Thursday, 25 June 2015

2020 vision: digital efficiency and innovation in the NHS

2020 vision: digital efficiency and innovation in the NHS Every year our Digital Health and Care Congress brings together a diverse group of people, united by an interest in digital health, to share and discuss the ways that digital products and services are changing and improving health systems. This year's congress was sold out yet again, demonstrating the huge interest in this area.

Among the many fascinating talks and discussions, I want to highlight a couple of important announcements that are very relevant as the NHS races to meet two prominent policy commitments by 2020: to achieve an unprecedented £22 billion of productivity savings, and to make all patient records digital and accessible in real time across all settings for patients and staff.

First, the top-down view. At the National Information Board’s leadership meeting, held at the Fund at the same time as the congress, there was a notable new focus on the contribution that better use of information and technology can make to the £22 billion productivity challenge. For the first time, chair Tim Kelsey shared the board's estimate of that contribution, saying that digital efficiency and innovation could make around a third of the savings required (up to £8.3 billion in total). This eye-catching figure is supposed to come from the role technology is expected to play in enabling many of the ambitious reforms and new models of care outlined in the NHS five year forward view.

The credibility of this top-down estimate will be tested in the coming months, as the board works to join it up with any savings realised from work on the ground. In future, expect to see a lot more emphasis on how technology can save money as well as improve the quality of care for patients, an assumption that has been questioned in the past.

Tim Kelsey also trumpeted the progress that the NHS has already made in some areas. For example, nearly all GPs (97 per cent) now offer patients online appointment booking, repeat prescriptions and access to summaries of their records. That's up from just 3 per cent a year ago. But while the technical capabilities are now in place, they are not always easy to use. The challenge is to make these channels as routine to use as others, like phoning or dropping in to a GP surgery. GPs and their suppliers would do well to learn and spread lessons from design-thinking to improve the ways these systems operate and fit into patients' lives – seeking and harnessing user feedback to continuously improve the experience, making it easy to use. The same will be true for the many new uses of technology and data due to be introduced before 2020 for both staff and patients.

The second announcement I want to consider comes from the local level, but it could have system-wide impact too. Rob Kenyon and Tony Shannon shared the achievements to date of the Leeds Care Record – a single patient record shared by multiple NHS organisations, GPs and the local council in Leeds.

They invited other areas to join their ‘Ripple’ programme to work together to understand how an NHS with a single record can be achieved across the system, not just in Leeds. Ripple will develop and document a set of open tools, systems architecture, the governance and the ways people can use it. The team plans to make this all open source, publishing it freely and allowing its reuse; a gift to the rest of the NHS and its patients.

So what are the benefits of using an open-source model? One benefit is that anyone can use or adapt the code for their particular application without having to buy it and without being locked in to an individual software supplier. Open source is most commonly used to develop software but can apply to the design and production processes for any product or service. You are benefiting from this approach right now, as the server sending you this blog runs on open-source software. Open source is a model that has struggled to gain traction in the NHS; its advocates blame ‘vendor lock in’ to proprietary platforms, its critics highlight a lack of a viable business model without ownership. But now that could change. The Leeds team’s ambition is that the NHS benefits from an approach that helps new innovators to build on the work of others, instead of starting from scratch or buying into proprietary platforms.

Though it’s early days, the Leeds Care Record is an example of innovation from within the NHS. And this is the sort of innovation that needs to be spread, sharing the lessons and tools for replicating it; something Leeds hope to achieve with its new community. Along with strategy and standards set from above by the National Information Board, this is the kind of change from within needed to meet the challenges for 2020. The King's Fund
Catch up with highlights from the congress
Read our interview with Tim Kelsey: Leading the technology revolution

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