health system and easy to use document scanners and, perhaps most importantly, interoperability with primary care health records is fully achieved. A recent switch to electronic record keeping at Royal Liverpool and Broadgreen University Hospitals NHS Trust reduced the likelihood of medication error by 50%.
However, evidence suggests that if healthcare professionals engage with IT system rollout, these systems can actually make their work easier as well. IT healthcare experience in the US, which is often ahead of the UK in implementing new technology, shows that technology does produce considerable benefits to make staff jobs easier when they are carefully designed with this goal in mind. IT platforms and systems can be used to reimagine current work processes. “Digital Doctor” Professor Robert Wachter (a US digital health expert advising the NHS) emphasises reimagining healthcare practice before digital adoption.
Systems in some hospitals allow staff to electronically record a patient’s pulse, temperature and blood pressure and act on alerts when the condition deteriorates. Meanwhile, software at Queen Alexandra Hospital in Portsmouth is estimated to have prevented 397 deaths by identifying vulnerable patients at imminent risk of norovirus.
Mobile platforms can also save hours of staff time. Imperial College Healthcare NHS Trust has pioneered giving community midwives remote access to electronic health records through mobile digital platforms. This reduces time spent on administration which, of course, allows for more face-to-face time with patients.
Digital skills at all levels of the NHS are critical in developing a “workforce that understands digital and data” according to Dr Sood. Hospital trust Chief Information Officers (CIOs) and Chief Clinical Information Officers (CCIOs) will be at the forefront of efforts to develop their colleagues’ digital literacy for the future. Nevertheless the rollout of new IT systems inevitably creates anxiety from some clinicians and other members of the workforce, who will need training and reassurance to overcome sometimes strong reservations over digital systems.
Whether government plans to fully digitise public secondary care are comprehensively successful or not, the fact remains that health professionals will increasingly find themselves working with, and relying on, IT platforms and systems.
Delegates at Understanding ModernGov’s event Transforming Digital Skills in the NHS will benefit from a head start in developing IT skills for their workforce, gaining an insight into the experience of NHS digital exemplars and hearing from leading IT officers on rollouts and continuously improving operating systems. Speakers will give attendees an in-depth understanding of digitisation through best-practice case studies and interactive workshops.