The above table shows how the GDE programme fits in to the wider IT Strategy.

In the third of three blogs, NHS England’s National Director: Operations and Information, and the Chief Information Officer (CIO) Health and Care in England look at how the Global Digital Exemplar (GDE) programme will work going forward:

Being a GDE is important for both the hospital and their vendor(s).

For the hospital it makes them the key reference client for their software supplier(s) which means they should expect responsive support and the opportunity to adopt new innovations at discounted costs.  It will also give them the opportunity to build a wealth of expertise as an implementation and support service to Fast Follower hospitals, offering the potential to generate revenue and expertise in the deployment configuration and operation of their solutions.

For a vendor it is the route to further sales both through the Fast Follower programme and because in the future we expect partnerships between hospitals to become an increasingly important part of the decision about which electronic health record to adopt and the point by point evaluation of systems to become less significant.  If the GDE programme is successful and offers a range of proven partnerships and solutions, why would any hospital pick an unproven system?

An important part of this strategy is to create a dynamic and good value market of IT vendors for the NHS.  That means that the wide range of vendors who have customers that have become GDEs in the first wave need to deliver if they want to be able to extend their solutions through the fast follower programme.  Those hospitals or vendors that weren’t advanced enough to become a GDE in the first wave also need the opportunity to become one.

Consequently, we will create a process over the next few months that allows:

• Hospitals that have been progressing outside the GDE programme to be evaluated and accredited as a GDE and thereafter have Fast Followers. This doesn’t mean that they will retrospectively receive GDE funding as that funding is already committed, but they will be able to have Fast Followers and be part of the GDE development programme.  This also creates the potential for a vendor who wants to enter the market to find a hospital that doesn’t have a system, invest in supporting them get to the GDE standard and become a GDE offered to Fast Followers.

We will shortly define how much each site needs to have achieved for a new hospital and their vendor(s) to be considered for GDE status and the process to support that.

• A similar process will be defined to enable Fast Followers who have hit the GDE standard to be reclassified as a GDE and be able to have Fast Followers of their own. This will create the ability for spread from multiple locations, not just the first wave GDEs.  It is anticipated that vendors will seek to agree Fast Followers in STPs who are developing their IT strategy with a view to achieving GDE status and becoming a hub for that STPs electronic record strategy.

We are, even in these early days of the GDE strategy, seeing three interesting developments:

1. Hospitals are talking to GDEs about not just deploying the same system, but actually running a shared electronic health records system, reducing the cost of deployment and creating patient benefit through fully shared records.
2. STPs are starting to talk about their electronic health records strategy and seeking to standardise on one or two acute and mental health systems across their population to reduce cost, share expertise and create a focus on the patient rather than the institution.
3. Belief in the potential and the necessity of electronic records is rising again. After a period of uncertainty following the end of the national programme, the combination of growing confidence and success at some of the GDEs and an emerging understanding of the need for high quality data for population health management has put IT back on the clinical and managerial agenda.

However, this is not a one way ride.  It is possible that not every GDE will succeed and not every system will prove to have the potential to meet the challenge of rapid and low cost spread to Fast Followers.  Whilst we will through every effort into making all of the GDEs and their Fast Followers a success, we will need a process whereby organisations that have been classified as GDEs can be declassified and lose their right to add further Fast Followers.

We announced the first wave of Acute Fast Followers in September 2016 and will be doing the same for mental health in a few months.

We will be putting in place a process to set a minimum level of performance GDEs need to achieve before they are cleared to have a second and further waves of Fast Followers.  We will combine this with the process for enabling new organisations to be classified as GDEs, so that any organisations that are now as good as the best GDEs will be able to accept wave 2 Fast Followers.  Therefore, the most advanced hospitals and vendors will be able to spread most quickly.

In future, we would like to move away from the approach of prioritising the funding support for further Fast Follower centrally and move to an approach whereby STPs and ACSs have their allocation of IT funds and are able to prioritise the balance of spending locally, within what are always very limited resources.  This approach is currently being discussed with the Treasury.

As Matthew noted in his blog setting out the IT Strategy, the US clinician and academic Bob Wachter noted that the allocation provided was insufficient funding to achieve the strategy vision of a paperless, joined up NHS.

This makes the work of the GDEs to create blue prints and implementation expertise to reduce costs crucial to creating an affordable approach to digitisation of the NHS; and secondly, we need the GDEs and FFs to be demonstrable successes so that when we go back to the Treasury for more money it is on the basis of a proven track record of improving quality and reducing cost through information technology.

Finally, in order to be able to extend the Fast Follower approach to organisations that want to deploy a new Electronic Health Record System, we need to establish an appropriate contractual framework.  In order to this we need to do two things:

• Create clarity where an organisation can take another hospital’s EHR without a procurement. Where two hospitals merge, are working within a network/chain or are closely linked within a common STP or ACS, it seems reasonable that they should be able to share an EHR.  We will create guideline so that the logic of genuinely linked organisations sharing systems can’t be abused to by-pass an open procurement process.
• For circumstances where a procurement is needed, we will create an OJEU compliant framework which has all GDE vendors on it with pre-negotiated terms and conditions, so that a hospital wishing to partner with a GDE only has to conduct a short mini-competition of the GDE options and demonstrate in a transparent way why they chose the partner that they did. NHS England will provide support for Trusts using this framework.

We have started the process to create this procurement framework to support the GDE / Fast Follower strategy, as part of creating a wider ACS & STP Innovation Partner framework for their population health management support needs.  GDE vendors will be contacted and reminded to participate.  We hope to have this framework in place around the start of next financial year.  This framework will be refreshed in October 18 and regularly thereafter to ensure that new GDE vendors can be added as they become accredited, and to remove vendors should they lose their accreditation.

• Read our first blog in this series: We must make IT compelling for clinicians.
• Read our second blog in this series: Progressing the acute Global Digital Exemplar.