By Dr Francesca Properzi, PhD. Research Manager, Centre for Health Solutions
Innovation and new technologies are acknowledged as key enablers of the digital transformation of the NHS, however, today, healthcare lags behind most other service industries in the adoption of technologies to improve performance and the service user experience. This week we launched our latest report, ‘Closing the digital gap: Shaping the future of UK healthcare’ which highlights the opportunities and future potential of digital technologies to tackle some of healthcare’s most intractable challenges.1 We acknowledge the numerous policy initiatives aimed at establishing ‘a digital NHS’, however, we also highlight a growing divide between policy ambition and the reality of the experience on the front-line.
The fundamental role of digital health technologies is to improve the quality of data and information flow to deliver timely, efficient and effective care. However, key challenges include the complex structures of the different health systems in the UK, the many internal and external stakeholders, including local and national governments, regulators, commissioners, providers, IT and digital technology suppliers and a wide range of end users with differing needs. This can often lead to misaligned interests, especially when it comes to sharing data and allocating resources. There is also an indisputable need for clinical autonomy and robust regulations to ensure appropriate and safe patient care. Moreover, responsibility for digital, data and technology has, till now, been highly fragmented, with accountability split across multiple agencies, teams and organisations.
Our research comprised an extensive literature review, interviews with 65 senior stakeholders across the healthcare ecosystem, a survey of 1,500 front-line clinical staff across the UK and insights from Deloitte colleagues working on digital transformation projects in the UK and globally.
Among the many digital health policy initiatives launched over the past six years, we identified the following as establishing a clear mandate for digital transformation:
- the Secretary of State for Health, Jeremy Hunt’s challenge for the NHS to go paperless by 2018
- the 2014 NHS Five Year Forward View which recognised the importance of digital technologies in closing three identified gaps (health and wellbeing, care and quality, and funding and efficiency)
- the National Information Board’s digital strategy ‘Personalised Health and Care 2020’ from 2014, which identified the need to ‘exploit the digital revolution’
- the 2016 Wachter report ‘Making IT Work’ which recommended that all NHS trusts should achieve a high degree of digitalisation by 2023 or be deemed by the Care Quality Commission to be non-compliant on quality and safety grounds
- the February 2019, NHS Long Term Plan (LTP) which expects digitally-enabled care to go mainstream across the NHS, and for all providers to have advanced to a core level of digitalisation by 2024.
While there is a consensus that a digital-first NHS is needed, our research suggests that without additional investment in the IT infrastructure across England, it is difficult to see how many trusts, especially those reporting financial deficits in 2018-19, can achieve the LTP’s expected levels of digital maturity by 2024.
Our survey respondents stated that the top three words that best describe the state of digitalisation today are ‘slow’, ‘expensive’ and ‘inefficient’ (see Figure 1). In addition they identified the five largest barriers to the adoption of digital solutions as the cost of the technology (55 per cent); finding the right digital solutions (11 per cent); complexity of the technology (10 per cent); bureaucracy (8 per cent); and training (6 per cent). Our interviewees confirmed the findings of both our survey results and our literature reviews, that effective digitalisation at scale continues to prove challenging. Indeed, the majority of interviewees believe that it will take over ten years to achieve a fully digital health system, with the three major challenges to achieving this being ‘funding’, ‘leadership’ and ‘interoperability’.
Figure 1. The top three words that come to mind when thinking about the UK healthcare’s journey towards digitalisation
Our interviewees also rated the current state of the IT infrastructure across UK healthcare as 5 out of 10, highlighting concerns about the wide variation in digital maturity, the general lack of investment in interoperability of electronic health records (EHRs), and concerns over data privacy and security. Moreover, our analysis of the validated digital maturity self-assessment of all NHS trusts in England (DMA) undertaken in 2016 and 2018, found that while the overall digital maturity had improved slightly, there is a growing digital maturity gap with scores varying from a low of 19 to a high of 98 out 100, and a national average of 66 out 100.
Moreover, since 2016 funding for digital transformation has also been targeted at the 25 per cent of trusts that were deemed to be more digitally mature (and having a strong financial position, and good Care Quality Commission rating). Likewise, the establishment of eight Local Health and Care Record Exemplars, while providing a much needed boost to accelerate integration, also risks increasing the digital maturity gap.
Five key steps to close the digital gap
Our research identified five key steps that are needed to close the gap:
- Create a robust health IT infrastructure for data storage, access to health data, and information sharing. This infrastructure should include reliable network connectivity and sufficient data storage capacity.
- Implement accessible electronic health records and invest in the basic technologies needed for digital transformation. EHRs provide a primary source of ‘point of care’ data and are rated by our survey respondents as the top technology for helping to improve the efficiency and effectiveness of clinicians and patient care.
- Address the challenge of interoperability. Our interviewees identified interoperability as one of the top challenges for healthcare, after funding and leadership. The consistent use of data standards and open application programme interfaces (APIs) and protocols across the UK can help improve access to and interoperability of EHR systems, however, open API standards will take time to become fully established.
- Establish a robust governance framework to support a culture of digital transformation. Healthcare organisations must comply with the regulatory requirements that apply to data and technology in general, and to data security and privacy in particular. GDPR compliance has significantly increased healthcare data security. When asked how they rate the ability of the NHS to protect patient data our interviewees scored it 7 out of 10 on average.
- Develop digital leadership skills and improve the digital literacy of staff and patients. Implementing digital solutions successfully requires: leaders with a clear vision about the role of digital technology in service transformation; clinical staff who feel consulted, empowered and trained in the use of the technology; and patients supported to develop their digital literacy.
Today, innovative technologies are used in pockets of the NHS, but have the potential to be disruptive if adopted at scale. Our research identified the following SMART characteristics that can help encourage adoption (Figure 2).
Figure 2. SMART solutions transforming healthcare today
We identified numerous examples of good practice and impressive initiatives across pockets of the NHS and our report includes 13 good practice evidence-based case studies and numerous other examples of transformation. Moreover, when we asked our survey respondents what three words they would hope to use to describe the state of health care digitalisation in five years’ time the top three were ‘efficient’, ‘effective’ and ‘safe’ (Figure 3).
Figure 3. We asked survey respondents what three words would the hope to use to describe the state of UK digitalisation in five years’ time
We concluded that, in 2019, digital transformation lags well behind where it needs to be if the NHS is to remain sustainable and affordable and deliver the ambition in the NHS LTP. The variable state of the IT infrastructure and differences in rates of adoption of technologies requires a more concerted emphasis on change management to accelerate and improve the quality of information flow, and close the digital gap. Policymakers therefore need to consolidate and increase their support for IT and digital innovation, including prioritising and ring-fencing funding as part of the next spending review. At the same time the UK’s existing health and care providers need to adopt a digital first mind-set and embrace the transformation needed to deliver a modern and responsive health and care system, or face being left behind and replaced by new incumbents with a more agile, innovative and accessible approach to care delivery.