In April, England became the first country in world to offer citizens the ability to access their GP records online and other digital services in primary care. In the first quarter of this year, more than 3.7m repeat prescriptions were ordered online. More than 3m people have registered for record access.
‘At first I was quite nervous about the prospect of patients accessing information that they may not understand, or that they may find upsetting,’ reflected one Huddersfield GP who is involved in a programme to trial online access. ‘This all changed when one of my diabetic patients signed up. Almost immediately, I could see a positive change. My patient started preparing ahead of his consultation by accessing his latest test results and comparing them to past results. This has meant the ten minutes we get together is very productive. Ten months down the line, I am even seeing this patient’s controls are improving.’
On the one hand much has been achieved over the last three years to put data and technology to work for patients, citizens and professionals. More than 96% of people registered with a GP now have a summary care record and more than a third of ambulance services now share that patient information in real time with A&E departments and out of hours services meaning clinicians can treat patients more safely based on knowledge of their medication history and especially allergies and other likely adverse reactions to drugs. More than 40,000 appointments for hospital services are booked each day on the new e-referrals service.
NHS Choices which now has more than 50m visits each month launched its first NHS ‘app’ store in March to promote access to mental health services, and there are more to follow. Last year, MyNHS was launched: a new digital tool that has transformed transparency of local services and allows you to compare the outcomes and effectiveness of more than 37,600 health and care organisations.
But much more needs to be done: the online revolution that has transformed so much of the rest of our lives does not support us nearly well enough as patients, citizens or care-givers. Hospitals and other providers lag behind general practice in digital record keeping and in patient-facing online services.
‘Electronic Records could have saved her life’ was the conclusion of a recent article by the journalist Margareta Pagano describing how her mother died because of paper prescription errors. Addenbroke’s hospital, where the tragedy occurred, has changed its procedures but the ‘NHS and the UK’s hospitals are still light years away from sharing or integrating patient data – whether it’s between GP surgeries and their patients, or indeed hospitals and their patients to improve care and, critically, for use in research,’ says Pagano.
Urgent action is a moral imperative. Patients are put at risk where paper is the currency of clinical practice. The evidence is clear that electronic prescribing systems which support clinicians ensure the right medicine is provided to the right person in the right quantity halve medication errors, yet only 14% of NHS hospital trusts currently deploy these systems.
Digital is not just a prerequisite of safety but also of cost-effectiveness. Taunton and Somerset NHS Foundation Trust spends more than £1m each year on the storage and transportation of paper records. There are over 200 acute and mental health Trusts in England – is it possible (just assuming they have similar costs) that £200m or more is spent on such services by the NHS each year? Taunton is now implementing an innovative open source electronic records strategy and is participating in an initiative to deliver interoperability across Somerset – one of several regional initiatives that are building digital momentum across England.
The Five Year Forward View identified the information revolution as a key enabler for health prevention, transforming care services and supporting delivery of the £22bn efficiency challenge. Last November the National Information Board (NIB) – which brings together organisations in the NHS, public health, clinical science, social care, local government and public representatives – set out a framework for action to support those objectives in Personalised Health and Care 2020. This confirmed that the national focus should be on the key technical systems that provide the ‘electronic glue’ which enables different parts of the health service to work together. It will be for the local NHS to decide upon and procure the clinical software that allows workflows and day-to-day diagnosis and treatment to be managed electronically, allowing the move away from paper. However, systems chosen must meet nationally specified interoperability and data standards so that information captured can be accessed or transferred across the numerous NHS and social care organisational boundaries that our patients visit and receive care from. The NIB Framework has been adopted as formal government policy.
At the Health and Care Innovation Expo in Manchester this week the leadership of the Five Year Forward View and NIB will launch some key initiatives to support delivery of a digitally enabled 21st century health and care service:
- to implement paper free services at point of care by 2020 – meaning a clinician can access all the records of a patient in real time without recourse to paper – and support local health economy leaders with training and support;
- to transform patient and professional access to online tools, ‘apps’ and services, including records, appointments and prescriptions – as well as improved wifi and network services;
- to improve safe access to GP, hospital, administrative and audit data for quality improvement, service planning and research – and, through the care.data initiative, to test new approaches to ensuring citizens are aware that they can opt out of their data being used in this way;
- to improve the transparency of outcomes in care services by expanding MyNHS.
The first of those commitments may be the most important. At Expo, guidance will be published which will describe how commissioner, providers and local communities will need to develop roadmaps by April 2016 – as a core part of service planning – that set out how their health and care system will achieve paper free working at point of care by 2020. They will be supported by new measures of ‘digital maturity’ which will track progress, share best practice and be built into routine assurance and regulatory oversight.
There are many real challenges to effective local delivery – we need committed leadership, technical capability and capacity, prioritised funding among them. Helping solve those problems over the next few months is vital and a key role for national bodies and the NIB itself.
Without interoperable digital data, high quality effective local services cannot be delivered; nor can we achieve a transformation in patient access to new online services and ‘apps’; nor will the NHS maximise its opportunity to be a world centre in medical science and research. Above all the NHS needs to take advantage of the opportunities new technologies offer because, as Margaret Pagano knows, the human imperative is overwhelming.
Tim Kelsey is National Director for Patients and Information at NHS England. He is also National Information Director and chair, National Information Board.