Harry Evans: Realising the future of digital health and artificial intelligence in health care

If you go into your GP practice nearly all of the interactions that you have with them they will put into a technological system, an electronic record, and that will all be recorded and all the processes and everything behind that is all done digitally.  That is a fantastic achievement and it is not something in the NHS we are very good at recognising as a system.

What has been less of a success is what we call in the system private provider digitisation.  So that’s hospitals.  Often hospitals, community trust, mental health trusts getting them all digital and all on a similar system where they can all talk to one another and what we’re aiming for in hospitals is what we call an electronic patient record and it would mean that there was a single source of truth on every patient that comes in through the door.

In terms of sharing that data further, so sharing between general practice and hospitals, sharing between hospitals and out of hours, all of those kinds of things, we are nowhere near where we need to be right now.  Actually, there have been many different schemes within the NHS to try and get it digitised.

So National Programme for IT was infamous, it was in the 2000s, it tried to do this digitisation of providers and it largely failed because it was overly centralised and to be honest it was incredibly poorly run.  Actually, if you look at estimates of failed IT programmes in the NHS before National Programme for IT, some estimates put that as high as 60%.  I think that’s remarkable and it just shows how difficult it is to do digital transformation in an organisation where the workforce numbers one million and which has over a £100 billion spent on it every year.

If you skip forward to 2016, Jeremy Hunt made a commitment to £4.2 billion for investing in technology in the NHS, and much of that was to go towards this digitisation of providers problem.  I think the overarching goal was that by 2020 we would be paperless.  It’s still not going to happen, I don’t think we’ve seen an official postponement of that target, but paperless 2020 always looked a bit optimistic.  Now we’re talking about 2023, probably.

So the global digital exemplar programme was set up to support this. Global digital exemplars, the GDE programme is the current programme that NHS England, NHS Digital are pursuing with local providers to pick winners essentially, to say okay we think that you’ve got a high level of digital maturity, so we’re going to match fund it and help you invest and help you then spread the learning that you have from implementing an electronic patient record in your hospital.  We’re going to help you blueprint that, understand what it is that made that implementation successful and then help you spread it.

Why is it so important that we digitise?  And why is it that electronic patient records tend to be the main focus at the moment?

So I think partly that’s where the national focus is.  It’s where there’s a lot of money going, electronic patient records are incredibly expensive.  They often lead to falls in productivity after they’ve been implemented and because they’re really, really complex and you’re getting staff to work in ways that they’ve never had to work before, but they are very attractive to providers at the moment, and they’re very attractive for, I’ve picked out four reasons here, there are more reasons than this but here’s four reasons that I think are really important.

Firstly, it’s about more reliable communication between clinicians so you don’t end up losing bits of paper, handwriting of doctors is a really big thing for nurses because they can never understand what any of it says, and I think it’s an ongoing battle to interpret a doctor’s handwriting.  That takes that out of the equation.

There’s also potential for communication, greater communication between the clinician and the patient and empowering the patient which don’t go into as much detail about but it’s a really important feature that’s starting to be realised.

Now in terms of improving quality of care, there’s not that much great evidence that an electronic patient record in itself does that, but there is good evidence that stuff you plug into an electronic patient record can help you with that.   So, if you are collecting data in real time about different patients, what some areas are trying to do is say, well hey why don’t we take some of that and create early warning systems.

Then there are two other things which my two icons on the right, which are about analytics and research.  We currently know very little about what goes on in hospitals, and what we do know is not particularly reliable.  Electronic patient records give managers and researchers a level of understanding of what’s going on that they never previously had and again it’s hard to say exactly where the benefits are going to come from here but they will come because having better information is really important for people doing analytics and people doing research.