The future of healthcare: our vision for digital, data and technology in health and care

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The UK’s Department of Health & Social Care has issued a fascinating Policy Paper on The future of healthcare: our vision for digital, data and technology in health and care.

mHealth Insights

All around us, a new generation of technology is changing our lives, from the everyday use of satnavs and smartphones through to the profound ability of genomics to help us develop personalised medicines for individuals.

It amazes me that a report of this importance starts talking about ‘satnavs and smartphones’. Just stand in London traffic and observe driver behaviour you will see that satnavs haven’t just converged to mobile but in 2018 mobile phones are categorically better satnavs than satnavs.

It’s not just your Uber driver but even the highest spec luxury cars have had their satnav/displays taken over by Apple thanks to CarPlay.

As for the idea of personalised medicines: The unpersonalised office visit only model of sick care struggles to even deal with basic communication issues and unpersonalised medicines so it has no hope of tackling personalised medicines without financial bankruptcy.

“Yet the state of online services, basic IT and clinical tools in health and care is far behind where it needs to be. Despite much good practice and some pockets of excellence, for many people – patients, service users, carers and staff – we still need to sort the basics”

Here’s a short talk I gave at Doctors2.0 in Paris where I explain how the consultation process needs to be transformed:

“Technology systems used daily across hospitals, GP surgeries, care homes, pharmacies and community care facilities don’t talk to each other, fail frequently and do not follow modern cyber security practices. As a result, some people are getting suboptimal care,1,2 staff are frustrated and money could be saved and released for the front line”

I think it’s also important to point out that students aren’t choosing medical careers and professionals are leaving the industry causing a workforce crisis (particularly as this all too often includes those who have just finished the most expensive medical degrees).

“Just being able to make the best use of mainstream products and services would transform health and social care in this country. But it’s not just about getting the current systems to work better – our ambition should be for the use of the best technology available for the NHS and social care sector. The potential of cutting-edge technologies to support preventative, predictive and personalised care is huge”

Seems simple but there’s a huge need for coordination of the NHS resources eg. if they continue to commit to inefficient expensive paper based solutions when there are much better less expensive mobile alternatives they signal to employees and Patients that it’s ok to have duplication of effort. 

Instead of today’s outlook (where Doctors are failed for having a mobile phone in a RCGP membership exam) perhaps it should be a requirement for staff to have a smartphone loaded with uptown date content and resources in order to provide care in the NHS?

“For example, we could use more data-driven technologies such as artificial intelligence (AI) to help diagnose diseases or conditions and to gain better insights into treatments and preventions that could benefit all of society. Or we could use robotics and voice assistants to support people and their carers in rehabilitation, dementia support or medication management. And appropriate use of NHS data could radically reduce the cost and time needed to generate new evidence on the effectiveness of interventions”

It’s such a shame that NHS documents about the future so quickly run ahead of themselves with wishful thinking about artificial intelligence. Maybe it’s all just part of a ruse to hand over more private data to major tech companies without consent?

“To reach this potential we need to focus on getting the basics right: the digital architecture of the health and care system – the building blocks. Open standards, secure identity and interoperability are critical to the safe and successful use of technology, ensuring that systems talk to each other and that the right data gets to the right place at the right time”

I think this is something that NHS have spent billions of pounds proving is not the right approach. We need to start with getting the basics right and that starts with providing Patients with access to their medical information. Consultant Paediatrician Prof Sam Lingam has been  doing this for +30 years and it really is the foundation stone on which building blocks need to be built.

“We need modular IT systems, where any module can be easily switched out, to create a market where providers compete on – and are rewarded for – quality. We also need to make sure patients and people who use care services have confidence that their data is held securely and used appropriately”

The only way of achieving this is via a mobile first approach. It should be obvious that Mobile authentication and notifications when your data is being used/accessed are standard in banking and travel industry eg. Here’s why ‘Mobile’ should be your NY2016 resolution.

But the gap between where we are and where we want to be is only getting bigger. We need to take a radical new approach to technology across the system and stop the narrative that it’s too difficult to do it right in health and care. The UK has the chance to lead the world on healthtech. We already have some of the world’s leading healthtech companies bringing new innovations and advancing the international reputation of our excellent science and research base. And, in the NHS, we have the world’s biggest health institution. We have the opportunity to build an ecosystem that continually creates the best healthtech – technology that can be exported, alongside new methods and insights that can contribute to health outcomes globally. We are committed to working with partners to make that happen

I think the challenge is it’s much more profitable to abuse Patient data than it is to use it. The various ‘Lead generation’ businesses working to create demand for mental health services via free* addiction helplines (that are still legal in the UK!) are a classic example of this.

I’m surprised that the UK and NHS are not prioritising the export of the highest quality service because they can’t compete with the low ethics that are easy to find across the rest of the world.

Our ultimate objective is the provision of better care and improved health outcomes for people in England. But this cannot be done without a clear focus on improving the technology used by the 1.4 million NHS staff,3,4 1.5 million-strong social care workforce and those many different groups who deliver and plan health and care services for the public

Imagine having just the communication needs to talk to this many staff and the efficiencies a MobileFirst strategy would give you?

“We don’t have all the answers – this should be the beginning of an open conversation about how we can iterate to best achieve what is needed and work with the many brilliant, forward-thinking people in the system to get it right”

I think this statement reinforces a common oversight made by strategists. Surely it’s obvious that often the most brilliant forward thinking people aren’t in the system eg. Steve Jobs wasn’t in the $Trillion Mobile phone industry that Apple disrupted, elderly Patients who want to FaceTime their Practice Nurse aren’t in a position where they can enact change, etc.

“Privacy and security. It is critical that we maintain public trust in how we hold, share and use data. Clear and mandated standards, guidance and frameworks for this will underpin the delivery of the best services and outcomes that meet user need and are based on the General Data Protection Regulation (GDPR) and consent where appropriate. 

We need to maintain a safe and secure data infrastructure that protects health and care services, patients and the public. The digital architecture of the health and care system needs to be underpinned by clear and commonly understood data and cyber security standards, mandated across the NHS, to ensure we are secure by default and that the penalties for data breaches are effective in protecting patients’ privacy”

I’m not so sure that there is a public trust to maintain when you realise the NHS is the world’s biggest buyer of Fax Machines eg. privacy issues aren’t always obvious, most NHS Patients already believe their data has already been hacked by criminals, etc

“Interoperability and openness. Our technology landscape is varied and diverse, and interoperability is poor. This:

  • increases costs because we are not taking advantage of economies of scale9
  • has patient safety implications and increases errors10
  • introduces delays in the transmission of data from one system to another11
  • slows the digitisation of those parts of the system still very poorly served by technology

The data and technology standards we agree to will be open so that anyone can see them and anyone writing code for use in the NHS knows what the standards are before they start. But it’s not just about technology – agreeing and adhering to clinical data standards will give us much better and more granular detail with which to fight disease and prevent and treat illness”

I think the success Apple is having with Health Records is proof that the NHS is not going to win this battle to drive data and technology standards. I think they can have some important influence but ultimately they’re users of technology not in the business of developing technology.

“We should be using the best off-the-shelf technology where our needs are like everyone else’s, and not building bespoke solutions where they are not needed”

This is easy to say but hard to put into practice. The best off-the-shelf technology in the world exists in the Android and iOS smartphones yet the NHS has been trying to develop it’s own App Store for 10+ years…

“Inclusion: Health and care services are for everyone. We need to design for, and with, people with different physical, mental health, social, cultural and learning needs, and for people with low digital literacy or those less able to access technology. Different people may need different services and some people will never use digital services themselves directly but will benefit from others using digital services and freeing resources to help them. We must acknowledge that those with the greatest health needs are also the most at risk of being left behind and build digital services with this in mind, ensuring the highest levels of accessibility wherever possible”

With 7 Billion citizens having a mobile connection it should be clear that the most inclusive technology in the world is the mobile phone. This is another great reason for the NHS to go MobileFirst, put their best people on making services made for mobile, prioritise mobile interactions over all the paper/PC/faxmachine interactions, etc.

“move to a mobile-first approach and make the same digital services easily accessible from mobile phones, tablets, laptops and assistive technologies like screen readers. We recognise that our users access digital services in a variety of contexts, and technology like mobile alerts and responsive design can be critical to supporting the workforce in their roles”

This is positive but there’s a gap between saying something and doing it that I feel the authors don’t fully understand or aren’t ready to accept or commit to. A mobile first approach for example automatically solves most of these issues eg. you don’t need a screen reader if you have a designed for mobile service (Apple has Voice Over built into iPhone, Android smartphones have TalkBalk and Select to Speak, etc).

“get the benefit of the continual security and functionality improvements that come with the ‘evergreen’ ecosystem of modern browsers and web technologies”

You would’ve thought the billions lost as a result of the WannaCry attack would’ve  woken the NHS up to this need. I have no idea how statements like this are made when NHS Hospitals like UCL are committing to £400 Million spends on the Epic EHR.

Internet first. When we adopt internet standards and protocols for our networks and digital services: we maximise the amount of technologies and digital services that will work for us and for those we care for.  we maximise the number of developers and software engineers that can help us transform health and care and meet the needs of our users.   we minimise what you need to learn to build software and digital services for health and care.  we maximise the amount of distributed data we can handle”

I find the value of the report is diminished by the way the authors throw around buzzwords carelessly. Is it a MobileFirst or InternetFirst strategy?

Perhaps the authors don’t realise Mobile is the newest mass media and are still thinking Mobile is the little Internet?

“Our health and care system will never be a centralised service, because it services the citizens of an entire nation, and so too should its infrastructure not be centralised. But appropriate access to our data from any part of it – like you can access your email from anywhere, as long as you have the right passwords – is an important part of delivering care and staying healthy where we want to be”

I find it odd to hear so much confidence about healthcare care ever being a centralised service. I wonder if the authors think the more than a million NHS Patient records that were given without consent to Deepmind/Google in exchange for a free app for dialysis Patients are now centralised?

I wonder if they realise parents of children with cancer are suffering because their dogs have more centralised records than their children?

Public cloud first. When we start with the assumption that all our services should run in the public cloud with no more locally managed servers:  we get the resilience and backups of some of the most cyber-aware and heavily invested companies in the world.   we can run and grow projects that work with infinite amounts of data or have unpredictable processing needs.   we can share data to increase security – and only those with appropriate access are able to see the data they need.  the commodity services we use, like word processing, should be continually upgraded and improved – without massive migration projects”

The problem with an “Mobile First”, “Internet First” and “Public Cloud first” strategy is that clearly nothing is being actually prioritised…

“Digital services. Ensure that digital services meet people’s needs – understand who the users of a system, website or service are, what they need to do, the problems or frustrations they experience and what they need from a system, website or service to achieve their goal”

I think most people have no idea how bad the NHS is at doing this eg. NHS Digital tried to educate the public about healthcare by paying chip shops to offer free internet access, a London Teaching Hospital built an iPhone App to help bereaved children compose electronic dance music tracks, etc.

“Innovation. Enable healthtech and innovation so the cutting-edge technology developed by our thriving healthtech economy can be more easily developed and used across the health and social care system, and the NHS and social care can benefit from world-leading innovation and research”

I’m not so keen on the cutting-edge. Perhaps they could just start by stripping away the dangerous outdated old processes eg. Fax Machines, printed prescribing formularies, etc.

“Build an open culture, working with innovators, academics, industry, staff and the people who use health and care services to deliver better outcomes for everyone, welcoming feedback and seeking constant improvement”

I wonder why this policy paper wasn’t written as a wiki that NHS Staff and Patients were invited to contribute to?

“Conclusion: We have the opportunity to create the most advanced health and care system in the world, and to become the global leader in healthtech. By harnessing the power of technology and creating an environment to enable innovation, we can manage the growing demand for services and create the secure and sustainable future for the NHS and social care system that we all want to see. When we follow the principles we have set out, we not only transform the health and care system and the healthtech economy to be the most advanced in the world – we also create organisations that can continue to evolve, improve and innovate with the best technologists and disruptors, wherever they may be. We have strong ambitions for the technologies we want to use, and the opportunity to create a world-leading environment for spreading and supporting innovation wherever it comes from. And we must never forget who we are building things for – those who depend on the health and care system to look after them and those who work within that system”

It’s fighting talk like this that makes change happen but it’s a bit concerning that the NHS is so clear about the fact that it’s building things for those who work within the NHS because clearly many of the things that technology most effectively does is replacing the need for workers. Perhaps it could make it clearer that it will use tech to help staff work smarter, more effectively and towards the top of their licence.

This document is for discussion. We want to hear from you:

  • Do you agree with these priorities?
  • What have we missed?
  • What good work should we support and build on?
  • What do we need to take into account when thinking about applying these principles to different parts of the health and care system?

A questionnaire has been set up for you to provide comments and feedback on the vision”

Here are my responses:

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About David Doherty
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