Iain Smith, Non-Executive Director for Silverlink Software, reflects on the history of digital transformation in the NHS and calls for a shake-up of procurement decisions, to create a digital ecosystem that meets the needs of UK healthcare.
In recent weeks, I have been considering the state of the UK health technology sector and it reminded me of an old story about a stranger lost in Dublin, who stops to ask a local for directions to St Stephen’s Green. The man looks at him and replies ‘well if I was going there, I wouldn’t be starting from here’.
The original intentions for the sector were good. In 2003, Connecting for Health (CfH) recognised that the National Programme for IT (NPfIT) provided an opportunity to create a successful UK-based healthcare software company which could succeed in the UK and go on to thrive globally. Unfortunately, for reasons which have been well documented, NPfIT failed, and with it, so did the plan to create a UK health technology giant.
Fast forward to today and the secondary care software market is increasingly being led by two large US suppliers. While their products provide comprehensive clinical functionality, they are expensive and designed for the US’s insurance-based healthcare system. As a result, a proportion of their functionality is focused on the collection of cost information to support the production of an accurate bill, which is irrelevant to the NHS.
The trend for trusts to replace their existing multi-supplier solutions with a large single-supplier is, I think, another hangover from NPfIT. In the commercial sector, companies are recognising that innovation and differentiation are enabled by deploying highly-modular internet and mobile applications. However, some of the largest secondary care trusts are investing tens (and sometimes hundreds) of millions of pounds in traditional transaction processing software.
Creating a digital ecosystem
There is an alternative. The issues previously encountered by trusts with multi-supplier solutions included data inconsistency and the inability to easily view all information held on a patient. But in the last two decades, there have been substantial developments in integration, data warehousing and clinical portal technologies. The proper application of these technologies can allow trusts to enhance their existing systems to meet their day-to-day needs. Any gaps in functionality can be filled with specialist modules integrated into the overall solution, and all of this can be done at a fraction of what it costs to replace all existing systems.
When I read about the amount of money some trusts are spending, I find it hard to believe there is a financial justification. If trusts kept the elements that worked, and only replaced those which needed replacing, the huge sums of money saved could be invested in specialist applications which are actually designed for the needs of the NHS.
There are numerous examples of these applications, and many of them are created and deployed by UK-based companies. For example, at Silverlink Software, we are working with a number of innovative technology companies to make it easier for patients to interact with the NHS. These initiatives include:
- Self-management of patients on waiting lists
- Appointment booking using a phone/device app
- Video consultation integrated into the patient administration system
- Improved document sharing to enable discharge and referral letters to be shared on a patient’s mobile device.
All of these partnership offerings are (a) highly innovative and (b) focused on NHS-specific requirements. We are also working on ways of ensuring that patient information can be integrated and shared securely across an Integrated Care System (ICS), without the need to replace all the existing systems in each hospital within the locality.
Shifting mindsets
As new organisational structures and inter-relationships in the NHS evolve, the conflict between the needs of the NHS and the technology delivered by US suppliers may well increase. As happened with PFI, contracts which made sense at the time of signature may start to look expensive and inflexible a few years later.
To avoid this, it is critical that local NHS decision-makers are empowered to consider all the options and choose a strategy that genuinely delivers the best functionality and value for their trust’s needs. But to do so, they need to consider the benefits of digital ecosystems and other ways of achieving digital transformation. In my opinion, alongside the onus on suppliers to articulate the value-add, it can be achieved by trusts creating an effective cost-benefit analysis model that considers both clinical and operational value, and, importantly, return on investment.
This should be part of their options appraisal and it should be published as part of the initial stage of procurement when suppliers are being engaged. This will go some way towards breaking down the perception that technology provided by large suppliers presents less of a risk and better value. It will also offer a level of transparency that will empower local leaders to learn from other trusts and make fast, informed decisions.
As a result, not only will more trusts begin to realise the benefits of multi-supplier solutions, but smaller UK-based healthcare technology companies will thrive. And the revenues generated by these companies will be ploughed back into creating more solutions targeted at the NHS.
There won’t be one national champion as CfH envisaged 20 years ago, but there will be dozens of successful UK companies delivering innovative new technology across all care settings. The alternative is a future landscape owned by large US players over whom the NHS will have little realistic control.
As I think back to the story from Ireland, getting to St Stephen’s Green might not be easy, but it’s a beautiful part of Dublin and definitely worth the journey!