We must make IT compelling for clinicians

Having set out the NHS IT strategy to deliver the triple aim of better health and better care at a lower cost, in the first of three blogs NHS England’s National Director: Operations and Information, and the Chief Information Officer (CIO) Health and Care in England, expands upon the Global Digital Exemplar (GDE) programme within the Enabling Clinicians stream.

This table shows how the GDE programme fits in to the wider IT Strategy:

Better Health, Better Care, Lower Cost
Empower People Enable Clinicians Integrate the Health and Care System Better Management Information Build the Future
Global Digital Exemplars
Foundational Infrastructure Projects

At the heart of this programme is the simple truth that if we don’t make it compelling for clinicians to use IT systems for their day to day work and enable them to capture accurate, timely clinical information within those systems, then most of the other opportunities within the IT strategy will be unfulfilled.

Then patients won’t have comprehensive records to access, management information will continue to be a poor representation of what is really happening in the service, and the development of new and innovative treatments by the UK Life Sciences industry using appropriately de-identified and consented clinical data from the NHS will be lost.

Most importantly, our citizens will not receive the benefit of services that are focussed on their individual needs utilising the insights available from comprehensive data being available at the point of care.

At present, the use of information systems by clinicians is patchy across the NHS.

In primary care we have very high levels of digitisation, with many GP practices near to paperless, but much of that data is not in a standardised, coded format, and is hard to extract and exchange. In acute hospitals, lots of data is highly standardised and shared, but most real-time clinical documentation is still on paper or held in local clinical systems and not integrated with the rest of the digital record. In community and mental health services, clinical data is captured electronically, but the level of structured coded clinical data and functionality is very low.

We will come back to the next phase of the development of primary care IT in a later blog.

The purpose of the GDE programme is to establish a process so we can move forward the digitisation of secondary care and ambulance services.

It starts with the recognition that even the most digitised hospitals in England are relatively immature by global standards.  You can find hospitals in virtually every country in Europe, in Australia, Canada, Singapore and many others that have been paperless, or near paperless, for many years.  Most major US hospitals are highly digitised and you won’t find a world class healthcare institution in the US that hasn’t been near paperless for a long time.

The aim of the GDE programme is to take the most digitised hospitals in England and invest in them to make them exemplars by international standards by deploying technology in a way that truly underpins their operating model, supports our wider interoperability strategy and avoids the “walled garden” legacy of trapping data in institutions rather than following the patient that the US programme created for itself.

We’re supporting selected digitally advanced acute and mental health trusts with funding and international partnership opportunities to become internationally recognised NHS providers delivering exceptional care, efficiently. Through the use of world-class digital technology and information, GDEs will share their learning and experiences to support other trusts.

When this approach was first announced, we were criticised for investing in the “haves” and ignoring the “have-nots.”  This was a deliberate strategy to clearly define what excellence in the use of IT in healthcare really means and to challenge the NHS to get out of its comfort zone. Each GDE has signed up to meet specific commitments as part of their funding agreement.

The programme will provide the evidence base to support the assertion that digitising hospitals can contribute to the triple aim of better health, better care and better value; and demonstrate that the NHS can and does excel at IT.

Finally, we want to create a vibrant market for IT vendors with both single supplier/enterprise wide and best of breed options, create competition among hospitals to participate in the programme, reward the best performers, and define the blueprint for success that others can follow.  Fundamentally, we want to accelerate the journey to digitisation for organisations by learning from experience within the service.

After application and evaluation processes we selected 12, which grew to 16, acute organisations who aspire to be GDEs and later, through a separate process 7 mental health organisations.  The aim was to not only identify the most advanced organisations but also to create a spread of vendors, geography, and ensure that best of breed and open source solutions were represented.  At the end of the programme it is expected these organisations will be recognised as being among the most advanced digital healthcare organisations globally.

In our next two blogs we will expand on how the Global Digital Exemplar programme is working in our Acute hospitals and Mental Health Trusts, and our plans for the programme in the future.

Matthew Swindells

Matthew Swindells is NHS England’s National Director: Operations and Information.

He joined NHS England in May 2016 from the Cerner Group and his role as Senior Vice President for Population Health and Global Strategy.

Matthew is responsible for national performance of the NHS against the NHS Constitution Standards, assurance of Clinical Commissioning Groups, achieving a paperless NHS, information and technology programmes and investment in data.

He has over 25 years’ experience in health care services and has worked in the Department of Health as a Chief Information Officer and as a Senior Policy Advisor to the Secretary of State for Health. Prior to this he served as a Principal Adviser in the Prime Minister’s Office of Public Service Reform.

Matthew began his career at Guys and St Thomas’ Hospital in the early 1990s, and went on to become Director of Clinical Services of Heatherwood and Wexham Park Hospital and later Chief Executive of the Royal Surrey County Hospital, in the early 2000s.

He is visiting professor and chair of the advisory committee in the School of Health Management at the University of Surrey and Member of the Editorial Board for the Journal of Population Health Management.

Will Smart

Will Smart is Chief Information Officer (CIO) Health and Care in England.

A joint appointment between NHS England and NHS Improvement, Will is responsible for providing strategic leadership across the whole of the NHS to ensure that the opportunities that digital technologies offer are fully exploited to improve the experience of patients and carers in their interactions with health and social care; the outcomes for patients; and improved efficiencies in how care is delivered.

Prior to taking up this role, Will was Chief Information Officer at the Royal Free London NHS Foundation Trust for six years and. He first worked in the NHS in Wales and Northern Ireland during his placement year from university, before taking up an analytics role at St. Mary’s NHS Trust in London on graduation.

In addition to senior roles in the NHS, Will has worked as a management consultant with major assignments focussing on IT strategy, service transformation, major IT service and contract reviews and outsourcing.

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