NHS test beds and information-sharing: supporting the integration of new health care technology

To kick off 2016, we published ‘The digital revolution
co-authored with Dr Cosima Gretton, looking at new and developing digital technologies that will change health and social care. These technologies could potentially be put to use in the NHS, but the main challenge lies in persuading health care providers to take up new models and methods of care.

On the NHS Confederation blog, Roz Davies recently looked back at NHS activity on digital health in 2015 and saw new progress in central programmes and in pockets of innovation across England. But the kind of care enabled by new technologies remains out of reach for most of the NHS.

There are policy developments afoot that aim to change this; some new for 2016 and others building on existing work.

NHS test beds

The first of these new developments came last Friday, when Simon Stevens, Chief Executive of NHS England, announced the identities of successful ‘test bed’ applicants – a new set of partnerships between NHS providers, commissioners, academic health science networks and a mixture of both new entrants and established NHS technology companies. They are designed to develop, implement and test new care pathways based on combinations of multiple innovations. Each is focused on a specific clinical challenge, set during the nine-month selection process the successful sites have just emerged from. So they are narrower in scope than the integrated care pioneers, pilots and vanguards, but like these, their success is also being measured based on their impact on the whole system. So at this stage, serious thought and planning about the kind of outputs and lessons potential copycat sites want and need will pay off in the long run.

Information-sharing

Creating an effective flow of information is one challenge facing the new test beds. Many digital technologies use information that flows from patients and their devices into the hands of professionals and back again, in a safe and timely manner. At the moment, these information flows are difficult to set up and use in the NHS – primarily for regulatory, cultural and economic reasons. Test beds will need to work with their patients and staff to get to grips with these issues, as some plan to deploy analytical expertise to large datasets generated through remote monitoring.

There are already some important events that test beds will be keeping an eye out for in 2016. The first will be in February, when Dame Fiona Caldicott is expected to publish the results of her review into the security standards for patient information-sharing across the NHS. This could have an important influence on the experience for both patients and clinicians using information held by the NHS for the purposes of direct care. But the headline-grabbing elements of the review will doubtless concern its impact on the care.data programme.

The second is the publication of the Wachter review looking at the use of digital technologies in secondary care, where information is currently fragmented and siloed. Robert Wachter, author of The digital doctor, will bring expertise and experience with US hospital electronic health records (EHRs) to an English context. The review will draw lessons from a recent study in the US which raised concerns that the US ‘has missed an opportunity to achieve health information exchange rather than just adoption of EHRs’. Robert Wachter will share his findings and answer questions at our Digital Health and Care Congress in July, just after his review is published.

Other key milestones for those interested in digital technology in the NHS include the publication of the final report of the Accelerated Access Review covering access to digital technology, and NHS England’s continued response to Martha Lane Fox’s recommendations for wi-fi in every NHS building and for new targets for GPs around digital access.

2016 probably won’t be the year we see widespread adoption of the technologies covered in our paper. But the beginnings of a framework that supports both local clinical teams and patients to use these technologies could emerge.

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Comments

#545714 Harry Longman
Chief Executive
GP Access Ltd

I think what you are pointing to is the NHS ecosystem of multiple interests and interactions, between policy, commissioners, providers, professional groups and so on, in which technology per se is perhaps a rather small part. So I have to agree that progress is frustratingly slow. But we press on: the technologies which work for everyone will come through.

#545719 Prof Minesh Khashu
Consultant, Prof.
NHS

The answer lies in making the NHS a social movement.
Micro, meso and macro level holistic change.

#545722 Pearl Baker
Independent Mental Health Advocate & Advisor/Carer
Independent

All very interesting, but unless you learn the basics of 'integration' it is a non starter. Those developing the 'tools' are not 'experts by experience'?

I will give you one example that arrived on my 'doorstep' so to speak.

Consultant advised the GP to amend the LTC MI patient's medication, by changing the dosage of a drug. The GP raised a Prescription, but failed to notify the Pharmacist if it was an ADD on, or a change to the current drug already being prescribed, fortunately the Pharmacist contacted the Carer for advice.

The medication is prescribed via a 'dosett' box method, often used for the vulnerable mentally ill, at my suggestion, now often used in my area.
the Carers name is on the Pharmacist file, so quick thinking resolved the problem. No it is NOT an ADD on!

This is going on as we 'speak' thousand of pound worth of 'repeat prescription drugs are thrown away each month, despite it also being very dangerous for the vulnerable.

Many LTC Mentally Ill Patients are being discharged from 'Care Plans' if they have not been in hospital for a while? despite still being treated by the GP, and often subject to a COP Order for 'Property and Finance' and still acknowledged as being subject to Section 117 of the 1983 MHA.

The above LTC Patients have in 'effect' dropped out of a system that is their to protect them.

Until the 'Powers' that be understand what the word 'Holistic' means including 'integration' those supposed to benefit from an improved system of Health and Social Care we will continue to Witness the NEGLECT exposed by me in NEWBURY Berks.

Professor Minesh Khashu is the closet to understanding the interpretation of 'HOLISTIC' so far, but more education and training is required by those who 'think' they know the system, but are way 'out of their depth'.

My final word is this how could a very vulnerable Mentally Ill individual with a 'stoma bag' end upon the streets, living 'rough'. The answer is this, the DWP are an important part of 'Integration' this person tried unsuccessfully to complete a 'fit for work' questionnaire, they ended up with no money to live on, and then taken to Court for failing to pay their rent? cost against them of £400 plus arrears in Rent, then the Loan 'Shark', and that was the beginning of the end.

I have mentioned two important organisations, not in the system of 'integration' HOUSING ASSOCIATION/DWP

No 'Care Plan' no Care manager Co-ordinator, always leaving, and never replaced.

This individuals was under section 117 of the 1983 for (free aftercare) the mother of 84 contacted me for help where I was able to ensure the LA did their 'job' and 'picked up the costs on Housing arrears.

I have demonstrated that their is not anybody within the system who knows it better than me, yet we Carers are often denied our 'Status' but we do have something to help us win the 'fight' it is called 'Duty of Care' it has a Legal definition, and can be used in a Court of LAW.

The All agencies involved in 'holistic' 'integration' could learn so much from 'experts by experience.

No 'Sharing' here!

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